1037DOH - Carrington Lectures (Professionalism + Ethics)

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What core feature makes an occupation a ‘profession’?

It provides a specialised and valued service and is accountable to the public interest for the conduct and performance of its members.

list unprofessional behaviour behaviours

• Criminal activity or convictions.

• Disregard for patient/public wellbeing or rights.

• Cancelling or missing appointments (unless unavoidable).

• Rude, abusive, or disrespectful conduct.

• Irresponsibility, poor timekeeping, or careless attitude.

• Dishonesty in business or finances.

• Misusing the dentist–patient relationship.

outline the hallmarks of professionalism

CONFIDENCE

• trust of pt needs to be earned

CONFIDENTIALITY

• of pt must be respected

COMPETENCE

• demonstrate skill and knowledge

CONTRACT

• unwritten one to provide the best care to pt must be upheld

COMMUNITY CARE

• be prepared to care for the community

COMMITMENT

• beyond 9 to 5, impacts life outside work

principles of professional conduct

• integrity (honest, do what you say you will)

• expertise (ongoing training, accreditation, having a set of skills - scope)

• standards (do work to a high and acceptable one)

• respectability (to all staff + pts, cleanliness)

• responsibility and reliability (duty and accountability, keep promises, other ppl rely on you)

• probity - good, honest, upright, ethical

• behaviour - public expectation

professional attributes

• altruism (pt before yourself, money shouldnt take precedence)

• accountability (answerable to what you do/don’t do tp pt, staff, prof. body)

• duty (duty of care)

• excellence (strive to continuously improve)

• honour and integrity (be honest, truthful, do what you say you will, dont misuse your status)

• respect for others (treat others the way you want to be treated - humanism)

What is the primary role of a profession’s governing body?

To set standards for entry, certification, conduct and performance, and to impose sanctions when members fail to meet those standards.

How was ‘ethics’ defined in the lecture?

The conscious and unconscious application of rules, principles and values that guide professional decisions about the right thing to do in any situation.

According to the General Dental Council (UK), what must dental professionals do to justify public trust?

• Justify the trust that your patients, the public and your colleagues have in you by always acting honestly and fairly.

• Apply these principles to clinical and professional relationships, and any business or educational activities you are involved in

State four of the stated aims of unit 1037DOH.

1. Develop awareness of the roles within the oral-health team.

2. Understand the expectations of being an oral-health professional.

3. Develop an appreciation for the dental profession

4. What constitutes ethical practice within the legislative framework for the scope of oral health practice in

   • Australia

   • School of Dentistry and Oral Health

List the six Australian Dental Council (ADC) Domains for a newly qualified dentist.

1. Professionalism,

2. Communication & Social Skills,

3. Critical Thinking,

4. Health Promotion,

5. Scientific & Clinical Knowledge,

6. Patient Care (with sub-domains of

• clinical information gathering,

• diagnosis/management planning,

• clinical treatment & evaluation).

Give five patient-centred behaviours required under ADC ‘Professionalism’.

1. demonstrate appropriate caring behaviour towards patients and respect professional boundaries in relationships between themselves, patient and members of the community

2. provide patient centred care

3. respect patient’s dignity and choices

4. acknowledge that all interactions, including history taking, diagnosis, treatment planning and treatment, must focus on the patient’s best interests

5. recognise and respect patient’s rights, particularly with regard to confidentiality, privacy and informed consent

Define ‘competency’.

• competency is knowledge, experience, critical thinking and problem-solving skills, professionalism, ethical values, diagnostic and technical and procedural skills

Define ‘competent’.

• behaviour expected of the beginning practitioner.

• this behaviour incorporates understanding skill, and values in an integrated response to the full range of requirements presented in practice

Define ‘evidence-based dentistry’.

(judicious integration of…)

• Judicious integration of systematic scientific evidence with the clinician’s expertise and the patient’s needs, preferences, medical history and oral-health literacy.

