1. Dental Ethics
Chapter 4
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2. Chapter 4
Lesson 4.1
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3. Learning Objectives Pronounce, define, and spell the Key Terms.
Explain the difference between being legal and being ethical.
Explain and give examples of the basic principles of ethics.
Discuss the American Dental Assistants Association Code of Ethics.
(Cont’d)
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4. Learning Objectives
(Cont’d)
Give examples of personal ethics and unethical behaviors.
Give examples of ethical dilemmas for each principle of ethics.
Develop case studies involving ethical dilemmas.
Describe the steps of ethical decision-making.
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5. Dentistry is a profession different from general businesses.
Introduction
Dentistry is a profession different from general businesses.
As a professional dental assistant, you are bound by an ethical code of conduct.
(Cont’d)
What is ethics? (Moral standards of conduct; rules or principles that govern proper conduct.)
An ethics curriculum is now required in every U.S. dental school (although at present 80% of all dental schools offer courses in ethics, the emphasis in many is on jurisprudence).
What is meant by “conduct”? (Comporting oneself or behaving in a certain way.)
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6. Introduction
(Cont’d)
Ethics deals with moral conduct (right and wrong behavior) and good and evil.
Ethics includes values, high standards of conduct, and professional and personal obligations in interacting with each other.
These qualities are important to us as dental healthcare professionals, as we provide dental care to our patients.
How do ethics relate to dentistry?
Sometimes a practitioner’s recommendation conflicts with what the patient wants. Sometimes what the patient wants may sound foolish to the dentist. How the dentist responds to these problems and many others determines the character of a dentist’s practice.
What questions does ethics seek to answer for the professional person?
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7. Introduction Ethics seeks to answer two basic questions:
(Cont’d)
Ethics seeks to answer two basic questions:
What should I do?
Why should I do it?
Ethics refers to what you should do, not what you must do. The law deals with what you must do.
Basic principles of ethics:
“Do no harm” (nonmaleficence): This principle comes from Hippocrates’ dictate to “do no harm.” It is the most basic element in morality.
Promotion of well-being (Beneficence): This principle is based on the idea that actions are ethical as long as they will benefit a person or community.
What is justice?
What is self-determination?
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8. Basic Principles of Ethics
A regard for self-determination (autonomy) includes the right to privacy, freedom of choice, and the acceptance of responsibility for one’s own actions.
A regard for justice involves treating people fairly and giving them what they deserve and are entitled to receive.
What are principles? (A basic generalization that is accepted as true and that can be used as a basis for reasoning or conduct.)
Some define justice in terms of equality: All people should get or have the same amount, regardless of how hard they work.
Others define justice in terms of equity: People should get benefits in proportion to what they contributed to producing those benefits.
Still others believe in equity with a bottom “safety net” level that protects people who, because of misfortune or disability, are unable to work or even help themselves.
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9. Examples of Ethical Principles
Informing a sales clerk that he or she has undercharged you for an item (principle of justice)
Admitting that you have made a serious error (principle of autonomy)
Helping a fellow student study (principle of well-being)
Refusing to gossip about a fellow student (principle of doing no harm)
Can you provide additional examples?
We live in a constantly changing world. With technological advances come hard choices that may challenge existing moral standards.
Our values are understood in the context of the lives we live and the decisions of individuals and of society around us. We cannot separate our values from our experiences.
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10. Examples of Unethical Behavior
Charging the patient for a full set of x-rays when only six films were taken (principle of justice)
Pressuring a classmate into a decision (principle of autonomy)
Refusing to help a classmate learn (principle of well-being)
Harming another person by repeating gossip about him or her (principle of doing no harm)
Can you provide additional examples?
Some situations occur so often that they may not even be perceived as having ethical content. Other times the circumstances are complex and the answers are not readily apparent. In both situations a background in philosophical ethics can be helpful in making sound decisions.
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11. Confidentiality
Confidentiality is a very important issue in the health profession.
Healthcare professionals have an obligation to respect the patient’s privacy.
However, conflicts involving the principle of confidentiality, such as in reporting suspected child or elder abuse, will arise.
Sometimes the patient’s right to confidentiality must be balanced against the rights of other individuals.
What is confidentiality? (A property by which information relating to an entity or party is not made available or disclosed to unauthorized individuals, entities, or processes.)
