Ethical Dilemmas Station

Autonomy

Related to the patient's individual dignity and is about respect for the individual and their ability to make decisions with regard to their own health. It includes the right to treatment, the choice of treatment, and the right to refuse treatment. A competent patient can always refuse treatment. They cannot insist on a treatment that a dentist feels can cause harm.

Beneficence

This states that the dentist should always act in the patient's best interest. This relates to doing the greatest good, whilst balancing risk and benefits. Dentists have an obligation to benefit the patient.

Non-maleficence

The dentist does not harm the patient. Dentists must avoid causing harm and strive to protect patients from harm.

Justice

Relates to fairness, equitable use of resources, and equal access to care. Individuals or groups should be similarly treated, and there should be awareness that an individual's treatment may affect the well-being of someone else as a consequence of scarce resources. The NHS has limits on the amount of money that can be sent. By spending a large amount of money on a single person, less money remains to be spent on others. NICE (The National Insitutie of Clinical Excellence) makes choices of how the budget is spent.

GDC principles

- Putting patients' interests first and acting to protect them

-Communicate effectively with patients

-Obtain Valid consent

- Maintain and protect patient information

-Have a clear and effective complaints procedure

-Work with colleagues in a way thats best for the patient interest

-Maintain, develop and work within your professional knowledge and skills

-Raise concerns if patients are at risk

-Make sure your personal behaviour maintains patients confidence in you and the dental profession

1. Approached by the police

If you are approached by the police for information regarding one of your patients, can you provide it?

- Yes

- Prevent serious crime/ apprehend or persecute offenders

-Court Order

-Definite public interest or justification

-Document

-Minimum data

-Consult team

2. Gillick Competence

The mother of a 17-year-old boy patient telephones and enquires whether her son has been attending his appointments with you. He attends alone. What would you do?

-Confidential

-Must be authorised

-GDC

-UK 16

- 14 informed insight (Gillik Competence)

-Seek support

3. Assisted Suicide Tony Nicklinson Case

Introduction

-Die with second party

-Suicide Act 1961 - illegal

-Controversial

Against

-Nial Dickson

-Fitness

-Licensing AS very dangerous

-Concern shortcut - Financial pressures

-Change mind

-Irrational distress

-Mental Capacity

Favour

-Mental Capacity + Voluntary

-Autonomy

-Role of Doctor

-Tribunal + avoid accusations

-Humane with dignity

-Illegal Suicide Act 1961

-GMC opposes dismissal, even speaking

Conclusion

-The LAW and GDC tightly regulated- terminally ill + mental capacity

- Clear Informed Decision 2 Doctors

-Beneficence+ non-maleficance prolong or end suffering

- Controversial Oregon

3. Euthanasia

Favour

- Autonomy

-End Immense Suffering

-Frustrating + Die with dignity

-Occur Regardless

-NHS resource palliative care

Against

- Preserve Life

- Focus shift away from medical research

-Quality of Palliative Care

- Doctor, not pull all effort - financially driven - Affect trust

-No safe to measure suffering- difficult to regulate

-Involuntary euthanasia

- Possibility of recovery

4. Parent Asking Questions

A 13-year-old patient's father calls following an appointment his child had with you that he was not present at. He wants to know what happened at the appointment. What should you do?

-Can't discuss over phone

-Come clinic

-Always confirm

-other impact disclosing info

-Parental Responsibility

- Children act (2004)

5. Treatment of Obese/Smokers

Some NHS Trusts are refusing to put obese patients and patients who smoke on the waiting list until they give up smoking and lose weight.

-lifestyle- morally wrong-national insurance

-smoker causes -addiction

-Obese childhood

-Impact on successful /risks operation

-Nutritionsit + behavioural therapist

-Obesity causes

- endocrine

-medication

-comfort eat

-disabilities

-genetic - run in family

-lack exercise

How to deal with obesity epidemic?

- educate schools GP nurse TV

-educate parent

-more exericse

-no fizzy drink

-supermarket

6. Patient Confidentiality

You are a junior dentist and you saw the exchange between two of your friends, both junior dentists, discussing patients on a private face book group. What would you do?

-Contact Immediately - no discussion professional experience online

-Identifiable- breach confidentiality

-Public trust

-Unacceptable

-Delete

7. Professional Boundaries

Sarah, a 16 year old student has come into the practice. You are the dentist looking after her. She asked you for a friend request on facebook. What would you do?

-Professional Boundary

-Potential risks - inappropriate use

-vulnerable

-blur boundaries

8. Dentist Behaviour

You are in a hospital canteen and you see three of your friends, who are junior dentists, laughing and joking about their patients and what t hey said to them. As a junior dentist, what would you do?

- immediately stop

-confidentiality breach

-senior dentist

- public space or internet chat

- social media

9. Competent

Only Competent patients can give consent. What is meant by competent?

-Capacity to consent- rational descison

-Adult: Living Will

-Children: Gillick Competence?

-Mature +understand consequence

-If incompetent ask parents

-Child in danger - social services

-Both parents refuse court order

10. Patient Choice

Do you think it is right for patients to make the choices as to what is in their own best interest?

Favour

-Own descisions

-Questioning dentist

Against

-No background knowledge

-Unreliable info

11. The Pregnant Neighbour

A dental nurse working in reception in a genral dental practice sees that her 16-year-old neighbour has had an appointment with one of the dentist in the practice last week. She reads through the notes and discover the girl is pregnant. She the goes to the neighbour's house to congratulate her in front of her parents on the fact she will soon become a mother. The girl had planned to have a termination, and didn' t want her parents to know. What do you think should happen in this case? What would you do if you had become aware of these breaches of confidentiality?