Define ‘informed consent’.

• A person’s voluntary decision about health care made with knowledge and understanding of the benefits and risks involved.

1. List 6 key elements of patient-centred care mentioned in the lecture.

1. display cultural and social sensitivity

2. respect for patient’s differences and autonomy

3. diagnose, relieve pain and suffering in an empathetic and kind manner

4. coordinate continuous care

5. advocate disease prevention

6. promote healthy lifestyle in a holistic approach to the patient + community

Identify the three main Australian bodies/documents regulating dental professional conduct that students must know.

1. AHPRA Code of Conduct,

2. Dental Board of Australia (DBA),

3. DOH Code of Professional Practice.

Why must dental practitioners engage in lifelong professional development?

• To foster continual growth, participate in peer review, contribute to knowledge generation and maintain public trust in the profession.

what is a profession

a vocation, especially one involving a degree of skill, learning/science

what is professionalism?

• relating to work that needs special skills/qualifications

• demonstrating high level of skill/training

• behaving in a correct/accepted/expected way at work

• doing your job well

why does professionalism involve putting the needs of others first?

• high level of skill

• demonstrates a commitment to the cause and garners trust from the public

• builds a relationship with the patient, touching on issues of trust and reliability

• shows the changing dynamic away from paternalism towards involving the patient in decision making

why does professionalism belong in the realm of ethics?

• it is a concept that informs how we ought to act

the compulsion to act morally is driven by what?

• an internalised set of moral rules or values

• can be considered voluntary

• it is an ‘ought’ action (driven by threat of sanction/punishment)

the ‘must’ action and ‘ethics’ are vital to give the dental profession guidance. why?

• both will influence many decisions and may have differing roles

• within the context of dentistry - ‘must’ represents a decision taken on the minimum standards that are expected to achieve for the safety of patients, staff + themselves

principles of professionalism (CCI RCC)

• competency

• conduct

• integrity

• responsibility

• courage

• compassion

why can the origins of dental ethics be found in traditional medical ethics?

• dentistry has been a recognised profession for less than 2 centuries

• previously it overlapped with med so thats why it shares ethics concepts

what is ethics?

ethics is the process involved with…

• study of ‘right’ and ‘wrong’

• ethics is the process involved with determining the most morally desirable course of action when confronted with a situation where a decision is required

ethics can be defined as…

• ?

• ?

• behaviour in relation to a chosen career

• a set of principles of right conduct

ethics refers to a specific code of conduct. this includes…

• moral code/obligation

• set of principles to guide behaviour

• framework of guiding principles (eg ADA guidelines for infection control)

• brings order and purpose (between laws)

• assists in guarding against actions of disrepute to profession

guard against actions for disrepute to profession refers to…

• an expected behaviour in relation to a chosen career

• behaviour being governed by a specific code of conduct

purposes of code of ethics

• increase awareness and sensitivity to ethical situations in practice

• define a standard of conduct that will give each individual a strong sense of ethical consciousness in professional practice and life

• each individual is responsible for the study and application of the code in which membership is held (eg AHPRA governing body for all health practitioners)

moral values are selected principles of ethical behaviour, including…

• individual autonomy and respect of human beings

• confidentiality

• societal trust

• beneficence

• nonmaleficence

• justice and fairness

• veracity

what factors influence ethical behaviour?

• parental/family values

• religious/cultural background

• important figures during upbringing

• schooling/education

• peers/colleagues

• media

for dental practitioners, there are additional factors that influence ones behaviour…

• begins at dental school

• role models - having qualities you wish to attain with strong influences on professional values, attitudes and behaviours

what are the most valued attributes of a role model?

• compassion

• integrity

• good relationship with patients

what are triggers for unethical behaviour?

