ph - w 8 & 10

• Know the meaning of each principle and how to recognize it in a scenario.

• Ethical dilemma definition

• Utilitarian ethics vs. Deontological ethics

• Informed consent: Requires capacity, adequate information, understanding, and voluntary choice.

• Clients have the right to refuse treatment when they have decision-making capacity and are appropriately informed.

• Personal beliefs do not justify discriminatory care or abandonment of professional responsibilities.

Ethics, Morality and Jurisprudence

Ethics

• Study of right and wrong - asks what we should do and why.

• Normative ethics = Establishes standards of right and wrong.

• Descriptive ethics = Studies people's actual moral beliefs without judging them.

• Professional ethics = Standards of conduct within a profession.

Moral Development

• Influenced by age, education, character and experience.

• Moral judgments = Decisions involving rights, duties or well-being.

Jurisprudence

• Theory and philosophy of law.

• Examples: Scope of practice, consent, documentation, practising without a licence.

• explores the deeper nature, purpose, and underlying principles of legal systems

Difference:

Ethics = moral responsibilities

Jurisprudence = legal principles.

Three Ethical Theories

Utilitarianism / Consequentialism — Outcomes

• Right action produces the greatest good for the greatest number.

• Considers benefits and harms to everyone affected.

• Example: Community water fluoridation benefits the majority.

• Lecture scenario: LDH notices restoration overhangs and considers the consequences of reporting versus ignoring them.

Deontology / Nonconsequentialism — Duties

• Actions judged by rules and obligations, not consequences.

• Some actions are right or wrong regardless of outcomes.

• Example: LDH feels obligated to follow an office contract limiting restorative options to amalgam.

does it follow rules or weigh the consequences of said rule

Virtue Ethics — Character

• Focuses on compassion, integrity and conscientiousness.

• Asks what a good person would do.

• Example: LDH volunteers at a public clinic because helping others reflects their character.

Four Normative Ethical Principles

Nonmaleficence — Do No Harm

• Prevent harm and follow standards.

• Breach: Performing an unqualified procedure or ignoring standard precautions.

Beneficence — Do Good

• Promote patient well-being and prevent harm.

• Examples: Oral cancer screening, necessary radiographs, replacing worn instrument tips.

Autonomy — Patient Choice

• Respect the patient's right to make informed decisions.

• Explain treatment, alternatives and consequences.

• Example: Patient refuses treatment after understanding the risks.

Justice — Fairness

• Equal treatment without discrimination.

• Example: Uninsured patient receives the same quality of care and treatment options.

Key Point: Beneficence and nonmaleficence both aim to benefit patients and prevent harm.

Six Supporting Ethical Concepts

Veracity — Truthfulness

• Be honest and disclose relevant information.

• Breach: Hiding a broken instrument tip or billing for services not provided.

Paternalism — Best Interests

• Acting in what the professional believes benefits the patient.

• May conflict with autonomy (aka patient’s choice)

• Example: Recommending premedication despite patient hesitation.

Informed Consent — Informed Choice

• Explain treatment and ensure understanding.

• Patient voluntarily accepts or refuses.

Confidentiality — Protect Information

• Keep patient information private.

• Exceptions may apply when required by law or in emergencies.

Fidelity — Keep Promises

• Loyalty and faithfulness to commitments.

• Example: Calling a patient back when promised.

Societal Trust — Public Confidence

- Maintain ethical standards, competence and professional integrity.

Informed Consent, Types and Refusal

Requirements

• Patient has decision-making capacity.

• Receives enough treatment information.

• Understands risks, benefits and consequences.

• Makes a voluntary decision.

Two Parts

1. LDH provides relevant information.

2. Patient decides based on that information.

Types

• Expressed: Verbal agreement or nodding.

• Written: Signed authorization (VCDH chart).

Informed Refusal

• Capable patient can refuse treatment.

• Explain consequences and document refusal.

Example: Patient declines recommended radiographs after understanding the risks.

Privacy, Confidentiality and Exceptions

Privacy

• Right to control access to personal information.

Confidentiality

• Duty to protect information obtained during care.

• Includes medical/dental history, findings, treatment discussions and records.

• Do not share with family, friends or on social media without appropriate authorization.

Exceptions

• Emergencies.

• Protecting third parties.

• When required by law.

• Certain legal guardian or capacity situations.

Examples

• Reporting suspected child abuse.

• Reporting legally reportable diseases.

• Providing necessary information to paramedics during an emergency.

Ethical Dilemmas and Conflicting Principles

Ethical Dilemma

• Occurs when two or more ethical principles conflict.

• Unlike an everyday choice, no option clearly satisfies every principle.

Lecture Example

• Patient requires antibiotic premedication but refuses it.

• Patient still requests treatment.

Conflicting Principles

• Autonomy: Respect patient's choice.

• Nonmaleficence: Avoid potential harm.

• Paternalism: Act in patient's perceived best interest.

Key Point

- Ethical principles must be balanced when deciding how to proceed.

Ethical Decision-Making

Fundamentals

• Identify the ethical problem.

• Determine which principles conflict.

