Table 4: Principles of the American Dental Association Code of Ethics Autonomy (“self-governance”)
The dentist has a duty to respect the patient’s rights to self-determination and confidentiality. This principle expresses the concept that professionals have a duty to treat the patient according to the patient’s desires, within the bounds of accepted treatment, and to protect the patient’s confidentiality. Under this principle, the dentist’s primary obligations include involving patients in treatment decisions in a meaningful way, with due consideration being given to the patient’s needs, desires, and abilities, all while safeguarding the patient’s privacy. The dentist has a duty to protect the patient from harm. Under this principle, the dentist’s primary obligations include keeping knowledge and skills current, knowing one’s own limitations and when to refer to a specialist or other professional, and knowing when and under what circumstances delegation of patient care to auxiliaries is appropriate. The dentist has a duty to act for the benefit of others. Under this principle, the dentist’s primary obligation is service to the patient and the public at large. The most important aspect of this obligation is the competent and timely delivery of dental care within the bounds of clinical circumstances presented by the patient, with due consideration being given to the needs, desires, and values of the patient. The same ethical considerations apply whether the dentist engages in fee-for-service, managed care, or some other practice arrangement. Dentists may choose to enter into contracts governing the provision of care to a group of patients; however, contract obligations do not excuse dentists from their ethical duty to put the patient’s welfare first. The dentist has a duty to treat people fairly. This principle expresses the concept that professionals have a duty to be fair in their dealings with patients, colleagues, and society. Under this principle, the dentist’s primary obligations include dealing with people justly and delivering dental care without prejudice. In its broadest sense, this principle expresses the concept that the dental profession should actively seek allies throughout society on specific activities that will help improve access to care for all.
Nonmaleficence (“do no harm”)
Beneficence (“do good”)
Justice (“fairness”)
Veracity (“truthfulness”) The dentist has a duty to communicate truthfully. This principle expresses the concept that professionals have a duty to be honest and trustworthy in their dealings with people. Under this principle, the dentist’s primary obligations include respecting the position of trust inherent in the dentist-patient relationship, communicating truthfully and without deception, and maintaining intellectual integrity. Note . Adapted from the American Dental Association (2020a). American Dental Association principles of ethics and code of professional conduct.
https://www.ada.org>about>principles>code.of>ethics Professional relationships and obligations
dilemma, there are six priorities, or central values, of dental practice. In order of importance, they are: 1. The patient’s life and general health.
All codes of ethics recognize three professional relationships that are at the core of most ethical dilemmas (Kaur and Singh, 2018; ADA, 2020a). These are: ● The professional and client. ● The professional and professional. ● The professional and society. Underlying all of these relationships is a foundation of trust; the same trust is at the core of professionalism itself. When either entity in a relationship violates trust, an ethical dilemma will most likely result. Besides trust violations, however, there are many other causes of ethical dilemmas. Furthermore, as the world changes, so do the ethical challenges involved. Professional obligations are inherent in the practice of dentistry as defined in the principles outlined above and in the very definition of professionalism discussed earlier in the course. Professional obligations imply that there is a duty involved, meaning that: ● To act or refrain from acting in a particular manner is something one ought to do in a given situation with the welfare and the best interests of the patient as the ultimate guiding force. ● Ethically defensible reasons exist to support the claim that one ought to act or refrain from acting in a certain manner and to meet the standards of community care and competence in the provision of dental services. ● These reasons make acting or refraining from acting relatively important compared with other possible actions in the situation. (Prasad, et al., 2019) As a result, ethical decision making is quite different from decision making in other aspects of a dental professional’s life. Professionals must be willing to make personal sacrifices for patients and the profession, identify conflicting professional obligations, and subsequently act on them. To help prioritize where to focus one’s attention when attempting to honor professional obligations in the midst of an ethical
2. The patient’s oral health. 3. The patient’s autonomy. 4. The dentist’s preferred patterns of practice. 5. Esthetic values. 6. Efficiency in the use of resources. (Prasad, et al., 2020) The patient’s life and general health
If a patient’s life or general health is at risk, a dental professional must always strive to protect it. There is no more important task in any given scenario. The patient’s oral health A patient’s oral health is the most obvious value that dental professionals seek with their patients. However, oral health is a very broad topic. Striving for a patient to be free of pain and to have optimal oral function is what dentists ultimately do for their patients, and this goal is extremely important when prioritizing a course of action in any scenario. The patient’s autonomy Respecting patient autonomy is important, and dental practitioners should honor it whenever possible. Patients have the right to determine what is done to their bodies. Informed consent is one example of honoring patient autonomy. Patients cannot make good treatment decisions about their oral health unless they have all relevant information. Patients also have the right to refuse dental treatment after dental practitioners inform them of the associated risks and benefits. Although this right does not mean that a patient can dictate care to the dental provider, patient autonomy does rank high on the priority list. The dentist’s preferred patterns of practice Dental providers who practice within the standard of care have a right to provide care in a manner that suits them. For example, providers can choose among different techniques, various dental materials, a variety of styles and brands of instruments, and
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