Ethics

Dentistry Profession

Dentists have commitments to themselves, each other, and society, following norms of conduct and competence standards.

Self-Reflective Questions for Dentists

- What kind of dentist am I?

- What kind of dentist would I like to become?

- What kind of person am I?

- What kind of person would I like to become?

Professionalism in Dentistry

Dentists articulate values and ideals to which individual dentists and the dental profession as a whole are committed, along with identifying the necessary skills to achieve these goals.

What is the difference between ethical and legal issues?

Ethical issues pertain to morality and principles of right and wrong, while legal issues involve laws and regulations established by governing bodies.

Ethics

Branch of philosophy concerned with defining and studying morality, encompassing norms, values, and beliefs accepted by society to establish what is right or wrong in human behavior.

Immanuel Kant's Goodness

An action is considered good if its maxim follows the moral law and is universally applicable without contradiction, emphasizing the inherent value of humanity.

Bioethics

Bioethics investigates moral issues arising from biological and medical sciences, aiming to bridge the gap between experimental science and humanistic values.

Deontology

Branch of ethics concerned with duties, especially those governing professional activities, and the moral obligations associated with a profession.

Professional Ethics Aspects

Professional ethics include responsibilities such as working in teams, ensuring integrated responses, and engaging in continuous reflection to construct ethical frameworks.

Professional Behavior

Both a value and a skill influenced by traits and education.

Healthcare Activity

Encompasses professional actions related to evaluating, diagnosing, treating, and preventing diseases, aiming to promote health and well-being under the supervision of accredited professionals.

Code of Ethics Establishment

Collective reflective analysis among professionals, considering ethical sensitivity, skills for reflection, and critical analysis of value guides.

Importance of Ethical Sensitivity

Ethical sensitivity and emotional openness are necessary for professionals to navigate ethical dilemmas effectively.

Skills for Ethical Reflection

Moral judgment, critical understanding of reality, and establishing fluid dialogues to seek consensus.

Ultimate Claim of Ethics

Individual conscience, guiding ethical decision-making and professional conduct.

Purpose of Code of Ethics

Guide professional behavior, protect individuals, and orient practices toward the betterment of society.

Areas of Professional Ethics

Profession itself, institutions, relationships with colleagues and patients, and broader societal responsibilities.

What should a Code of Ethics include?

Encompass rules specific to the profession, considerations for the workplace environment, and guidelines for professional conduct in various contexts.

Fundamental Colleague Relationships

Essential for effective teamwork, requiring communication, respect, and collaboration.

Patient Role in Ethics

Patients are central to practice, and ethics should ensure respect for their rights and concerns.

Value Guides in Professional Ethics

Clarify, orient, and guide possible interventions in professional practice, resulting from collective reflection

Role of Value Guides

Provide guidance for ethical interventions, not to solve complex problems but to direct ethical actions.

Adaptation of Value Guides

Subject to modification, revision, and extension as circumstances change, to maintain relevance and effectiveness in guiding ethical practices.

Code of Ethics Development

Clarify and seek appropriate procedures for resolving ethical dilemmas through interactive and consensual processes among professionals.

Significance of Code of Ethics Development

High degree of professional maturity and an increase in professional recognition within the field

Dynamic Nature of Code of Ethics

Must be flexible to adapt to societal changes and emerging ethical issues effectively.

Contextualized Code of Ethics

Reflects personal and collective reflection, containing the minimum ethical criteria necessary for the profession.

Healthcare Activity Definition - Mora (2007)

Any direct or indirect action on the human body carried out by a health worker in the exercise of any profession within the healthcare sector

Healthcare Activity Definition (Martinez-Calcerrada, 1986)

Professional performance or activity of health professionals aimed at or contributing to obtaining therapeutic or health-promoting effects in accordance with the corresponding techniques or arts

Morality Essence (Socrates)

Propriety of actions, suggesting that moral conduct is only possible when based on knowledge of the good and justice

Bioethics Focus (Morlans, 2016)

Systematic study of moral dimensions of life sciences and healthcare, addressing the ethical implications raised by advancements in biological and medical sciences.

