ETHICAL PRINCIPLES-What is right and wrong in Medicine /Dentistry

MEDICAL AND DENTAL ETHICS

ETHICS

Definition of Ethics

• Is defined as “the science of the ideal human character and behavior in situations where distinction must be made between right and wrong, duty must be followed and good interpersonal relations maintained”.

Ethical Principles

1. To do no harm (non- Maleficence)

2. To do good (Beneficence)

3. Respect for persons

4. Justices

5. Truthfulness

6. Confidentiality

1)To do no harm (Non-Maleficence)

• It is considered to be the foundation of social morality.

• It is clear that although dental care professionals support this principle in theory they are at times violate this principle

• For example : Iatrogenic diseases.

2)To do good (Beneficence)

• It should be the role of dentists and dental hygienists to benefit patients, as well as not to inflict harm.

• The expectation of the patient is that the care provider will initiate beneficial action and that there is an agreement between the doctor and patient that some good will occur.

• In the process of treating a patient what has to be weighed are the consequences of treatment versus no treatment, e.g.: questionable dental caries.

• The attempts should be to maximize the benefits and minimize harm.

3)Respect for persons

• This incorporates at least two other ethical

principles of which

1. Autonomy dictates that health care professionals respect the patients capacity for self determination in making decision regarding their treatment

2. Informed consent is an essential component of a patient’s right to autonomy.

• Dentists sometimes attempt to direct a patient toward a particular mode of treatment stressing certain advantages and not mentioning disadvantages.

• It is unethical to mislead or misinform the patient.

• Dentists are seen as a paternalistic figure and Paternalism in health care can take the form of withholding information, restricting choices, or making the choice for the patient.

• Informed Consent

• It is the first stated and the largest principle of the Nuremberg code.

• The Nuremberg code identified four attributes without which a consent cannot be considered valid.

• Consent must be

– Voluntary

– Legally competent

– Informed and

– Comprehending

The informed consent is a two step process

• First information is presented to the subject by the investigator.

• Secondly, the subject satisfies himself or herself that he or she understands and based upon this understanding either agrees or refuses to participate in the research projects.

4)Justice

• The primary duty of the health professional is service irrespective of class, creed etc.

• Justice demands that each person be treated equally.

• It calls for an obligation to protect the weak and to ensure equity in rights and benefits, both for groups and individuals.

• It calls for universal coverage and for care according to need.

• The principle of justice in relation to health care calls for community participation in decisions and care which is effective and affordable.

5)Truthfulness

• The patient – doctor relationship is based on trust.

• Lying shows disrespect to the patient and threatens relationship.

• Studies in 1950 and 1960 (on terminally ill patients) had shown that the physicians had the right, indeed duty to withhold bad news when they believed it would upset the patient.

6)Confidentiality

• Is a principle that can be traced to the Hippocratic Oath and exists today in the international code of Medical Ethics.

• Every patient has the right to expect that all communications and records pertaining to his/her care will be treated as confidential.

• It is very natural to want to gossip about a patient, particularly if it is someone special or possibly a neighbour, but to do so would break a bond of trust between dental professional and patient

• Earlier it was widely accepted that confidentiality could be breached if it was thought it would benefit the patient.

• Now patient’s permission has to be taken.

• In no instance other than in the court of law or the patient changes the dentist, should confidentiality be breached.

Some Unethical Practices by Dentists

• Practice by unregistered persons employed by the dentist.

• Dentists signed under his name and authority issuing any certificate, which is untrue, misleading or improper.

• Use of bogus diplomas.

• Allowing commission

• Dentists advertising whether directly or indirectly for the purpose of obtaining patients or promoting his own professional advantage.

• Practice without a dental qualification

• Dentist’s board displays a membership

• Use of terms like tooth puller, Denture maker etc

• Commercial advertisements regarding practice, but dentists are allowed to advertise when they need some staff.

• It should be in normal type and should state only the nature of vacancy

• To sell physicians samples in clinic at a profit

• If a dentist whishes to announce in newspaper, the announcement should not contain his professional degree, his address and announcement should not appear in more than 3 issues of the publication.

• Not informing patients regarding change of ownership, change of address

• Dentists name in dental health education pamphlet which is distributed to public.

References

1. Peter S. Ethics in dentistry.Text book of Community dentistry. Edition 6
2. Hiremath SS.Medical & Dental ethics.Text book of preventive and community dentistry . 2nd edition