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JOURNAL REVIEWS  
Year : 2012  |  Volume : 2  |  Issue : 1  |  Page : 45-48
Ethical dilemmas in dentistry


Department of Oral Pathology and Microbiology, Meenakshi Ammal Dental College and Hospital, Maduravoyal, Chennai, Tamil Nadu, India

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Date of Web Publication17-Jul-2013
 

How to cite this article:
Arvind S, Indu Bharkavi S K. Ethical dilemmas in dentistry. J Educ Ethics Dent 2012;2:45-8

How to cite this URL:
Arvind S, Indu Bharkavi S K. Ethical dilemmas in dentistry. J Educ Ethics Dent [serial online] 2012 [cited 2024 Mar 28];2:45-8. Available from: https://www.jeed.in/text.asp?2012/2/1/45/115148



   Clinical Ethics Committees and the Formulation of Health-care Policy Top


Len Doyal

Journal of Medical Ethics 2001;27:144-149

The clinical ethical committees have been framing health-care policies, resolving conflicts and accrediting health-care bodies. The role of clinical ethics committee in a doctor - patient relationship could be both constructive and destructive. The formulation of principles depends on the geographic and the social conditions prevailing. The respect for autonomy of patient and justice must be preserved at any cost. The importance of clinical ethics committee in academic field is well-known.

Another aspect of ethical dilemmas is professional conflicts, where the basic motto of benefitting the patient depends upon, the clinicians, whose treatment protocol may vary from one clinician to the other. In these situations clinical ethical committee can be of great help where law is indeterminate. The policy formulation must be proactive as well as reactive. Under these circumstances the acceptability of clinical ethics committee depends upon the respect for the members and the law in place.

The various committees formulated the laws at national and local levels and these must be communicated in a constructive manner to all health-care providers. Another key demand is to make instant decision during the policy making. These must include policies on maintaining confidentiality, resource allocations and to remain hassle free from legal issues. The major back holes on clinical ethics committee in policy formulation include their acceptance or the lack of it as advisory panel.

The success of their formulation depends on the appropriate implementations of their policies. Last but not the least the support of the institutions is critical for the success of such clinical ethics committees and their formulations.


   Curriculum Evaluation of Ethical Reasoning and Professional Responsibility Top


Carole R Christie, Coun M, Densie M Bowen, Carlene S Paarmann

Journal of Dental Education 2003;67:55-63

Code of Ethics for dental hygienists provides for five core values to be fundamental namely autonomy, nonmaleficence, beneficence, justice and veracity. An exhaustive study was conducted among Baccalaureate Dental Hygiene Programs at Idaho State University, USA to evaluate the curriculum of ethics and professional responsibility among the students and competency of ethical training in achieving the core principles. First major and supporting competencies were identified and all the faculty members were surveyed regarding the curriculum content with respect to the competencies.

Based on these data, a new professionalism document of competency was devised. The clinical performance of students in these areas was assessed. Then the senior and junior students were surveyed regarding their attitude on the core values in individual case situations. All the surveys were done with anonymity and confidentiality promise.

Results showed that 28 out of 34 courses had a grade of 95.4% to 91.02% on an average among the students of first and final years respectively. Senior students were familiar with legal regulations, competent to record the case procedures, experienced in community service and more open in peer evaluation while the juniors were honest in accepting their mistakes and following ergonomic principles. This study indicated that ethical and professional responsibilities though has its place in the curriculum, requires further improvement and adherence to the core values of Code of Conduct.


   Ethical Climate in Academic Dentistry in India: Faculty and Student Perception Top


Shashidhar Acharya

Journal of Dental Education 2005;69:671-680

According to Weber's Institutional Ethics Audit Model the institutions are classified into four types namely: Ethical firms which ignore ethics, compliance firms that attempts to practice ethics to certain extent, emerging ethical firm that tries to create ethical environment and integrity firms that rigorously pursues ethical practice. Victor and Cullen's Ethical Climate Questionnaire classifies ethical climate into self-centered morality seen in ethical firms, consensual morality seen in compliance firms and universal morality seen in integrity firms.

Clarkson and Deck determined ethical practices to be based on: Code of Conduct, Code of Practice and Code of Ethics. The ethical policy can established through use of rules as in compliance firms, seeking advice, act and disclose seen in emerging ethical firms and use of guideline principles seen in integrity firms. Also, ethical firms do not provide ethical training while compliance forms provide guidelines. Emerging ethical firms offer interactive sessions and Integrity firms attach value to ethical conduct. The enforcement and promotion can be done with awards and punishments.

A study was conducted at Manipal University College of Dental Sciences to address the ethical climate and perception of students and faculty regarding ethics. Ethical Climate Questionnaire and General Health Questionnaire (GHQ) were used to review 28 faculties and 28 undergraduate students. Senior faculties considered the institution to be working under consensual morality while junior faculties considered it to be more of self-centered. Overall a mixed response was received. The students' response ranged from low to high in GHQ. The school's ethical climate had nearly equal influence of all three types of morality. Psychological distress of the samples had an impact on the results. The analysis of the Code of Ethics in practice showed the institution to be a compliance firm. The perception of students and faculties were similar.


