Dental Ethics: A Brief Review __________________________________________________________________
Although such decisions are usually made on a practical level rather than a theoretical level, at times it is important to be able to relate a decision to its underlying system or principle. It is important to note that in its advisory opinion, the ADA states [1]: As is the case with all patients, when considering the treatment of patients with a physical, intellectual, or developmental disability or disabilities, including patients infected with human immunodeficiency virus, hepatitis B virus, hepatitis C virus, or another bloodborne pathogen, or are otherwise medically compromised, the individual dentist should deter- mine if he or she has the need of another’s skills, knowledge, equipment or expertise, and if so, con- sultation or referral…is indicated. However, the ADA goes on to state that dentists shall not refuse to accept patients into their practice or deny service to patients because of the patient’s race, creed, color, gender, sexual orientation, gender identity, national origin, or disability [1]. DEFINITIONS OF ETHICAL PRINCIPLES The ADA recognizes five major ethical principles of sig- nificance to dental professionals: patient autonomy, veracity, beneficence, nonmaleficence, and justice [1]. PATIENT AUTONOMY Autonomy refers to the right of the patient to determine what will be done with his or her own person (i.e., self-governance). It also involves the patient’s right to have confidentiality of his or her own medical history and records, and for the medical personnel to safeguard that right. The dentist should involve the patient in treatment decisions in a meaningful way, with due consideration being given to the patient’s needs and desires [1]. Ozar, Sokol, and Patthoff present four possible models of the patient-dentist relationship [3]: • The guild model, in which the dentist is the sole active decision-maker • The agent model, in which the important aspects of decision-making are solely the responsibility of the patient • The commercial model, in which both the patient and the dentist are decision-makers, but the dentist is con- sidered a producer selling her/his goods, with only the moral obligations of any other seller (e.g., not to cheat or defraud the buyer • The interactive model, in which the dentist and patient are equal partners in important respects to decision- making
APPLICATION OF ETHICAL THEORIES It is important to remember that ethical theories are just theories. They do not provide the absolute solutions for every ethical dilemma. They do provide a framework for ethical decision making when adjoined to the critical information obtained from patients and families. Most dental professionals combine the theoretical principles that fit best for the patient and situation. When the practi- tioner-patient relationship is established, a moral relationship exists. Though not an inherent gift, moral reasoning is required to reach ethically sound decisions. This is a skill, and moral reasoning must be practiced so it becomes part of any dental professional’s life. Although all ethical systems treat decisions about ethical prob- lems and ethical dilemmas, the decision reached regarding a specific conflict will vary depending on the system used. For example, a dentist assigned to care for a patient with acquired immune deficiency syndrome (AIDS) might have strong fears about contracting the disease and transmitting it to his or her family. Is it ethical to refuse the assignment? A dentist deciding purely on the basis of utilitarianism would weigh the good of his or her family members against the good of the patient. Based on the greatest good principle, it would be ethical to refuse to care for the patient. In addition, because utilitarianism holds that the ends justify the means, preventing the spread of human immunodeficiency virus (HIV) to the dentist’s family would justify refusal of the patient. Based upon deontology, duty and justice are the underlying and unchanging moral principles to follow in making the deci- sion. A person who becomes a dentist accepts the obligations and duties of the role. Caring for patients with infectious diseases is one of those obligations; therefore, refusal, except in particular circumstances, would be a violation of this duty. In this system, another unchanging moral principle, justice, would require healthcare professionals to provide adequate care for all patients. Refusing to care for a patient with AIDS would violate this principle. According to the natural law system, refusing to care for a patient with AIDS would be unethical. One of the primary goals of the natural law system is to help the person develop to maximum potential. Refusing to have contact with a patient with AIDS would diminish the patient’s ability to develop fully. A good person, by natural law definition, would view the opportunity to care for a patient with AIDS as a chance to participate in the overall plan of creation and fulfill a set of ultimate goals.
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