• Gather relevant facts and patient concerns.

• Consider alternatives and their consequences.

• Review duties, rights and professional standards.

• Choose and justify an ethical action.

Three Ways of Thinking

• Utilitarian: Which option produces the best overall outcome?

• Deontological: What duties and obligations apply?

• Virtue: What would a compassionate, ethical professional do?

Key Point

- Ethical principles guide decisions but do not automatically provide one correct answer.

Dental Hygiene Client's Bill of Rights

Key Client Rights

• Choose their dental hygiene provider.

• Know their provider's credentials.

• Receive competent, professional care.

• Be treated with dignity and respect.

• Have personal information kept confidential.

• Receive explanations about care.

• Participate in treatment decisions.

• Give informed consent or refusal.

• Receive appropriate referrals when necessary.

• Have concerns addressed appropriately.

Connection to Ethics

• Autonomy: Informed decisions.

• Justice: Fair treatment.

• Beneficence: Appropriate care.

• Confidentiality: Privacy protection.

Note: This is a condensed study summary of client rights, not a word-for-word reproduction of the Bill of Rights.

Code of Ethics and Critical Thinking

Code of Ethics

• Establishes professional ethical expectations.

• Guides conduct and decision-making.

• Helps maintain public confidence.

Critical Thinking

• A Code of Ethics does not provide exact answers to every situation.

• Helps professionals understand the reasoning behind ethical behaviour.

• LDHs must learn and apply ethical principles.

Example

- When autonomy conflicts with nonmaleficence, the LDH uses ethical reasoning rather than relying on one principle alone.

Six BCCOHP Professional Standards (PRINCIPLES)

Principle 1 — Patient Interests First

- Prioritize patient well-being.

Principle 2 — Safe and Competent Care

- Practise within competence and protect patient safety.

Principle 3 — Cultural Awareness and Inclusion

- Respect differences and avoid discrimination.

Principle 4 — Communication and Consent

- Explain care clearly and obtain informed consent.

Principle 5 — Collaboration

- Work with other professionals and refer appropriately.

Principle 6 — Public Trust

- Maintain honesty, professionalism and appropriate boundaries.

Professional Responsibilities and Public Trust

Professional Responsibilities

• Practise within scope and competence.

• Follow practice standards.

• Protect patient safety.

• Communicate honestly.

• Respect confidentiality.

• Recognize when referrals are necessary.

Patient Safety

• Address concerns when a colleague's practice may place patients at risk.

• Take appropriate steps to protect patients.

Societal Trust

- Public confidence depends on ethical behaviour and professional competence.

Example: LDH appropriately addresses a colleague's unsafe practice instead of ignoring it.

Ethical Conflicts and Dental Hygiene Scenarios

Autonomy vs. Nonmaleficence

• Patient refuses recommended premedication but wants treatment.

• Patient choice conflicts with preventing harm.

Paternalism vs. Autonomy

• LDH believes a treatment is best, but patient disagrees.

• Professional recommendation conflicts with patient choice.

Veracity vs. Self-Interest

• LDH breaks an instrument tip and considers hiding it.

• Truthfulness requires disclosure.

Fidelity

• LDH promises to call a patient with information.

• Must follow through.

Justice

• Patient has no insurance.

• Still deserves fair and respectful care.

Exam Review Questions

• Which ethical principle means “do no harm”?

  • Nonmaleficence

• An LDH volunteers at a community clinic because they believe it is the right thing to do. Which ethical theory?

  • Virtue ethics

• What is the best example of autonomy?

  • Providing all treatment options so the client can make an informed decision.

• An LDH breaks an instrument tip but does not tell the client. Which concept is breached?

  • Veracity

• What is beneficence?

  • Acting to promote the good and well-being of the client.

• A client refuses recommended premedication but still wants treatment. What is this?

  • Ethical dilemma

• What is paternalism?

  • Professionals acting in the client's best interest.

• What does informed consent require?

  • The client understands treatment and possible consequences.

• What type of consent occurs when a client verbally agrees?

  • Expressed consent

• Which ethical concept requires keeping client information private?

  • Confidentiality

• What is an acceptable exception to confidentiality?

  • Reporting suspected child abuse.

• What is fidelity?

  • Loyalty and faithfulness to commitments.

• What is societal trust based on?

  • Commitment to ethical standards and competence.

• When does an ethical dilemma occur?

  • When two or more ethical principles conflict.

• What is the purpose of a Code of Ethics?

  • To guide ethical decision-making.

• Which principle promotes the client's good and well-being?

  • Beneficence

• What is an example of beneficence in dental hygiene?

  • Participating in an oral cancer screening program.

• Why are beneficence and nonmaleficence closely linked?

  • Both aim to benefit the client and prevent harm.

• What is the primary purpose of informed consent under BCCOHP Professional Standards?

  • To ensure patients make informed decisions about their care.

• What is an example of effective communication under BCCOHP Professional Standards?

  • Confirming the patient understands post-treatment instructions.

• What should an LDH do when a colleague's practice may put patients at risk?

  • Discuss the concern appropriately and take steps to protect patients.