The ADA recognizes the responsibility of its members to report suspected cases of abuse and neglect of patients to the appropriate authorities.
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12. Fig. 4-1 Patients have the right to expect that their conversations in the dental office will be kept confidential.
Healthcare professionals have an obligation to respect the patient’s privacy. In addition to moral and ethical principles for patient confidentiality, HIPAA (Health Insurance Portability and Accountability Act) has very definite legal requirements for the confidentiality of patients’ health information.
Why is it important that dental professionals adhere to HIPAA standards?
The dentist must write a privacy policy, a document for his or her patients detailing the office’s practices.
Would this conversation between the front-desk personnel and the patient be private if another patient were present?
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13. Professional Codes of Ethics
All of the major professions (e.g., dental, medical, legal) have written codes of ethics.
These are voluntary standards of behavior, not laws, and serve as a method of self-policing within a profession.
The codes of ethics of most professions have been revised to keep them consistent with the times, but there has never been a change in the moral intent or overall idealism.
Do you have a personal code of ethics?
A code of ethics can provide a benchmark for self-evaluation.
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14. Reasons for a Code of Ethics
To demonstrate to the public the standard of conduct that can be expected from its members.
To increase the ethical consciousness and ethical responsibility of its members.
To guide its members in making informed ethical decisions.
To establish a standard for professional judgment and conduct.
What is the code of ethics for the ADAA?
How is the law related to ethics?
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15. The Difference Between Ethics and Law
Legal issues are settled with the use of laws and court decisions. Ethical issues are subject to individual interpretation with regard to the right or wrong of a particular situation.
(Cont’d)
Ethical obligations may, and often do, exceed legal duties. In resolving any ethical problem not explicitly covered by the ethical code, dental professionals should consider the ethical principles, the patient's needs and interests, and any applicable laws.
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16. The Difference Between Ethics and Law
(Cont’d)
Laws are very specific and are written by people authorized to write them.
The law is often referred to as being “black and white” or “right or wrong.”
Ethics are less specific and have more gray areas. Ethics are the conscience of the profession.
Laws set the minimum standard of behavior; ethics set the highest standard of behavior.
The connection between law and ethics is very close.
Discuss how laws set a minimum while ethics set the highest standard of behavior.
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17. Solving Ethical Dilemmas
Step 1: Identify the alternatives.
Step 2: Determine all implications.
Step 3: Rank the alternatives.
Step 4: Choose a course of action.
How do you know whether you are making the right decisions at each step?
To whom can you go for help in resolving ethical dilemmas that arise in your professional environment?
When you follow these steps and make a decision about what should and should not be done ethically and professionally, you will be more comfortable with your decision.
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18. Legal and Ethical Implications
You may be faced with a situation in which your dentist employer’s conduct violates ethical standards.
Before you make any judgments, be absolutely certain of all the information and circumstances.
If violations of ethical conduct have been committed, you must make some decisions.
What is a standard of care? (A diagnostic and treatment process that a clinician should follow for a certain type of patient, illness, or clinical circumstance. In legal terms, it is the level at which the average prudent provider in a given community would practice. It is how similarly qualified practitioners would have managed the patient's care under the same or similar circumstances.)
The healthcare-malpractice plaintiff must establish the appropriate standard of care and demonstrate that the standard of care has been breached.
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19. Ethical Decision-Making
Do you wish to remain under these circumstances?
Should you seek other employment?
If you remain, will it affect you in the eyes of future employers?
(Cont’d)
Discuss ethical dilemmas a dental assistant might face that would cause him or her to ask these questions.
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20. Ethical Decision-Making
(Cont’d)
These decisions are difficult, especially if you like your employer and enjoy your job.
A dental assistant is not legally obligated to report questionable actions on the part of the dentist or to try to alter the circumstances. However, an ethical dental assistant will not wish to participate in substandard care or unlawful practices that may be harmful to patients.
More sources of information about dental ethics:
The ADA Code of Ethics.
The American College of Dentists’ ethics handbook for dentists; the college now includes a section on dental ethics in each issue of its journal.
The U.S.-based Professional Ethics in Dentistry Network.
An international dental ethics association called IDEALS (the International Dental Ethics and Law Society)
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