Bioethics Scope (Potter, 1971)

Investigates moral problems arising from the biological and medical sciences, emerging as an attempt to establish a bridge between experimental science and humanism..

Defense of Patient Dimension in Bioethics

Crucial for humanizing health sciences and upholding patient dignity and rights.

Dentist Functions (Hortal, 2011)

1. They provide a specific service to society in an institutionalized form.

2. Dentists perform a set of professional activities and earn a livelihood, dedicating themselves to it on a stable basis.

3. Dentists form collectives with other professionals to gain control over the practice of the profession.

4. Access to dentistry is granted after a process of theoretical and practical training, upon which accreditation to practice the profession depends.

Guaranteed Principles in Codes of Ethics

1. Individual rights and individual welfare, encompassing the guarantee of the user's right to make their own decisions and choices (principle of self-determination and confidentiality) and providing for the welfare of the user (principle of respect for the user, service, help, and respect for human rights).

2. Public welfare, which seeks to ensure the interests and welfare of parties other than the user, emphasizing social justice, solidarity, community participation, and coordinated teamwork.

3. Inequalities and structural oppression: Social justice lies in the commitment and denunciation of situations of institutional exploitation or abuse..

Principles of Public Welfare

1.     Social justice

2.     Solidarity

3.     Community participation

4.     Coordinated teamwork.

Hippocratic Oath Significance

Dates back to ancient times, symbolizes the ethos (character) of physicians. It guides and protects practitioners, instilling confidence in patients and society. The oath reflects a commitment to ethical conduct, emphasizing principles such as treating patients with respect, avoiding harm, maintaining confidentiality, and upholding professional integrity.

Financial Relationship in Hippocratic Oath

1. Fees are only ethically justified when the professional's conduct seeks perfection in the art of practice.

2. The honest physician should not seek profit but glory, in accordance with the swiftness of evil.

3. Physicians should consider the patient's financial situation when setting fees, without being overly demanding or lacking in humanity.

4. Physicians may often provide services free of charge.

Ritual in Ethics and Knowledge Mastery (Orth, 2019)

Ethics and the mastery of scientific and technical knowledge form a ritual that must always be observed. Profit is considered a consequence that should not be underestimated, but it should never be placed first in the temporal sequence of events.

COEM (2018) Hippocratic Oath Principles

1. Safeguarding life, health, and human dignity as fundamental rights.

2. Providing the best possible care to all patients regardless of various factors.

3. Keeping and respecting patient confidentiality.

4. Respecting scientific achievements, sharing knowledge, and showing gratitude to teachers.

5. Continuing to study and train throughout professional life.

6. Treating colleagues with respect and avoiding malicious criticism.

7. Exercising the profession with dignity and ethics in the service of society.

8. Love, enjoy and defend the profession with enthusiasm, always seeking the good of my patients.

Maimonides' Prayer Main Points

1. Focusing on love for the profession and all creatures.

2. Avoiding the influence of greed and desire for glory in practicing medicine.

3. Being ready to serve all individuals, regardless of their circumstances.

4. Viewing patients solely as those who suffer.

5. Maintaining clarity of mind and focus on the patient's well-being.

6. Building trust with patients and respecting their confidence.

7. Avoiding interference from non-professionals at the patient's bedside.

8. Remaining invulnerable to criticism and maintaining perseverance in the truth.

9. Grant me the necessary forbearance and patience with passionate or rude patients.

10. Make me moderate in all things but insatiable in my love of science.

11. Apart from me, the idea that I can do anything.

12. Give me strength, kindness, and the opportunity to expand my knowledge more and more.

13. May I discover today in my knowledge, things that I did not suspect yesterday, because art is great, but the spirit of man can always advance forwardh.

Geneva Declaration Purpose

·       An update of the Hippocratic Oath proposed by the World Medical Association (WMA) General Assembly held in September 1948.

