For example, consider a scenario of a patient who visits the dentist only in cases of emergency as opposed to a patient who regularly schedules care and has many dental needs. Mill might say that treating the patient who comes in only for emergencies is a waste of time when the practitioner could be caring for the regular patient who is more likely to have a positive treatment outcome. It can be seen that using this philosophy alone when approaching ethics in dental practice will not work. Dental professionals have the ethical obligation to relieve pain in all patients. Deontological ethics Deontology is an ethical theory developed by Immanuel Kant, an 18th-century German philosopher. According to this theory the consequences of an action do not matter; it is the duty or obligation to do what is right in any situation that makes an action right or wrong. Kant believed that individual autonomy and individual rights took precedence over what effect any action had on the multitude. He believed that people must never be used as a means to an end (Ethics Unwrapped, 2021). Deontology is the exact opposite of the theory of utilitarianism. Whereas utilitarian ethics would see treating the sporadic patient as taking the practitioner’s time away from the patient who is more likely to have a positive treatment outcome, Kant would say that this irregular patient has just as much of a right to care as the regular, consistent patient. The Belmont Report The Belmont Report of 1979 was the document that strongly influenced the development of the current codes of professional ethics in health care. Principlism is the name given to the 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 professions can agree. The American Dental Association’s Principles of Ethics and Code of Professional Conduct (commonly known as the ADA Code ), the American College of Dentists’ (ADC) Ethics Handbook for Dentists , 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 professions. The latest edition of the ADA Code was released in Table 1: Comparison of Ethical Principles Used in Dentistry The Belmont Report The American Dental Association Code
Deontology is a rigid ethical theory. Although the prior example does not seem unreasonable, if one takes this theory literally, a scientist who strictly abided by Kant’s rules would never be able to perform research on human subjects. Under stringent guidelines, it is common practice to involve human subjects in research that exposes them to some measure of risk in order to benefit society. Deontology does not recognize this as an ethical practice. Because of its rigidity, deontology is not an ethical theory that always works well when applied to ethical dilemmas in dental practice (Crutchfield, Johnson, Brandt, & Fleming, 2016). Virtue ethics The ancient Greek philosophers Aristotle and Plato advocated virtue ethics. They considered an action virtuous if, once completed, it would lead the nature of the doer toward excellence of character. Clarification of the principles which indicate whether a practice or action is correct underlie this theory (Prassad, et. al., 2019). Once again, consider the example of the irregular patient. Using this ethical theory, a dental practitioner must decide whether he or she considers it more virtuous to treat or not to treat the patient. Which action would propel the practitioner closer to excellence of character? It can be seen that using this type of ethics can be confusing when trying to navigate through an ethical dilemma in the dental office, making virtue ethics an impractical approach to problem solving.
TRANSFORMING ETHICAL PRINCIPLES INTO PROFESSIONAL CODES
2020, the ACD’s Ethics Handbook was revised in 2016, and the latest edition of the ADHA Code also came out in 2016. It is important to remember that although each principle in a professional code of ethics has its own merits, the principles do not stand alone. They complement one another but at the same time often conflict with one another when ethical dilemmas occur. An ethical dilemma is a situation in which no best course of action exists; the person must choose between at least two options that have advantages and disadvantages. To solve ethical dilemmas, it is essential to identify which principles apply, how they conflict, and which ones take priority in a given scenario. Dental practitioners must also consider professional obligations and standards of care. An exploration of the process of ethical decision making later in the course will offer the opportunity to examine this concept more closely. Table 1 compares the ethical principles most commonly used in dentistry.
The American Dental Hygienists’ Association Core Values
The American College of Dentists Core Values
• Autonomy. • Beneficence. • Justice.
• Autonomy. • Beneficence. • Justice. • Nonmaleficence. • Veracity.
• Autonomy. • Beneficence. • Justice and fairness. • Nonmaleficence. • Veracity. • Confidentiality. • Societal trust.
• Autonomy. • Beneficence. • Justice. • Competence. • Veracity. • Compassion. • Professionalism. • Tolerance. • Integrity.
The ADA Code has adopted the three principles of the Belmont Report and defined them as follows: respect for autonomy (“self- governance”), beneficence (“do good”), and justice (“fairness”). It also introduces two other principles: nonmaleficence (“do no harm”) and veracity (“truthfulness”; ADA, 2020a). These five principles are a common theme throughout codes of professional conduct in health care. The ADHA has also added the core values of confidentiality (“protection of client information”) and societal trust (“the valuing of public trust in
the profession”) to its code (ADHA, 2016). The ACD added compassion, competence, integrity, professionalism, and tolerance, as part of their core values (ACD, 2016). The adoption of ethical principles by the ADA, ACD, and ADHA helps members of the professions aspire to provide care at a higher level than the simple performance of procedures. The introduction section of the ADA Code 2020 eloquently states its purpose:
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