DENTAL ETHICS NOTES

DENTAL ETHICS:  Dental ethics means moral duties and obligations of the dentist towards his patients, professional colleagues and to the society.

-Code of ethics was framed by the DCI in 1975

-Later notified by Government of India as “Dentists (code of ethics) Regulations 1976

-It is in force from August 1976

Principles:

1. To do no harm (non-maleficence)

  • it is considered to be the foundation of social morality
  • although dental professionals support this principle in theory they are at times guilty of transgressions that go beyond a limitations(break a rule or law)
  • iatrogenic disease doctor-induced illness,and all of us in dental fields have seen overhanging restorations cause periodontal disease or failure to sterilize instruments cause infection
  • the dentists in cases where pain cannot be avoided can make attempts to minimize the pain
  • if feasible, the alternative of minimal or no treatment can be presented to the patient

2. To do good (beneficence)

  • Beneficence is required of all the health care providers
  • Role of dentists is to benefit patients as well as not to inflict harm
  • Patient expects that the care provider initiates a beneficial action
  • There is an agreement between the doctor and the patient that some good will result
  • In treating questionable dental caries, it is not enough to say that it will not harm the patient
  • The point to be noted is whether it is of any good to the patient
  • Attempts should be maximize the Benefits and minimize harm

3. Respect for others

It incorporates at least two fundamental ethical considerations:

  1. Autonomywhich dictates that health care professionals respect the patient’s capacity for self-determination in making decisions concerning their treatment plan
  • The primary way to respect individuals is to abide by their choices whether or not others believe these choices to be wise or beneficial
  • Patients should be active participants in their treatment
  1. Informed consent–  both legal and an ethical concept, is an essential component of a patient’s right to autonomy
  • It is first stated and the largest principle of Nuremberg code
  • Nuremberg code identifies four attributes of consent without which consent cannot be considered valid.
  • Consent must be
  • Voluntary
  • Legally competent
  • Informed
  • Comprehending
  • The ‘informed consent’ is a two-step process
  • First –information is presented to the patient by the doctor
  • Secondly-the patient satisfies himself or herself that he or she understands,and based upon this understanding either agrees or refuses to undergo the treatment.
  • Informed consent consists of :
  • A description of the procedures to be carried out
  • A description of any benefits to the subject or to the others ,which may reasonably be expected from the treatment
  • A description of any reasonably foreseeable risks or discomforts to the subject
  • A statement that the patient has understood the procedures and willing to undergo the treatment
  • A statement describing the extent,if any,to which confidentiality of records identifying the subject will be maintained
  • A disclosure of appropriate alternative procedures or courses of treatment.if any,that might be advantageous to the subject
  • The signature of the patient and of a witness

4. Justice

  • Described as fairness or equal treatment ,giving to each her or his right or due
  • The primary duty of the health professional is service irrespective of class,creed etc.
  • Justice demands that each person should be treated equally
  • Principle of justice calls for an obligation to protect the weak and to ensure equity in rights and benefits,both for groups and for individuals
  • Dentists can provide some free or discounted care in their offices to those who are truly needy,or they can provide financial support to those or donate some time to clinics for low-income patients
  • On a large scale local or statewide programs that seek to extend care to dentally needy clients

5. Veracity or Truthfulness

  • Patient-doctor relationship is based on trust
  • Lying shows disrespect to the patient and threatens relationship
  • Truthfulness or veracity is an ethical principle that one would expect to go unquestioned, yet many health care professionals practice in a less than truthful way
  • Dentist may feel that it would be better if the patient took a certain course of action and therefore manipulates the information that is given to the patient
  • Whatever the reason,the relationship will ultimately suffer and the dentist will be guilty of transgressing a major ethical principle

6. Confidentiality

  • Patients have the right to expect that all communications and records pertaining to their care will be treated as confidential
  • Gossiping about the patient’s confidentiality would break a bond of trust between the dental professional and the patient
  • Knowledge of a patient gained in the course of examination and treatment is privileged and should not be disclosed without the consent of the patient or an order from the presiding judge in a Court of Law

Ethical rules:

The duties and obligations of dentists towards the patients

  •  Should be friendly,courteous,sympathetic and helpful
  • Punctual in his/her appointments
  • Should establish a well merited reputation for professional ability an fidelity
  • Patient welfare should be conserved to the utmost of the practitioner’s ability
  • Should not permit considerations of religion, nationality, race, party politics or social standing to intervene between his duties and his patients
  • Personal information of the patient should be kept confidential.it is also obligation of the dentist to see that his auxiliary staff observe this rule.

Duties of dentists towards one another

  • every dentist should cherish a proper pride in his/her colleagues and should not disparage them either by act or word
  • when the dentist is entrusted with the care of the patient of another during sickness or absence, mutual arrangements should be made regarding remuneration
  • a dentist called upon in any emergency to treat the patient of another dentist shall be entitled to charge the patient for his services
  • if a dentist is consulted by the patient of another dentist and the former finds that the patient is suffering from previous faulty treatment. It is his duty to institute correct treatment at once with as little comments and in such a manner as to avoid reflection on his predecessor

Duties of dentists to the public

  • Dentist has to assume a leadership role in the community on matters related to dental health.

Some unethical practices

  • Practice by unregistered persons employed by the dentist
  • Allowing commission
  • Dentist signed under his name and authority issuing any certificate which is untrue,mislading or improper
  • Use of bogus diplomas etc.
  • Paying or accepting commissions
  • If the planned treatment is beyond the dentist’s skills,the patient is not referred to a consultant