·       Create a new document that fulfils the function that the Hippocratic text had at the time of its creation. To create a moral basis for all physicians (World War II).

·       Little public impact.

·       Amended in 1968, 1983 and 1994, and revised in 2005 and 2006.

Popper's ethical principles

1. Recognition of the absence of undisputed authority.

2. Acknowledgment that mistakes are inevitable, but efforts should be made to prevent them.

3. Recognition of the fallibility of theories and the need for scientists to seek out flaws.

4. Emphasis on learning from mistakes and being self-critical.

5. Acceptance of rational criticism as a means to approach objective truth.

6. We must learn from them

7. We must know its cause

8. We must be self-critical and honest with them.

9. We must gratefully accept that which makes us conscious.

10. We need other people to correct our mistakes

11. Self-criticism is the best, but criticism of others is necessary.

12. Rational criticism must always be: specific, substantiated and argued, in order to approach an objective truth

What ethical principles are emphasized in the European Charter of Medical Ethics?

1. Advocating for human physical and mental health while respecting life and dignity.

2. Prioritizing the health interests of patients and providing essential care without discrimination.

3. Considering the patient's environment as a crucial element in their health.

4. Maintaining patient confidentiality and using professional knowledge for the benefit of patients.

5. Respecting personal autonomy while acting in accordance with the principle of therapeutic efficacy.

6. Utilize professional knowledge to enhance or maintain patient health without causing harm.

7. You must use all the resources that science offers you to apply them appropriately to your patient.

8. Act in line with therapeutic effectiveness while respecting patient autonomy and equitable resource use.

9. Maintain the integrity of the individual as part of health protection efforts.

10. Reject any form of torture or cruel, inhuman, or degrading treatment.

11. Ensure transparency regarding potential conflicts of interest and maintain technical and moral independence.

12. Inform patients if conditions prevent complete professional independence, ensuring the right to treatment.

13. Even during service strikes, provide necessary emergency treatment and care to patients.

14. While not obliged to provide treatment against personal beliefs, respect patient autonomy and choices.

15. Conduct medical practice with conscience, dignity, and independence for oneself and others.

Relying on others means establishing a dialogue that in turn requires:

1.     Intellectual preparation for understanding

2.     Tolerance to admit new ideas

3.     Ethical training to discover the borders between good and bad

Social and moral importance of professions

1.     Specific good that provides society

2.     Ability to create identity and community

3.     Ability to strengthen social networks and enhance the virtues to reach excellence.

Professional organization:

Individual and cooperative activity

Defend the privileges of the group against those of the Society

Avoid corporatism - define good practices of the profession

Social activity - purpose: to provide a specific good to society (with beneficiaries)

Oral health according to the FDI - 2016

multifaceted and includes, among other things, the ability to speak, smile, smell, taste, touch, chew, swallow, and convey a range of emotions through facial expressions with confidence and without pain, discomfort, or discomfort. craniofacial complex disease”

Social importance of professions

Professions provide specific good to society and enhance social networks.

Professional organization

Involves individual and cooperative activity, defending group privileges against societal interests.

Oral health

Multifaceted concept including speaking, smiling, tasting, and conveying emotions confidently.

Dental treatment recommendation

Involves diagnosing needs, establishing fiduciary and contractual relationships.

Oral health involves

- Speaking

- Smiling

- Smelling

- Tasting

- Touching

- Chewing

- Swallowing

- Conveying emotions confidently without pain or discomfort (FDI, 2016).

Ethics objective

Protecting the physical and mental wholeness of sick individuals.

Principles of ethics in dentistry

- Beneficence: Duty to cure the sick and provide efficient service.

- Non-maleficence: Obligation not to harm patients or others.

- Autonomy: Right of patients to decide with adequate information.

Principle of justice

Duty not to discriminate; distributive equity largely falls on health administration.

Hastings Center Report objectives

Focus on prevention, relief of suffering, assistance, and healing in dentistry.

June 2017 – Conclusions conference of deans of dentistry from Spanish universities

Reformulation of undergraduate and postgraduate curricula to promote ethical behavior and necessary skills acquisition.

