L4 Professionalism in Dentistry Application of Ethics in Clinical PDF

FACULTY OF DENTISTRY – Fostering A Balanced Professional in Dentistry ‫اﻟر ْﺣ َﻣ ِن ﱠ‬...

FACULTY OF DENTISTRY – Fostering A Balanced Professional in Dentistry ‫اﻟر ْﺣ َﻣ ِن ﱠ‬ ‫اار ِﺣﯾم‬ ‫ــــــــــــــــــم اﷲِ ﱠ‬ ِ ْ‫ﺑِﺳ‬ Al-fathihah In the name of Allah, the most beneficent, the most merciful ‫اﻟر ۡﺣ ٰﻣ ِن‬ May peace, mercy, and blessings ‫ﺑِ ۡﺳ ِم ﷲِ ﱠ‬ ِ ّ‫﴾ اَ ۡﻟ َﺣ ۡﻣ ُد ِ ﱣ ِ َرب‬1:1﴿ ‫اﻟر ِﺣ ۡﯾ ِم‬ ‫ﱠ‬ of Allah be with you ‫اﻟرﺣ ٰﻣ ِن‬ ۡ ۙ ۡ ‫﴾ ﱠ‬1:2﴿ َ‫اﻟﻌٰ ﻠ ِﻣﯾن‬ َ ۡ ‫﴾ ٰﻣ ِﻠ ِك ﯾَ ۡو ِم‬1:3﴿ ‫اﻟر ِﺣ ۡﯾ ِ ۙم‬ ‫ﱠ‬ Behavioural Science and Oral Health َ‫﴾ اِﯾﱠﺎكَ ﻧ َۡﻌﺑُ ُد َواِﯾﱠﺎك‬1:4﴿ ‫اﻟ ِّد ۡﯾ ِؕن‬ ‫ط‬َ ‫ﺻ َرا‬ ّ ِ ‫﴾ ا ِۡھ ِدﻧَﺎ اﻟ‬1:5﴿ ‫ﻧ َۡﺳﺗَ ِﻌ ۡﯾ ُؕن‬ َ‫ط اﻟﱠ ِذ ۡﯾنَ اَ ۡﻧﻌَ ۡﻣت‬ َ ‫ﺻ َرا‬ ِ ﴾1:6﴿ ‫ۡاﻟ ُﻣ ۡﺳﺗَ ِﻘ ۡﯾ ۙ َم‬ “Every praise be to ۡ‫ب َﻋﻠَ ۡﯾ ِﮭم‬ ِ ‫َﻏ ۡﯾ ِر ۡاﻟ َﻣ ۡﻐﺿ ُۡو‬ ۡ‫َﻋﻠَ ۡﯾ ِﮭم‬ Him, to Whom all ﴾ 1:7﴿ َ‫ﺿﺎ ٓ ِﻟّ ۡﯾن‬ ‫َو َﻻ اﻟ ﱠ‬ praise is due! And blessings and `peace be upon the compassionate Rabbish rahli sadri, Prophet, and upon his wa yassirli amri, wah Family and his lul uqdatan min Companions and upon lisaani, yaf kahu kauli all his true Followers after them!”. ”O my Lord expand me my breast, and ease my task for me and remove the impediment from my speech, so Application to Professionalism and Ethics they may understand what I say,” Prof. Emeritus Dato’ Dr. Wan Mohamad Nasir bin Wan Othman  DDWan Do right, Do good Integrity is always doing the right thing even if no one was watching. Faith is always doing the good things because Allah is always watching  ETHICS Learning Outcome Intention Action At the end of this session, students are Do Good Right able to: explain the relationship between Avoid the various elements of ethics Bad Wrong (C4); Make appropriate decisions based on ethics (C6); and appreciate the importance of ethics in practice of dentistry.(A3)  PROFESSIONALISM IN DENTISTRY Virtues Professional Ethical principles Loyalty Beneficence Integrity Non-maleficence Honesty Autonomy Courage Justice Friendliness Veracity Benevolence Law Action: Application Moral Principles Right or Wrong Make ETHICS Motive: decision (Virtues) Good or Bad Relationship Ethical Theories Profession: Occupation Utilitarianism Education, code of Oaths End justify means ethics and trust Hippocatic (Classic) Deontology Professional: member Means justify end Hippocratic (Modern) of group, subscribe to Virtue Ethics Muslim Physician COE and enforced them Moral Character Student Pledge (FoD, USIM) Professionalism: Internalise professional values  Virtues and Moral Principles Confidentiality Leadership Loyalty Patience Equity No discrimination Honesty Hardworking Teamwork Discipline Responsibility Integrity Self-control Compassion Empathy Accountability Respect Sincerity Time management Passionate  Virtues and Moral Principles Relationship with patients and others Listen to the patient needs Well mannered; Kind-hearted. Be Credible – the quality of being trusted, convincing, believable Commitment – put all efforts to do the work and with enthusiasm Excellence (Itqan) – continue to pursue highest level of quality Teamwork – clear goals, encourage differences in opinion, trust, collaborate Comply to requirements of the contract/agreement Time: timeliness, be punctual Continual learning -update nowledge and honed the skills & attitude Always be prepared – In the clinic: Prepare all the documents needed in an organised manner. – Prepare for the presentation, examination and other activities Behave as required for a Muslim dentist - respect others - soft spoken - confident (professional) - stay calm and selawat always - wear proper attire to suit the occasion CASE STUDY Case of signing the consent on the treatment card The staff at the Registration Counter is responsible for registering new patients which include getting the signature of the patient as consent before going to see the dentist. The policy states the person must sign the consent on the card. However, the consent was signed by the daughter of the patient who is an elderly lady. Do you, as a dentist accept it? On what ethical theory do you make that decision. Deontology: – Those who adopts a strong duty-based ethic (someone who believes in absolute duties) will typically hold closely to the literal text of the policy and make no exceptions, because it is viewed that upholding employer’s/ profession’s policy as her job. Utilitarianism: – People who favour evaluating the outcome of an act rather than the act itself -- may be more willing to grant exceptions to keep the patient happy.  Come la, we go to see picture A person who invites a friend to a movie that she wants to watch because she does not want to go alone. The friend was quite reluctant but after some persuasion decided to go to the movie. Ethical egoism – The person is thinking of his/her own self-interests first. Self-interest is “looking towards ones own personal advantage” Selfishness is ”acting or doing according to ones own interests and needs without regard for those of others, keeping good things for oneself and not sharing”  The compassionate dentist AA is a known donor. He volunteers his time for those in need and tries to give as much as he can. His virtue is compassion. At work, AA is a dentist, and his compassion also has a place there. He helps his peers regularly and goes out of his way to make sure a project gets done. What theory does this scenario describe? Virtue ethics Beneficence –do good People who holds a set of morals and virtues personally will use them every day, both in and out of work. It is important for us to have a strong set of virtues, because these behaviours will carry over into the work environment.  