Module 3) Evidence-Based Ethics and Moral Development

Ethics is based on

well-founded standards of right and wrong that prescribe what humans ought to do, usually in terms of rights, obligations, benefits to society, fairness, or specific virtues.

Ethics also refers to the study and development

of one's ethical standards. Feelings, laws, and social norms can deviate from what is ethical. So it is necessary to constantly examine one's standards to ensure that they are reasonable and well-founded

The Ethical Dental Hygienist

the potential for an ethical situation arises anytime a dental hygienist interacts with a patient, with members of the dental team, or with individuals involved in care, such as family, caregivers or members of specialty practices

• Is cognizant of the respect each patient deserves.

• Maintains communication among all parties responsible for dental hygiene treatment.

• Attains a knowledge of current standards of care through continuing education coursework and reading professional journal articles about new research.

• Is aware of ethical issues such as conflict of interest while treating patients, the legal scope of one’s duties, and dealing with impaired colleagues

• Possesses the ability to assess and justify the reporting of unacceptable practices.

Ethics refers to

the rules that a social system provides us with

Morals are

our own principles

Theories of Cognitive Moral Development: Piaget’s Four-Stage Model

piaget argues that moral development is closely related with cognitive development

Piaget’s Four-Stage Model #1 Premoral/Amoral Stage:

Children at this stage do not yet understand rules or morality. Their actions are not influenced by any moral principles

Piaget’s Four-Stage Model #2 Egocentric Stage:

At this stage, children's moral reasoning is centered around themselves. They follow rules mainly to avoid punishment or gain rewards but don't understand the broader social implications.

Piaget’s Four-Stage Model #3 Heteronomous Morality:

Children begin to understand rules, but they see them as fixed and imposed by authority figures. Moral reasoning is focused on obedience and avoiding punishment. Rules are viewed as unchangeable

Piaget’s Four-Stage Model #4 Autonomous Morality:

Children begin to see rules as flexible and changeable through agreement. Moral reasoning is based on fairness, justice, and considering the intentions behind actions. They understand that rules are not absolute but can be adjusted for equity.

Kohlberg’s Three-Level Model Level 1

Stage 1: obedience and punishment: behavior driven by avoiding punishment

Stage 2: individual interest: behavior driven by self-interest and rewards

Kohlberg’s Three-Level Model Level 2

Stage 3: Interpersonal: behavior driven by social approval

Stage 4: Authority: behavior drive by obeying authority and conforming to social order

Kohlberg’s Three-Level Model Level 3

Stage 5: Social Contract: behavior driven by balance of social order and individual rights

Stage 6: Universal Ethics: behavior driven by internal moral principles

Gilligan’s Model

States that feminine moral reasoning is typically different from masculine moral reasoning

• feminine=caring; masculine=justice

• unlinke Kohlberg, Gilligan includes non-cognitive growth in her model

What is Evidence?

a process of integrating the best available research with clinical expertise and the patient’s unique values and circumstances

The best research evidence is usually from

relevant research that has been carried out using sound methodology.

Clinical expertise 

is a combination of the clinician’s experience, education, and clinical skills

The practice context

includes characteristics of the situation in which the interaction between patient and health professional is taking place.

Evidence-Based Practice (EBP)

• Involves careful consideration of new information, methods, treatment and research findings in making decisions about how to best care for patients/society/communities

• Recognizes that care is individualized and ever changing as new research, new clinician techniques or procedures or new client characteristics are empirically supported.

• Evidence has exploratory status, and can be overturned, displaced, or superseded in light of new findings.

How does EBP involve Ethics?

• Improve Health: EBP tries to improve health by determining what treatments work better (beneficence)

• Decrease Harm: EBP tries to decrease harm by identifying which treatments don’t work as well (nonmaleficence)