dental ethics 2

dentist - patient relationship as a PATERNALISTIC one has been widely ….. in recent years both in ethics and in law

rejected

duty

not to “refuse to accept patients into their

practice or deny dental service to patients because

of the patient’s race, creed, color, sex or national

origin”

right

to decline to treat a patient, except for the

provision of emergency care, for humanitarian

reasons, or where the laws of the country dictate

otherwise.

legitimate

Legitimate grounds for such refusal include a full

practice, (lack of) educational qualifications and

specialisation (finally it is up to dentist's

conscience)

what is one of the core values of dentistry and is an essential element of a good therapeutic relationship

compassion

reasons for a dentist anting to terminate a relationship with a patient

• dentist moving or stopping practice

• patient refusal or inability to pay for the dentists services

• dislike of the patient and the dentist for each other

• patients refusal to comply with the dentists recommendations

patients with HIV and other blood borne infection should ….

should not be denied treatment solely because of their infections

• oath of Hippocrates

• prohibition of sexual relations between dentists and their patients

• avoid family members if possible

true or false

true

the concept of informed consent applies equally to what

refusal of treatment or choice among alternative treatments

explicit consent is given

orally or in writing

what the exceptions to explicit consent

• patient voluntarily gave their decision making authority to the dentist or to a third party

• insurances where the disclosure of information would case harm to the patient

decision making for incompetent patients

Treatment decisions should be based on

the patients’ best interests.

• Dentists must keep in mind that a

patient’s refusal of a recommended

treatment does not mean that the

patient is incompetent

confidentiality is a

cornerstone of medical ethics since the time of hippocrates

what must professional dentist ensure

must ensure professional

confidentiality of all information about patients

and their treatment.

The high value that is placed on confidentiality has

three sources

autonomy, respect for others and

trust.

Autonomy relates to

relates to confidentiality in that personal information about an individual belongs to him or her and should not be made known to others without his or her consent.

Confidentiality is also important because human beings

deserve

respect preserving their privacy

…….is an essential part of the dentist-patient relationship.

trust

who can breach confidentiality

Dental assistants, receptionists, etc.—require access to a patient’s health records

* Interpreters

* Patients who are not competent

breaching confidentiality to comply with legal reequipments - example

in child abuse

HIV + patient

• disclosure to a partner may be

• and it may be …

may not be unethical and may be justified if the patient is unwilling to inform them

How they can meet the dental needs of at least some of these patients (with financial struggles)

* Accepting patients covered by insurance that provides compensation below the rate usually charged by the dentist;

* Allowing patients to pay over an extended period;

* Reducing or eliminating fees for some patients

Conflict of interest with a

commercial organisation

* Companies offer dentists gifts and other benefits

that range from free samples to travel and

accommodation at educational events to

excessive remuneration for research activities

* Convince the dentist to use or prescribe the

company’s products

* In the case of a health-related product, the

dentist has an independent obligation to inquire

into the truth and accuracy of product claims

and verify that they are founded on accepted

scientific knowledge or research

Resource allocation

* At the highest (‘macro’) level,

governments decide how much of the

overall budget should be allocated to

health

* At the institutional (‘meso’) level, which

includes hospitals, clinics, healthcare

agencies, and dentists’ offices,

authorities decide how to allocate their

resources

* At the individual patient (‘micro’) level,

dentists decide X-rays, complex

treatments, etc

* “The dentist should...support and

promote accepted measures to improve

the oral health of the public.” (avoiding

wasteful and inefficient practices)

In dealing with these allocation issues, dentists must decide which approach to justice is preferable

libertarian

utilitarian

egalitarian

restorative

libertarian

resources should be distributed

according to market principles (US)

utilitarian

* resources should be distributed

according to the principle of maximum

benefit for all

egalitarian

* resources should be distributed

strictly according to need (Sweden)

restorative

* resources should be distributed

so as to favour the historically disadvantaged

(South Africa)