-Dismissed

-GDC performance committee

-Consequence- lose trust

12. Suspected abuse

You are a dentist working in the emergency department in a dental hospital. Mary, a 30-year-old teacher and a mother of two young children, presents at an emergency patient. You observe facial swelling and bruising. Mary complains of soreness and pain from an avulsed tooth. This is not the first time she attended the dental hospital for a treatment in similar circumstances. On questioning, she confides in you that her husband is abusing her. He tends to hit her when drunk and then becomes tearfully apologetic when sober. She asks you not to tell anyone else. Should you:

1. Keep the secret from anyone else at the patient's request

2. Talk directly to the husband without the patient's knowledge

3. Contact your dental defence organisation for advice on how to proceed

4. Contact the domestic violence unit at the police station without Mary's consent for you to do so.

1 + 3 appropriate

- encourge support

-husband seek counselling

-children?

-witness statement

-speak to team

-document

2+4 inappropriate

-unadvisable ethically

-confidentiality

13. Copy of their notes

A patient asks for a copy of their notes. What would you do?

-dental record department

-Data Protection Act (1998)

14. The Teenage Patient

You are a general dental practitioner. A 14 year old girl, who you have known as a patient for the last five years, asks if she can tell you something but requests that before she does so, you promise not tell anyone else. What should you do or say in this case?

-Cant promise but try best to protect

- might need to tell others

-duty to protect children + young ppl

-national and local protocols

-observation

15. MMR Vaccine

Do you think the government is right to insist that the NHS should only allowed the combined MMR vaccine rather than three individual vaccines?

-autism vs MMR

-MMR safer

-parents forget

-increase measles

16. Patient Treatment Plan

A referring dentist rings you asking for details of a patients orthodontict treatment plan. What would you do?

-write info

-The Confidentiality NHS Code of Practice

-Consult patient

17. Confidentiality

A School secretary rings the practice to check whether a 14 year old pupil has been attending for orthodontic treatment as he or she has been claiming when, in fact, the student has been bunking off school on a regular basis. How would you respond to this telephone request?

- breach of confidentiality

- contact parents

-precent accidental disclosure

18. Abortion

What are your views in relation to abortions?

Intro

- England Scotland Wales - Abortion Act 1967.

- Northern Ireland - Offences against the Person Act 1861.

- 24 weeks

Support

-Autonomy - Question

- Beneficence

- M&P on woman

- M&P on child

- greater risk

- rape mental illness

Agaisnt

- Non Maleficence

- Justice

- form contraception

- irresponsible sex - STI

- psychological problems

- vulnerable humans

19. Banning Sale of Tobacco

What are the arguments for and against banning the sale of tobacco ?

For

- Lung diseases

- Predisposition to addiction

- secondary smokers

Against

- Large revenue

- Choose activities

- Black Market

- quality

-crimes to find smoking habit

20. Debate on Drugs

Some drugs have led legislations brought against them but there are many drugs out their that haven't got legislation.

1. Think of possible issues surrounding these drugs

2. Should the government bring legislation agaisnt these drugs or do people have a right to decide?

3. What can government do to enforce legislation?

1. - UK biggest killer

- break homes relationships

2.

Favour

- moral issue

-money on addiction help

- organized crime - society regulate

-legislation,education and rehabiliation

-Netherland and portugal

- strength

-poverty

-services

-alternative drug

-educate side effects

-stigmization

-overcrowding in prison

-sex workers

- purity of drugs

Against

- make own choice

-NHS costing

-drugs on a decline- endorsement

- party full of drugs

-not remove side effects

-law abiding citizzens

-suicide

3.

-legitmate pharmacutical companies

- safe drug sellers license

ID prindted on pills

-locked

-reports

-strength labelled

-professional-overdose

-label side effect

-information leaflets

21. Exposure to HIV

An HIV postive patient was bleeding from a laceration and needed urgent treatment. Would you put the patient or your own safety first?

- own safety

-dressing to patient

-apply pressure

-gloves

22. Blood Transfusion

A mother comes to A&E with her seven year old daughter who is bleeding profusely, and refuses to allow you to administer a blood transfusion to the child. What would you do?

-stop bleeding

-ask mother consent

-dont ask child

-ask mother concerns

-mother level of understanding

-blood is screened

-legal team and apply court order

-childs father

-give if fatal

23. Gillick Competence

What is Gillick Competence

-1985 Mrs Gillick Local Health Authority

- House of Lord. Lord Fraser

-Doctor decision

-contraceptive

-capacity for decision

24. Vaccinations

Should vaccinations be made compulsory?

Intro

- prevent child getting disease

-prevent spread + eradicate

- emotive + risk of vaccination

FOR

Autonomy - right

Beneficence- immuisation safe

AGAINST

Non-Maleficence- not 100

Justice- Government potential impacts of non - vaccinated child

- Difficult issue - tricky situation- not wish to legislate- protect children

- risk cant be ignored

-Wales April 2013 - 600 measles

-save thousand lives

CONCLUSION

- complex

-educating parents

-leaflets

-affect dentist patient relationship

-leave law

25. Confidentiality

When would a dentist break confidentiality?

-long standing obligation -respect patient trust

-patient privacy -restirct access

- trusting environment

-implied consent

-confide with other dentsit

-greater harm maintaining confidentiality

-epilepsy

-child abuse

-prevent harm

-individuals serious danger

Public Welfare

-by law health inspector

-public health outweighs

-court

-police

-missing/diceased persson

-criminal case