• fear of failure

• greed and envy

• stresses and pressures

• influence of peers

• individual ability to justify behaviour (can influence an individuals action)

• punishment is a strong deterrent, but it in itself doesn’t instil ethical behaviour

difference between jurisprudence and ethics

• ethics is study of morality + behaviour in relation to chosen career

• jurisprudence is the philosophy or science of law

• it is the science that teaches the application of every branch of dental knowledge, to the purposes of law

• ethics and law tend to be intertwined and inseparable

what is dental ethics?

• intrinsic component of dental practice

• not scientific/technical questions (eg how to administer local anaesthetic) but questions about values, rights and responsibilities

• dental practitioners face these questions just as often as the technical ones

• study of morality (reflection + analysis of decisions and behaviour - whether past, present or future)

why aren’t ethical questions in dentistry equally challenging to answer?

• some are easy to answer mainly because there is a well-developed consensus on the right way to act in the situation

• for example - dent. practs should always get consent for treatment

• others are more difficult, esp. for those which no consensus has been developed and where all options have drawbacks

• for example - risks related to performing a procedure

rules for ethical behaviour

• dont lie

  • be trustworthy and tell the truth

• dont hurt each other

  • take care in your actions and inactions

  • know your limits

• don’t spill someone else’s secret

  • patients tell practitioners things bc they believe they will be protected and treated with care

• don’t steal (take things without permission)

  • if you intend to extract part of a patient, make sure you have their consent

• be kind to each other

  • treat others with the same care and consideration as you would wish to be treated

ethical challenges

• making judgements

  • difficult situations

• conscious/unconscious applications of

  • rules, principles or values

• professional decision making

  • the ‘right’ thing/action to do in a given situation

what are ethical challenges influenced by?

• individual philosophy and values (restoration vs extraction)

• patient perception of us

what is an ethical dilemma?

• problem that may involve 2 morally correct choices

• may not have a single answer - depending on choice, outcomes can differ

how is an ethical dilemma resolved?

to resolve…

• facts must be gathered

• ethical principles and theories applied

• don’t explore opinions

• also consider

  • transparency (do i mind others knowing what i chose?)

  • effect (who’s affected by my decision)

  • fairness (would my decision be considered fair by those affected?)

• identify alternatives

• determine professional implications

• rank alternatives (best alternative? if equal, choose either)

how do laws help practitioners with ethics?

• they specify how practitioners are required to deal with ethical issues in patient care and research

• example - regulatory officials in each country can + do punish practitioners for ethical violations

• usually dental ethics requirements + law are similar but shouldn’t be confused with each other

legal systems vary how? tends to be what?

• vary in many respects around the world

• tends to be a set of common principles

what are the different regulatory bodies?

• AHPRA

  • licensing body in australia

• health practitioner regulation national law act 2009 - queensland

  • licensing of health practitioners, full, limited, speciality registration to practice

• dental councils (ADC)

• dental boards (DBA)

• medical/pharmaceutical boards etc

  • (above 3) accreditation in education + training

  • have the power to suspend/remove a dent pract. registration, even when no law has been broken

  • enforceable bc of health practitioners registration

criminal law

• identifies?

• includes?

• examples of offences?

• identifies requirements of personal behaviour in relation to society

• includes offences against what society considers acceptable

• examples of offences:

  • murder/assault

  • theft/fraud

  • race relations + discrimination

civil law

• one citizen against another (patient vs practitioner)

• examples of allegations

  • breach of contract

  • negligence (incl. med/dent negligence)

• in each situation, there is a statutory point of reference, i.e

  • an act/law/set of regulations made to give practical effect to legislation

  • text of legal (statutory) instruments referred to/interpreted in context of a given set of circumstances

• implies we can refer for guidance to laws/regulations in relation to issues under consideration

laws can differ significantly from ….. while ethics is generally ……

• one country to another

• applicable across national boundaries

ethics often prescribes _____ standards of behaviour than does the law

• higher

occasionally, situations may arise where ethics and law conflict. what do you do here?

• must use own best judgement whether to comply with law or follow ethical principles

what does the AHPRA do?