   Ethical Dilemmas Reported by Fourth - Year Dental Students Top


Helen M Sharp, Raymond A Kuthy, Kieth E Heller

Journal of Dental Education 2005;69:1116-1122

The dental curriculum includes ethics as a subject. However, there are wide differences in the content being taught under ethical spectrum. Hence, it is the role of the teachers to keep the students engaged and interested in ethics, given their tight schedule. A survey was conducted on the "Essays" compiled by the fourth year students regarding their experiences in extramural postings. 123 essays submitted to the University of Iowa were taken for a double blinded study. From 50 randomly selected papers, initial categories were identified and trial coding was carried out to finalize 16 primary issues pertaining to pediatric, adult and geriatric patients.

A total of 172 primary ethical issues were identified and most reported ones were patient's lack of resource, professional conflict, standard of care and surrogate influence. Other reported issues included decision making by patients, demands and refusal of specific treatment, neglect, incompetence of the students, mistakes, inadequate consent, confidentiality breach, communication gap and truth disclosure. Pediatric patients faced lack of resources, professional conflict and surrogate influence as major issues. Lack of resource and surrogate influence was also concerning geriatric patients while in adults the problem was mostly the lack of resources.

These essays however do not reflect the real situation and was based on just one school. Also, the reports on confidentiality breach, informed consent, breaking of bad news and mistakes that are commonly faced on daily scale were not much reported. Despite the limitations, survey points out to the framework for the identification of ethical curriculum. With the goal of improving the students ability to identify and address ethical dilemmas and improve their ethical reasoning, careful evaluation of the curriculum must be done with the consideration of student perception.


   Analysis of the Ethical Aspects of Professional Confidentiality in Dental Practice Top


Clieda Adas Saliba Garbin, Artênio José Isper Garbin, Nemre Adas Sailba, Daniela Coelho de Lima, Ana Paula Ayala de Macedo

Journal of Applied Oral Science 2008;16:75-80

Ethics in regard to the professional confidentiality is much needed in the medical field. Most health professionals and students are unaware of the ethics and its seriousness. Hence, it is the duty of the health-care institution to teach ethics for their students.

Patient history should be maintained confidentially and patient should get belief over the professionals, so that the patient reveals the true history. Also, if there is a team taking part in treating the patient, patient details can be discussed among them but should not get revealed apart from their team mates who will include a doctor, technical assistants, nurse, etc. It is the patient's right to have his privacy and expect his history to be maintained completely confidential. According to the Code of Ethics of dentists, fourth article, clause XI, it informs that the health professional should "keep professional confidentiality".

The aim of the author's study was to assess the awareness and attitude of 100 dentists working in the city of Andradina, Sao Paulo State, Brazil with respect to professional confidentiality in dental practice, even though the dentists surveyed in this were reported to be aware of professional confidentiality. But, they showed difference towards dental, ethical and legal aspects.

It can be well-understood from the words of the author that it is important to plan and execute the dental procedure in the interest of patient, despite the view that sharing of information is inevitable in the health-care delivery system.

Thus in a nutshell, it can be stated that professional confidentiality must be maintained in order to ensure that the patient overcomes the embarrassment and gives his true and complete history. Thus, it can be expected that a harmonious relationship prevails between the patient and the doctor.


   Human Rights and Ethical Considerations in Oral Health Research Top


Richard P Ellen, Richard Singleton

Journal of Canadian Dental Association 2008;74:439-439e

The ethical basis of health-care research lies in the human right consideration, which in turn differs from one nation to another. Since researches on topics such as origin and end of life, genetic studies, stem cell therapy, cloning and embryonic studies involve people's participation, there are various regulatory bodies to authorize the research in terms of human rights protection. Ethical review boards are mandatory to assess the research being carried out. Such a board must include specialists in medicine, research, ethics and law apart from a commoner. Their role is to ensure that human rights, dignity of the population are preserved. There should be proper consent obtained, confidentiality is maintained, equality in distributing benefits and burdens, reducing the ill effects, a strong scientific background in research undertaken. There are also private boards working as corporate entities. The problems may arise when working on population from other nations like human immunodeficiency virus research on Africans. The sentiments of races such as aborigines or ethnic groups must be respected when undertaking research in them. Ethical review in private practice must be reanalyzed.

The issue of conflict of interest arises when the researcher has a bias and tries to obtain a favorable result for materialistic or other gains. Also, the recruitment of dependent personnals such as students, subordinates or patients under their own care could lead to conflict of interest. It is mandatory for research boards to ensure and researches to declare a study free from conflict of interest. The researcher's honesty must be complete and he must not involve in manipulating the methodology or results for any personal motives. The issues related to publications such as plagiarisms, intellectual robbery must be addressed by suitable agencies and transparency in research must be ensured. Oral health-care research being a pivotal part in health-care field must strictly adhere to sound ethical principles.