The case of mild overbite Puan JJ, a 28-year-old up-and-coming accountant in a leading company in the country was a patient of Dr. GG. After all necessary treatment were completed, she requested Dr. GG for a referral to an orthodontist to correct a mild overbite. Dr. P refuses because it is his professional opinion that the treatment is unnecessary. Do you agree with the decision of Dr. GG? Justify your answer. Paternalism Autonomy Consultative Self-esteem  Autonomy The patient is central to the practice of dentistry Patient's right to choose = self-rule or self-governance Opposite of paternalistic doctor-patient relationship - “the doctor knows best” The role of doctor is to provide information so that the patient can make a balanced and informed decision as to whether they consent to the procedure or not. Information include all aspect about the condition and treatment including consequences and cost. It also involved the objective measure (use of index) to determine need. Provides information and patient understands it. The patient has mental capacity to make the decision The dental practitioner must respect the patient’s cultural, religious and spiritual beliefs with regards to treatment.  Child patient with fractured jaw A 4-year-old with an obvious jaw fracture is brought to the emergency department by her maid. Both the maid and emergency room staff have attempted to reach her parents without success. Can you treat this child without parental permission? Your first concern is to the health and welfare of the child (patient’s interest). You tried to reach her parents for consent without success You proceeded with taking x-rays and treatment of her fractured jaw. Rapid treatment of the child's pain and fracture are in her best interest. When optimal treatment requires immediate intervention, treatment should not be delayed even if consent has not been obtained.  Dentist on-call A dentist was called to the Emergency Department to see to a patient who was incapacitated by the accident. You rushed to treat the patient by providing intervention to ensure that the airway is clear, stem the bleeding and suture the wound. What would you do? Why? This is an example in health care where the principle of beneficence is given priority over the principle of respect for patient autonomy.  Beneficence Do good Actions done to benefit the others Concern for patient’s welfare: – Take actions on what you believe is in the best interest of the patient – Consider that every health intervention has a potential to harm the patient, it is imperative that the practitioner look at every option on what is the best course of action for a patient. – Take appropriate action to restore patients to healthy state..  The Independent Practitioner Dr. NN just completed his one-year compulsory service and set up a dental practice in his hometown. He felt that being a qualified practitioner, he can do all the procedures, including implant. He has read on implant and has yet to enrol in a hands-on implant course. So, when a patent requested for implant, he decided to proceed with the procedure. It turned out that after the treatment, the patient had several complications, including numbness. What ethical principle that he breached? Justify your answer.  DDWan Practice Independently Recognise Act in the Autonomy Limitation best interest of the Know your limit: Decision based on: patient prior learning discuss consult experience refer continual learning no external influence ethical consideration  Non-maleficence First do no harm = Prinum non nocere – incidental harm - carelessness and negligence (failure to take proper care) – intended harm - deliberate and inflicted pain, – intrinsic harm - is directly brought about by the action.  Justice Justice Not discriminating Equity Distributive justice of resources  Veracity Veracity = Truthtelling – Be honest with patients – Do not recommend unnecessary dental procedures – Keep to the promise Example - Before using the handpiece, the dentist agrees to stop the drill temporarily if the patient raises the hand  DDWan Strive to be a balanced person Start with good intention, but continue to uphold it. Live in the present moment, but reflect the past and consider future possibilities. Be an autonomous practitioner, but recognise our limitations. Be competent, but continue to learn to be proficient Be contented, but never stop improving. Be kind, but do not let people take advantage of you. Trust others, but do not be deceived. Pray and hope for the best, but must strive to achieve it.  DDWan Allah knows best - wallahu a'lam bissawab ‫وﷲ أﻋﻠم ﺑﺎﻟﺻواب‬ ُ ُ ‫ أ َ ْﺷ َﮭ ُد أ َ ْن َﻻ ِإﻟﮫَ ِإ َﻻﱠ أ َ ْﻧتَ أ َ ْﺳﺗ َ ْﻐ ِﻔ ُركَ َوأَﺗ‬، َ‫ﺳ ْﺑ َﺣﺎﻧَكَ اﻟﻠﱠ ُﮭ ﱠم َو ِﺑ َﺣ ْﻣدِك‬ َ‫وب ِإﻟَﯾْك‬ ُ Glory is to You, O Allah, and Doa praise is to You. I bear witness Kaffarah Subhaanaka Allaahumma wa bihamdika, that there is none worthy of 'ash-hadu 'an laa 'ilaaha 'illaa 'Anta, worship but You. I seek Your 'astaghfiruka wa 'atoobu 'ilayka forgiveness and repent to You. 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