• works in partnership with the National Boards to implement the National Registration and Accreditation Scheme, under the Health Practitioner Regulation National Law as in force in each state and territory

• ensures that Australia’s registered health practitioners are suitably trained, qualified and safe to practice

• protect the public

each of the 15 National Boards have an approved ______ __ _____/______ that applies to the registered health practitioners they regulate.

code of conduct/ethics

12 National boards share a code of conduct for the practitioners that they regulate. what does the code describe? what does it achieve by doing this?

• the professional behaviour and conduct the National Boards expect from registered health practitioners

• by defining these, the code supports good patient care and delivery of appropriate, effective services within an ethical framework, keeping the public safe

list the first 3 principles of the code of conduct

1. put patients first - safe, effective and collaborative practice

2. Aboriginal and Torres Strait Islander health and cultural safety

3. respectful and culturally safe practice for all

list principle 4-6 of the code of conduct

4. working with patients

   • base relationships on respect, trust and effective communication

   • maintain effective + professional relationships

   • provide explanations that enable patients to understand + participate in their care

5. working with other practitioners

   • health care needs to be free of discrimination, bullying and harassment

   • good relationships with colleagues and other practitioners strengthen the practitioner-patient relationship

6. working with the healthcare system

   • use resources wisely

   • practitioners have a responsibility to contribute to effectiveness + efficiency of the healthcare system

list principles 7-9 of the code of conduct

7. minimising risk to patients

   • put patient safety (incl. cultural safety) first

   • maintain professional capability through ongoing professional development

   • self-reflection

   • understand + apply principles of clinical governance, risk minimisation and management in practice

8. professional behaviour

   • display behaviour that warrants trust + respect of the community

   • practice ethically and honestly

9. maintaining practitioner health and wellbeing

   • seek appropriate work-life balance

list principles 10 and 11 of the code of conduct

10. teaching, supervising and assessing

    • support above roles to develop the health workforce

11. ethical research

    • recognise the importance of ethical, evidence-based research for quality healthcare and policy development.

    • conduct research ethically.

    • support the decision-making of research participants.

patient care is your primary concern in clinical practice. providing good care includes that you:

• asses patient, take history, views, and appropriate physical examination where relevant

• make, record and implement a suitable management plan (incl. treatment, advice, and if needed liaising with other practitioners)

• facilitate coordination and continuity of care

• work within your limits/competence and refer when its in the best interest of the patient

• healthcare decisions are shared responsibility of treating pract. and the patient who may want to involve family, carers etc

• respect rights of patients to make their own decisions about their current + future healthcare

maintaining a high level of professional competence and conduct is essential for good care. good practice includes that you:

• 6 dp’s

• maintain adequate knowledge + skills to provide safe + effective care

• have adequate records and consider the balance of potential benefit and harm in all clinical decisions

• communicate effectively with patients so they have enough info to make an informed decision

• respect the patient if they choose to refuse treatment

• support the right of a patient to seek a second opinion

• consult and take advice from colleagues when appropriate

good practice involves…

• recognising and working within the limits of a practitioner’s competence and scope of practice, which may change over time

• when moving into a new area of practice, ensuring that the clinician has undertaken sufficient training and/or qualifications to achieve competency in that area

• practicing patient-centred care, encouraging patients to take interest and responsibility in the management of their health and supporting them in this

• considering the balance of benefit and harm in all clinical management decisions

what is shared decision making?

• making decisions about healthcare is the shared responsibility of the treating practitioner and patient/client who may wish to involve their family, carer/s or others

• practitioners have the responsibility to create and foster conditions for this to occur

what is the australian charter of healthcare rights?

• adopted for use in australia in july 2008

• describes rights that consumers (or someone they care for) can expect when receiving healthcare

• these rights apply to all people in all places where healthcare is provided in australia

• includes public and private hospital, day procedure services, general practice and other community health services

coordinated action carried out by 2 or more individuals jointly, concurrently or sequentially implies that there is…

• common agreed goals

• clear awareness for others

• respect for others’ roles and functions

• cannot be expected to emerge naturally

what is a dental team?

