Dental Ethics PDF

CH(1): ETHICS AS A DEFINING CHARACTERISTIC OF DENTISTRY  Both the science and practice of dentistry require dentists to make value judgments. The importance of dentists examining the ethical parameters of their practice is further underscored by the fact that patients are often vuln...

CH(1): ETHICS AS A DEFINING CHARACTERISTIC OF DENTISTRY  Both the science and practice of dentistry require dentists to make value judgments. The importance of dentists examining the ethical parameters of their practice is further underscored by the fact that patients are often vulnerable and fully dependent on dentists for their oral healthcare needs. Patients must be able to trust dentists, and the relationship between dentist and patient is generally considered to be a fiduciary one. In turn, individual dentists and the profession at large must warrant the public’s trust, which requires (among other things) that dentists allocate scarce oral healthcare resources, including their own time, fairly among patients in need.  CAN DENTISTRY BE PRACTICED WITHOUT MAKING VALUE JUDGMENTS? Critics may acknowledge the reality of these complexities but insist that making value judgments on behalf of patients goes beyond dentists’ expertise. By applying the methods of biomedical science, dentists can discover lots of facts about oral diseases. But whether such treatments are actually of value to patients, and whether patients ought to undergo them, can only be decided by the patients themselves – or so these critics would insist.  WHAT DO WE MEAN BY AN EFFECTIVE TREATMENT? To use this term means that there is some state of affairs that does not yet exist but which is desirable Effective or Desired? The World Health Organization (WHO) defined health as “a state of complete, physical, mental, and social well-being and not merely the absence of disease or infirmity  THE FIDUCIARY RELATIONSHIP A fiduciary is someone who manages money or property for someone else The relationship between patient and dentist is therefore also characterized as a fiduciary relationship, or a relationship of trust. The FDI World Dental Federation’s 2016 definition of oral health emphasizes that “oral health is multifaceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow and convey a range of emotions through facial expressions with confidence and without pain, discomfort and disease of the craniofacial complex.”  Patients’ vulnerability is compounded by their dependence on experts to take care of their needs. Warranting patients’ trust in the profession of dentistry is an important ethical challenge for each individual dentist. The interventions provided by dentists are purely elective or aim to reach a non-health goal (such as beauty), so the relationship changes as well from a fiduciary relationship between a healthcare provider and a patient, to a contractual relationship between a businessperson and a client. In turn, that change generates a different set of ethical principles and norms to which the dentist must adhere.  BENEFICENCE AND NON-MALEFICENCE In the ancient Hippocratic Oath: “I will apply dietetic measures for the benefit of the sick according to my ability and judgment. I will keep them from harm and injustice.” Patients must be able to trust that dentists will always seek to advance the patient’s well-being and even give priority to the patient’s interests (as opposed to the dentist’s own interests). As already explained, if a dentist wants to decide what treatment is truly in the patient’s best interest, the dentist cannot rely on scientific facts only, but must involve the patient in the decision-making process. Even well-intentioned dentists are likely to harm their patients occasionally, but We tend to call those risks side effects, but they are no less real  SCARCE RESOURCES AND THE INEVITABILITY OF CHOICES BETWEEN PATIENTS The trust of patients in dentists is not vested first and foremost in individual dentists, but in the profession of dentistry as a whole. But knowing that all dentists are competent is unlikely to make patients trust dentists if patients cannot gain access to the dental services they urgently need. Dentists bear responsibilities not only to patients but also to the people working for and with the dentist, be they employees, fellow dentists, or other health professionals. Dentists must accept responsibility for these inevitable balancing acts. CH(2): INTRODUCTION TO DENTAL ETHICS The many meanings of the term ethics The word ethics (derived from ancient Greek) and morality (derived from Latin) literally mean the same, as do the adjectives ethical and moral. An ethicist studies morality, but an ethicist is not necessarily a moral person. Ethics involves a critical examination Dental ethics critically examines the values, principles, and norms shaping the practice of dentistry. This examination differs from the empirical research Difference between a descriptive and a prescriptive approach  PERSONAL OPINION OR REASONED ARGUMENT? Note that in an ethical dialog, the question is not who is right, but what is right and why. It is the ideas and arguments that count, not the people voicing them.  A FAIR DEBATE Fairness in an ethical dialog first and foremost implies GENUINE RESPECT for ideas, one’s own as well as those of others. Genuine respect is not a matter of polite tolerance, it entails interest and concern, a willingness to listen to new ideas, to carefully consider them, and to critically test and appraise them. This may lead one to exchange one’s opinions for new and superior insights, adjust one’s own opinions, or defend them against alternative ideas that fail this critical test. There are three main strategies that participants in an ethical debate can use to move the discussion forward in a constructive and fair manner: Ask questions Provide explanations Construct arguments