Competency profile of dental graduates (Association for Dental Education in Europe, 2017)

Ethics is highlighted as the basis of professionalism, emphasizing well-being, patient autonomy, and commitment to justice.

Three fundamental ethical principles in all aspects of dentistry, that new graduate needs to apply:

1. Primacy of well-being

2. Patient autonomy

3. Commitment to justice

Emergency care

Unforeseen event in which medical attention must be immediate, since it involves a risk to life or intense suffering.

Dentist-patient interaction - Rest y Narváez (1994)

1. The recognition and analysis of the ethical problems of the profession (moral sensitivity)

2. The reasoned argumentation and the moral judgment of the actions to be carried out (moral

reasoning)

3. Commitment to the ethical principles of the profession (moral motivation)The implementation

of an action plan (moral action)

Patients' trust in dentists

Primarily vested in the dental profession as a whole, not individual dentists.

Key skills for good communication

- Assertiveness: Reasonable and respectable affirmations.

- Empathy: Identifying with the patient's state of mind.

- Active Listening: Listening carefully, interpreting feelings, expressing understanding.

Active listening

1. Listen carefully to what we are told

2. Interpret the feelings of the speaker

3. Demonstrate that these feelings are recognized and understood

4. Distinguish coherent and contradictory messages

5. Express to the patient what we think we have heard

Practice of care

- Welcoming, listening, knowing the patient.

- Elements of care: Attention, Responsibility, Competence, Receptivity.

- Observation and dialogue are crucial

Professionalism

Competence, technical quality, humanity, and ethics in dental practice.

Good communication:

help to reduce anxiety and possible fears that may arise in the patient, both those that refer to the pathology itself or to the therapy that must be applied.

Fundamental Aspects of Communication

- Verbal: Content of the conversation.

- Vocal: Tone and manner of speaking.

- Visual: Body language and expressions.

Attention

Realizing the needs of others, experiencing empathy with their needs and points of view

Responsibility

Take responsibility for a specific set of practices and cultural norms

Competence

Putting the skill into practice concerning the needs of another person

Receptivity

Listen to the position of the other so that an answer can be offered

To be a good dentist you need to:

- Listen, observe and understand

- Reassure

- Reflect

- Communicate

A good professional is able to

1. Empathize with the sick

2. Remember that each person is different

3. Dispense the information according to the biography of the patient

4. Earning their trust, as an essential tool

5. Leave a light of hope, without deceiving

The dentists role is to:

diagnose, resolve, and maintain oral health.

Consequences of Decision Making

- Professional stress or burnout can result.

- Iatrogenesis

Negligen iatrogenesis

Situations in which the professional ignores or does not take into account recommendations based on solid and well-established evidence.

Illustrated iatrogenesis

Scenarios of uncertainty in which the professional adopts an inventive behavior, to obtain diagnostic or therapeutic results. It is unacceptable outside of regulated research or innovation activities

Cultural iatrogenesis

Interventions or diagnostic or therapeutic decisions with sufficient evidence or not, but accepted by the entire scientific community, which with it express undesirable effects. They can also be preventive interventions with intrinsic unwanted effects. It is prudent and refutable or acceptable depending on the case.

Perverse iatrogenesis

When risks are minimized, despite being known.

Utilitarian iatrogenesis

Doing the greatest good for the most people, minimizing individual risk. It's hard to accept this kind of risk.

What should the profession ensure

All dentists meet basic knowledge and skill levels and follow clinical practice protocols.

Emergency care situation requirement - Da Fonseca (2015)

- Solid, consolidated and diversified knowledge of the action protocols in the different emergency situations.

- Necessary equipment for the effective performance of all the necessary actions for he total recovery of the patient.