• group of people who together provide care for a patient

• mutually accountable

• have complementary skills with a common purpose

factors to consider for a team approach

• co-operate

• use strengths of each team member

• identify and acknowledge variety of roles

• provide facilities that assists team members to become a good team

• recognise contribution of each team member

good/effective dental teamwork requires…

• good leadership

• clear, shared aims

• work together to achieve a goal

• roles and responsibilities may be different but should be defined

• understand scope of each member

list some things relating to relating to colleagues

(ok i couldnt think of any other way to say this)

• claims of superiority (unethical - avoid)

• referrals (have documentation, be professional)

• commenting on others (don’t be drawn into overly criticising someone)

• defamation (no justification for the statement - lowers the reputation of the person by publicising a false statement)

• differences of opinion (colleagues won’t always have the same opinions - maintain appropriate ethical standards)

• conflict (breakdown in relationship)

• competition (competing for jobs, unworthy and unethical to disseminate adverse info to promote ones own interests)

• raising concerns (deal with it urself if u can but raise concerns directly if its appropriate)

• whistle-blowing (making others aware of your concerns - esp those in authority)

what are some factors that may influence moral values?

• parental/family values

• religion/culture

• role models

• school/education

• peers/colleagues

• media

what are morals?

guiding principles in relation to what is right/wrong and applies to behaviour

morality relates to _______

honesty

recommendations for practice online

• Be mindful of the potential issues that arise from online behaviour

• Use social media purposefully (want positive interactions/market your practice)

• Be informed of the complexities of online interactions and stay up to date with research in this field

• Be aware of unintended consequences as well as permanence of online posts

• Be mindful of the blurring between public and private boundaries

• Exercise caution when considering accepting contact requests from patients

what is ‘autonomy’?

• the right of an individual to follow their own self-directed choices in life

• assumed that the individual is capable of making a decision in the first place

what are some situations where a person might not be able to make a decision?

• mental capacity

  • full/partial

• temporary incapacity

  • unconsciousness

  • trauma

  • drugs/alcohol

  • illness

  • mental state (eg anxiety)

what to ask to assess competence of pt?

• ‘can pt understand and assimilate info being provided?’

• ‘can pt make a decision?’

along with a signature of consent, what else should you ensure?

• that the pt understands potential issues and treatment theyre getting in detail

• the decision/s taken by the patient are made freely and without coercion

what are some factors related to autonomy?

• choice

• free will

• competence

• best interest principle

• information

pt’s choice is made according to the pt’s own:

• values and code of conduct

a pt’s decision can be influenced by (clinically)

• treatment options which they’re told about

• eg dentist knows implant is best choice but doesn’t give patient the choice of fixed bridge implants for different reasons (eg more money for dentist)

you should always act HONESTLY, and FAIRLY - this justifies the trust the pt’s, public and colleagues have in you. where should you also apply these principles to?

• to clinical situations

• professional relationships

• business/educational activities

what are beauchamp and childress’ 4 principles?

1. respect for autonomy

2. beneficence

3. non-maleficence

4. justice

describe beauchamp and childress’ PRINCIPLE 1 (_________ ___ __________)

• respect for autonomy

• maintain respect

• give informed choice to pt

• respect DM capacities and ability of pt

• pt has the right to decide in the end

describe beauchamp and childress’ PRINCIPLE 2 (____________)

• beneficence

• Balancing benefits of treatment (need implant, but gives options to patient and explain what can go wrong – give benefit of the doubt)

• Risks + costs

• Benefit of patient (everything under here is for benefit of the patient)

• Simply improve situation of others

• Refrain from causing harm

• eg) providing vax for general population, reviving a drowning victim

describe beauchamp and childress’ PRINCIPLE 3 (____-________)