   An Innovative Approach to Teaching Ethics and Professionalism Top


Barry Schwartz

Journal of Canadian Dental Association 2009;75:338-340

One of the major issues that need to be addressed today according to Macy Report is inculcating ethical and professional aspects into dental curriculum apart from clinical and academic training. The author explains about the ethical training provided at Schulich School of Medicine and Dentistry. The students are provided with training in ethical and professional set up such that they can become successfully recognized clinicians. The curriculum includes a practice administration course wherein proactive measures are taken to educate the students about their ethical and professional conduct. Apart from lectures, classroom activities are conducted in first year and students are enlightened on the need for caring and honesty to their patients through case discussions. They are encouraged to compile essays and involve in group discussions. In third year of the under graduation, students are set into groups and provided with live situation and are evaluated based on their reaction. In the fourth year, the course provides insight on communication skills, law and medical jurisprudence along with ethical reinforcement so that they can employ it in live patient situations.

The students are also actively involved in research activity on ethics. Research based group discussions followed by peer evaluation form a part of the curriculum. There are also projects on global ethics through community programs organized in Lebaonnan and Tanzania and consideration of patient's opinion in designing the dental curriculum has the author as a major participant. The students in their first and final years are directed to maintain a journal wherein they can incorporate their personal views on ethical grounds. This will help the students graduating to be better professionals.


   Ethics, Empathy and Education of Dentists Top


David A Nash

Journal of Dental Education 2010;74:567-578

Ethical education aims at imparting comprehensive skills and adequate knowledge to the dentist aimed at providing the patient with oral and general health. Psychologists and workers on evolution of human behavior consider Men to be naturally empathic. Aristotle, David Humes, Adam Smith and Charles Darwin are the major players in explaining the Naturalistic concept of ethics. They all consider humans to be social animals and have an innate empathy towards fellow beings and they advocate the principal of natural morality. Another school of thought by philosophers such as Thomas Hobbes, Immanual Kant and others believe that the human behavior is influenced by social and rational environmental influences.

Evolution of ethics over the years has stated various views on the empathic nature among humans to stem from both natural and reciprocal behavior. The empathy shown to the fellow beings comes with an expectation of a return help from the fellow beings. Also one is known to be more considerate to his own kin compared to others. The religions across the world also preach reciprocal ethics. Empathy means "feeling into" and empathic behavior of humans' has its base on various factors such as parental care, emotional development and environmental influences. There is a definitive genetic component involved too and is considered to be a natural instinct that is influenced by systemic behavior.

A success of a clinician depends not only on his skills but also on the concern has for his patients. This concern stems from empathetic nature and empathy is the ability of the person to understand the requirements of his fellow beings in need. Feministic approach of ethics has its base on caring rather than morality and is analogous to the holistic natural concept of ethics. Trust is another factor crucial for the success of the clinician and patients must believe that their doctor's work is for their good. Moral responsibility and conduct is a quality that should be reinforced from childhood. Morality and Empathy should be advocated in child and adult development. Empathy among the doctors must be "detached concern" according to Hojat. Many philosophers consider it to be mandatory for emotional intelligence to be a criterion for admission in dental colleges. Intellectual empathy and Emotional empathy must be enhanced by ethical training for better patient care.


   Ethics and Electronic Health Record in Dental School Clinics Top


Robert A Cederberg, John A Valenza

Journal of Dental Education 2012;76:584-589

Electronic health records have been an innovative tool that has lessened the work burden of dentists in a big way. The major advantage of these Electronic Health Records (EHRs) is their accessibility at wish and will. The demographics and the scheduled treatment protocol for patient can be easily maintained and accessed when necessary. The pitfall however lies in the fact that any unethical access of the information can lead to consequences. Digitalization also helps in incorporating the patient's in their treatment planning more easily than with paper based records. On contrary it tends to distance the patient from his clinician.

Dental schools have also been widely using digital recording in academic and clinical setting. With the point of access being at hand, there is improved quality of treatment strategies and increased professionalism in the set up. The question of ethics arises at this juncture as this may prove to be an easy way for malpractice. While EHRs may not be a pathway to cheating, they do provide an easy setting for unethical behaviors. The authors mention about various unethical practices with EHRs such as: Hacking the passwords and sharing them, accessing the procedure codes, breach of patient's trust by misusing his personal details and avoiding the patient when devising the treatment protocol. Solutions for these problems lie in training and enlightening the students on ethical behavior and moral and social responsibility. Surveillance system must be put in place. Thus, EHRs are double edged swords and proper usage can make them a boon to the dentists.

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Correspondence Address:
S Arvind
Department of Oral Pathology and Microbiology, Meenakshi Ammal Dental College and Hospital, Maduravoyal, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


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