Dental Ethics: A Brief Review __________________________________________________________________
BENEFICENCE Beneficence refers to the ethical principle of doing or promot- ing good. Community service, in the form of offering free dental care to the needy, is one example of how a dentist can elevate the esteem of the profession. The Academy of General Dentistry requires that Lifelong Learning and Service Recog- nition Candidates complete at least 100 hours of approved dental-related community/volunteer service, such as commu- nity education panels and the provision of pro bono patient care, or service to organized dentistry [13]. In addition, when a dental professional has achieved, through research or investigation, results that promote or safeguard the health of the public, he or she has an obligation to share those results with the profession. This does not prevent a dentist from seeking copyright or patent protection. Assessment for and identification of abuse is another example of practices to promote good. Orofacial trauma is common in cases of abuse, and in most states, dental professionals are obliged to report patients with symptoms consistent with domestic violence and child or elder abuse. The dentist is often the first healthcare provider to treat the victim and is therefore ideally positioned to provide intervention by reporting to the appropriate authorities and offering information on domestic violence shelters and other resources to patients. NONMALEFICENCE Nonmaleficence simply means that dental professionals must try to avoid doing harm to the patient. It is the duty of the dental professional to evaluate his or her own skills and rec- ognize when further education is required or when referral to a specialist is in the best interest of the patient. A dentist must complete a patient’s treatment once it has begun or make arrangements for appropriate care if for any reason the dentist cannot complete the care. Dental professionals who continue to practice while using substances that impair their ability to practice or who suffer from mental or physical impairment are not acting ethically and are violating the law. Colleagues of an impaired dental professional (e.g., in the case of substance abuse) should report the individual to the professional assistance committee of their dental society. Dentists who are consulted for a second opinion should not have a vested interest in the recommended treatment. Accord- ing to the ADA’s Principles of Ethics and Code of Professional Conduct, when delegating patient care, the dentist is required to protect the health of the patient using only qualified auxiliary personnel while prescribing and supervising the patient care. A dentist may delegate remediable tasks to dental hygienists and dental assistants so long as delegation of the task poses no increased risk to the patient and the task may
be legally delegated. In general, tasks that may be delegated are those that do not create unalterable changes in the oral cavity or contiguous structures, are reversible, and do not expose a patient to increased risks. The use of a laser or laser device of any type is not a remediable task [1]. All dentists, regardless of their bloodborne pathogen status, have an ethical obligation to immediately inform any patient who may have been exposed to blood or other potentially infec- tious material in the dental office of the need for postexposure evaluation and follow-up [1]. They are obligated to immediately refer the patient to a qualified healthcare practitioner who may provide postexposure services. The dentist’s ethical obligation in the event of an exposure incident extends to providing infor- mation concerning the dentist’s own bloodborne pathogen status to the evaluating healthcare practitioner if the dentist is the source individual, and to submitting to testing that will assist in the evaluation of the patient. If a staff member or other third person is the source individual, the dentist should encourage that person to cooperate as needed for the patient’s evaluation. Dentists should avoid personal relationships with their patients, as the potential for exploitation cannot be overstated. The judgment of what may be in the patient’s best interest may be impaired where there is a personal relationship. Dentists should be sensitive to the patient’s perception of inappropri- ate behavior [1]. JUSTICE Justice is broadly understood as fairness; however, it also per- tains to what someone or a group is owed. It implies fairness in relationships and dealings with patients, colleagues, and society. It also relates to the distribution or allocation of a scarce resource or treatment without prejudice. Ozar, Sokol, and Patthoff write, “when a society’s structures for distribut- ing resources are ethically sound, a common adjective used to describe the society is just. When a society’s structures are ethically deficient, one proper term is unjust” [3]. Distributive justice, coined by Aristotle to describe the effort to determine which kinds of distributive structures are ethical and which are not, could also be called social justice as it applies to dentists, dental patients, and society’s distributive structures [3]. Dentists shall not refuse to accept patients into their practice or deny dental service to patients because of the patient’s race, creed, color, sex, gender identity, or national origin [1]. Dentists should also avoid discrimination when making refer- rals to other dental professionals and in their hiring practices. According to Ozar, Sokol, and Patthoff, the primary consid- erations when making referrals are the specialists’ technical expertise, communication skills, manner, and philosophy of dental practice [3].
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