• non-maleficence

• Avoiding causation of harm

• If treatment involves harm, must be minimal, not disproportionate with benefits

• Hippocrates – do no harm

• You cant do anything that would purposely harm patients – eg doing a treatment that you aren’t trained/competent to perform

• Malice – desire to harm others, spite or extreme ill will

describe beauchamp and childress’ PRINCIPLE 4 (_______)

• justice

• Treat patients equally and fairly

• Being accountable for ones actions or inaction

• Need to make sure all patients has access to a basic level of dental care regardless of income/social status

• Never discriminate unfairly against those who present themselves for treatment/oral care

• You cant overcharge someone bc they are obviously rich lol

what is the ‘best interest’ principle?

• Applied when pts lack capacity to make their own decisions.

• Clinician provides treatment in what is judged to be the pt’s best interest.

• Legal Framework

  • Law sets age thresholds for decision-making capacity (e.g., 16–18 years).

  • Parents typically regarded as acting in best interests of their children.

• Adults without Capacity

  • Creates an ethical dilemma for practitioners.

  • Challenge: balancing pt autonomy vs. acting in best interest.

• Key Ethical Questions

  • What is in the best interests of pt?

  • Whose moral codes are used to decide this?

according to the ‘best interest’ principle, what should be considered regarding the patient?

• values and preferences if known to be competent in the past

• psych, spiritual, physical wellbeing

• overall quality of life

• relationship/impact of pt’s condition on family/carers (who has pt’s best interests at heart?')

• best to share ‘best interest’ decision with colleagues and others responsible for pt’s care

what should be considered (on the prac.’s side) when making clinical decisions?

• identifying alternatives 

• professional implications (whats acceptable to do given situation, identify obligations relevant to situation)

• rank alternatives (best, if equal tell pt can choose either, what’s best?)

• choose course of action (comfortable? ethical obligation? can do this treatment (within scope?))

consent is about and relies on…

• effective communication

• trusting relationship between pt and prof

• respect for pt autonomy within pt capacity

• info to be shared so pt feels they make a decision for their own benefit according to their own values

• RESPECT RIGHTS OF PATIENT IS ESSENTIAL ETHICAL RIGHT

consent is not about protecting those providing the treatment, it is about…

• creating recognition of patient autonomy

________ is a key part of the consent process. but this can be misleading bc it implies that you just need to give it to the pt, rather than making sure the pt understands it fully.

emphasis for sufficient patient knowledge?

information

• purpose of proposed treatment

• nature of treatment

• likely effects

• risks/side effects

• alternatives (other than no tx)

• cost

• patient needs to know EVERYTHING:)

if patients have a limited competence/capacity to make their own decisions, then what should you do?

• seek consent from the caregiver

for consent to be valid, you need to…

• make sure the pt recieved enough info to make a decision and understands it too

• find out what pt wants to know and what you think they need to know too

• DONT PRESSURE PT TO TAKE ADVICE

• remember pt can refuse tx/consent

who and what does confidentiality apply to?

• all members of dental team (recept, hygiene, assistant etc)

• pt info gained in professional role

• email addresses, ph no., med history, age, sex, gender etc

________ is a vital part of the code of medical and dental ethics

• confidentiality

if pt requests access to their records, can you give it to them? what else should you think about?

• yeah you can give it

• need to consider info being accidentally revealed elsewhere

• prevent unauthorised access - store records securely while in your possession 

why should pt info be kept secret?

• if they think we can’t do that - they won’t tell us anything

• pt must be protected from distress, discrimination and potential stigmatisation

• disclosure may cause harm to pt’s

any info given to you in the context of your professional relationship with a patient is bound by the _______ ____ _ ___________

• ethical duty of confidentiality

specifics about personal health information (confidentiality)?

• obtained in the course of consultation/tx, is confidential 

• none of it should, in normal circumstances, be disclosed to any third party without the permission of the pt