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
many more options. Dental providers have a right to practice in their comfort zones, following their personal preferences, within the generally accepted standard of care. They should consider their preferred patterns of practice when ethical dilemmas arise, as long as they first honor the former three central values. Esthetic values Esthetics are important, and providers must pay attention to the oral and facial appearance of patients and to esthetic standards; however, this value ranks lower than the patient’s life and general health, oral health, and autonomy, as well as the dentist’s preferred patterns of practice. Unless a dilemma directly relates to an esthetics case, the dental provider should consider the previous four values first. Efficiency in the use of resources Dental expertise and other resources are not unlimited. Dental providers must consider allocation of resources and costs when developing patient treatment plans and solving ethical dilemmas. Use of resources is definitely a lower priority than the first three values. However, some might argue that it would rank above the dentist’s preferred patterns of practice. The main point is that cost and allocation of resources should not be a primary consideration when solving an ethical dilemma.
BALANCING LAW AND ETHICS
At various times in health care, ethics and the law can work either synergistically or in opposition to one another. Although the study of healthcare law is a course in and of itself, it is important to have some basic knowledge of how law and ethics may intersect when confronting ethical dilemmas. Dental clinicians must obey local, state, and federal regulations which govern the practice of dentistry and the specific regulations established by their state board of dentistry. They must also obey laws which govern issues which concern their employees. When laws and professional ethics conflict the best interest, safety and well-being of the patient must be placed first (XXXXX, et al., 2021). It is important to remember some of the basic differences between ethics and the law. Laws can change over time, will vary from state to state, and can be significantly influenced by politics and economic interests. Ethical standards, however, transcend all of these considerations. Although legal rules have shaped bioethical principles and their application, bioethical principles have strongly influenced the development of law. Laws are a composite of rules and regulations while ethics represent a formal or informal rule of behavior. Legal rights have a foundation in law while ethical rights have a foundation in principles and ethical values (XXXXX, et al., 2021). Consider the Nuremberg Code and the Belmont Report as examples. Legal duties are also often ethical duties, but ethical duties may not always be legal obligations. Although individuals may have an ethical obligation to obey the law, the law is often the lower standard even though ethics and the law may draw on the same sources of authority. Ethical principles generally provide the foundation for laws, as can be seen in the example of informed consent. A patient’s right to personal autonomy is the basis for the healthcare provider’s legal obligation to obtain informed consent from patients before commencing treatment. Another example is the legal mandate to report suspected cases of child abuse and neglect. This law is anchored in the principle of beneficence. Dentistry is regulated by federal and state laws. Federal laws apply to all dentists, whereas state laws vary and apply only to dentists practicing in a particular state. Most states regulate the dental profession through a Dental Practice Act that falls under the purview of a state board of dentistry or board of dental examiners. Laws regulating the profession are also enforced by different bodies in different states. The standard of care in its most empiric definition “is the level at which the average, prudent provider in a given community
would practice.” If a general dentist performs procedure that would often be performed by a specialist, he/she is held to the standard of care of the clinician in that given specialty (Dental Beacon, 2017). The discernment of the standard of care can be difficult as the words “average and prudent” cannot easily be defined. Does community refer to the town city or country in which the clinician practices? The standard of care is, however, a fluid concept. As new technologies emerge and are accepted by the profession and the scope of practice is expanded or contracted, the standard of care must also change. As noted above, Dental Practice Acts define the scope of the practice of dentistry in each state. For instance, the ability of dentists to delegate duties to dental auxiliaries is not consistent nationally. Some states allow for expanded duties such as the taking of impressions or the placement of dental restorations. Other states do not allow dentists to delegate these same duties. Practicing within the standard of care involves abiding by the Dental Practice Act in the state in which the dentist holds a license as well as upholding ethical professional obligations. The parallel between ethics and the law can be seen by comparing the language in the ADA Code (2020) with a state’s Dental Practice Act. For example, the ADA Code (2020) addresses the delegation of duties to dental auxiliaries under the principle of nonmaleficence in Section 2.C. Use of Auxiliary Personnel: “Dentists shall be obliged to protect the health of their patients by only assigning to qualified auxiliaries those duties which can be legally delegated. Dentists shall be further obliged to prescribe and supervise the patient care provided by all auxiliary personnel working under their direction” (p. 6). This wording can be seen to complement that of the Dental Practice Act of any state, whether expanded duties are permissible or not. Offenses against the law are either civil or criminal (Erstad, 2018). An offense against a person or group for which some satisfaction is sought, usually in monetary form, is classified as civil. A criminal offense is a wrongful act against society, and criminal law is charged to protect the public as a whole against the harmful acts of others. Most healthcare issues that become legal issues are dealt with as civil offenses. Civil law can be further broken down into two primary categories: contract law and tort law . A contract is an agreement between two or more consenting parties to perform or not perform a legal act for which there is sufficient consideration. (“Consideration” is a vital element in contract law; it is the benefit or value bargained for between the parties.) A “breach of contract” occurs if either party fails to comply with the terms
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