DCA05DE Dental Ethics and the Digital Age, 3rd Edition _ _________________________________________
This study continued unchanged until an undercover inves- tigation by the media brought the situation to the public’s attention. When the story broke in 1972, few of the 74 origi- nal study participants were alive. Other research that caused similar ethical concerns during this period was taking place in U.S. prisons, such as the Holmesburg Prison in Philadelphia, and disabled children’s inpatient facilities, such as the Wil- lowbrook State School in Staten Island (Rosenbaum, 2020; Amramova, 2019). In 1974, in response to concerns over controversial U.S. research, Congress established the National Commission for the Protection of Research Subjects. The Commission was tasked with defining ethical principles for human subject research and clarifying legitimate research practices. In 1979, the Commission released the Belmont Report, which laid the foundation for modern healthcare ethics. The report identified three core principles: respect for persons (recogniz- ing autonomy and protecting those with limited capacity), beneficence (minimizing harm while maximizing benefits), and justice (ensuring fairness in research). These principles form the basis for informed consent today (U.S. Department of Health and Human Services (HHS), 2024). Healthcare Consideration The research atrocities committed during Nazi Germany and in the U.S., such as the Tuskegee Syphilis Study, profoundly impacted 20th century healthcare ethics, leading to the development of strict guidelines to protect human subjects. These horrific events underscored the need for informed consent, respect for human dignity, and rigorous ethical oversight in medical research. The 20th century was a pivotal time in the evolution of medical ethics. As technology became more sophisticated and health- care consumers more knowledgeable, healthcare practitioners had no choice but to look more closely at ethical practices sur- rounding patient care and research involving human subjects. The following historical events also significantly influenced the evolution of biomedical ethics in the 20th century (Jonsen, 2000; Weijer, 2005): • Discovery of DNA (1953): Launched the field of genetics and genetic engineering, sparking ongoing ethical debates. • Oral Contraceptives (1960): Led to debates on the moral permissibility of birth control. • Chronic Hemodialysis (1960): Limited resources for life-saving treatment raised ethical questions about patient selection. • Harvard Definition of Brain Death (1968): Sparked debates over the definition of irreversible coma with the advent of artificial life support. • Roe v. Wade (1973): Supreme Court ruling that a woman’s right to privacy extends to abortion, fueling ongoing moral debates.
• Karen Ann Quinlan Case (1976): Led to discussions on a “persistent vegetative state” and prompted the creation of hospital ethics committees. • Baby Louise Brown (1978): The birth of the first “test-tube baby” sparked mixed reactions about in vitro fertilization. • Baby Doe (1982): Raised ethical questions about the care of infants with disabilities. • Artificial Heart (1982): The first successful artificial heart transplant sparked debate over healthcare resource allocation. • AIDS Pandemic (1983): Brought up ethical issues like patient confidentiality and the balance between patient rights and public health. • Patient Self-Determination Act (1990): Inspired by the Cruzan case, this act focused on advance directives and end-of-life decisions. • Terri Schiavo Case (2005): Highlighted the ethical complexities of life support and end-of-life decisions. • Oregon Death with Dignity Act (1997): Addressed assisted dying, relevant to cases like Terri Schiavo’s. TRANSFORMING ETHICAL PRINCIPLES INTO PROFESSIONAL CODES The Belmont Report of 1979 strongly influenced the develop- ment of the current codes of professional ethics in health care. Principlism is the name of the ethical theory derived from the recommendations in the Belmont Report; this theory forms the basis of all codes of ethics in the health professions today. Principlism provides a practical approach to solving ethical dilemmas in health care, offering a standard upon which health professionals can agree. The American Dental Association’s Principles of Ethics and Code of Conduct (commonly known as the ADA Code), the American College of Dentists (ACD) Ethics Handbook for Dentistry, and the American Dental Hygienists’ Association (ADHA) Bylaws and Code of Ethics (or ADHA Code) are no exceptions. These associations revise their living documents periodically to address new ethical issues within their profes- sions. It is important to remember that although each principle in a professional code of ethics has its merits, the principles do not stand alone. They complement one another but, at the same time, often conflict when ethical dilemmas occur. An ethical dilemma is a situation in which a person faces a dif- ficult choice between two or more conflicting moral principles, where each option has significant ethical implications, and none can be chosen without compromising another ethical value. In such dilemmas, the right course of action is unclear, often requiring a balance between competing duties, rights, or values. Ethical dilemmas in healthcare are often high stakes as a patient’s health or well-being may be at stake. Exploring the
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