“Quick guide to the treatment of medical emergencies in the dental office" (Hernández - Juyol, 2000)

1. Always treat patients when their medical history has been taken

2. Consult with the patient's family doctor whenever we consider it appropriate

3. Be alert to any adverse reaction that we observe

4. Recognize situations and be familiar with the signs and symptoms of potential emergencies

5. Know how to perform basic patient monitoring (assess the degree of consciousness, measure heart rate,

respiratory rate and blood pressure)

6. Regularly check the emergency equipment (all elements must be in perfect condition)

7. Be properly trained, both the professional and the entire team of collaborators, in cardiopulmonary

resuscitation maneuvers - CPR (each one in their functions)

8. Have controlled access to specialized medical care, as quickly as possible.

Dentist adaptation

Dentists need training aligned with societal expectations and must adapt to changing social conditions, emphasizing humility.

Three periods define clinical relationships:

1. Age of paternalism: Specialist as sole decision-maker with patient absolut trust. Unidirectional

2. Era of autonomy: Informed consent by American Hospital Association - 1969. First duty of charity of the doctor

3. Era of bureaucracy: Efficiency in treatment and resource management prioritized. Wishes of health specialists and their patients are subordinated to the guidelines of the administration

What ethical principles are emphasized in the European Charter of Medical Ethics?

1. Advocating for human physical and mental health while respecting life and dignity.

2. Prioritizing the health interests of patients and providing essential care without discrimination.

3. Considering the patient's environment as a crucial element in their health.

4. Maintaining patient confidentiality and using professional knowledge for the benefit of patients.

5. Respecting personal autonomy while acting in accordance with the principle of therapeutic efficacy.

6. Utilize professional knowledge to enhance or maintain patient health without causing harm.

7. You must use all the resources that science offers you to apply them appropriately to your patient.

8. Act in line with therapeutic effectiveness while respecting patient autonomy and equitable resource use.

9. Maintain the integrity of the individual as part of health protection efforts.

10. Reject any form of torture or cruel, inhuman, or degrading treatment.

11. Ensure transparency regarding potential conflicts of interest and maintain technical and moral independence.

12. Inform patients if conditions prevent complete professional independence, ensuring the right to treatment.

13. Even during service strikes, provide necessary emergency treatment and care to patients.

14. While not obliged to provide treatment against personal beliefs, respect patient autonomy and choices.

15. Conduct medical practice with conscience, dignity, and independence for oneself and others.

Art. 1 Definition and objectives

The Spanish Code of Dental Ethics and Deontology establishes the moral values, ethical standards, and deontological principles guiding dentists' professional conduct..

Article 2: Professional and Collegial Value

The association prioritizes promoting and developing professional ethics and deontology. It commits to actions that ensure dentists' compliance with the Code

Article 3: Scope of Application

This Code applies to all dentists, regardless of specialization, ideology, or any other condition. It also extends to foreign professionals practicing in Spain through agreements or participation in professional events.

Article 4: Corporate-Collegial Responsibility

Dentists are subject to internal disciplinary responsibility based on ethical-deontological and legal principles outlined in the Statutes of Dentists and Stomatologists.

Article 5: Disciplinary Regime

Non-compliance with the Code constitutes a disciplinary offense, addressed according to the Statutes of Dentists and Stomatologists and related regulations.

Article 6: Clinical Act

A clinical act by a dentist includes lawful activities aimed at treating diseases, promoting health, and conducting research within the scope of their competence.

Article 7: The Dentist

Dentists are primarily responsible for preserving oral health, ensuring quality and efficiency in practice, and promoting overall health.

Article 8: Continuing Dental Education

Continuous education is an ethical duty, right, and responsibility for dentists throughout their careers.

Article 9: Relationship with the Community

Dentists must fulfill their professional duties to the community efficiently and responsibly, ensuring optimal use of resources.

Article 10: Healthcare System

Dentists must fulfill their professional duties to the community efficiently and responsibly, ensuring optimal use of resources.

Article 11: Principle of Equality of Patients

Dentists must treat all patients with integrity and diligence, without discrimination based on any personal or social factors.

Article 12: Priority of the Patient's Interests

The patient's health and safety take precedence over any other interest, with dentists prioritizing patient well-being in their practice.