Ethics and Professionalism

academic honor code

a set of rules or ethical
principles governing an academic community based on ideals that
da set of rules or ethical
principles governing an academic community based on ideals that
define what constitutes honorable behavior within that community. The
use of an honor code depends on the notion that people (at least within
the community) can be trusted to act honorably.

Framing”

ethical decisions you make relate to how you view situation

Overconfidence Bias

Most are overly confident in own morality

utilitarianism

a moral theory that judges the rightness or wrongness of actions based on their consequences, specifically aiming to maximize overall well-being or happiness for the greatest number of people

deontological approach

an ethical theory that judges the morality of actions based on whether they align with a set of rules or duties

bystander effect

social psychological phenomenon where individuals are less likely to offer help to a person in distress when other people are present

substance abuse disorder

spectrum like

recreational misuse

inappropriate use

abuse

excessive use

is addiction the same as dependency

no

addiction

a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environments, and life experieces

are prevention efforts/treatments for addicition as succesful as other chronic diseases

generally yes

opiates

naturally occuring narcoics

opiate example

morphine, codeine, and heroin

opioids

synthetic narcotics

opioid examples

oxycodone, hydrocodone, methacodone, fentanyl

fentanyl

• synthetic opiod produced in china and mexico

• 100x more potent than morphine

• 50x more potent than heroin

lethal dose of fentanyl

2 mg

xylazine

• animal tranquilizer that causes necrotic lesions on the skin

• often added to fentanyl as an enhancer

what percent of all IR opiod medication is prescribed by dentists

6%, about 185 million doses

alcoholism ___ during prohibition

decreased due to low supply

according to the CDC, how much of their opiods do patients use post op

about one half, with the other half being saved in the patients home

standard of care for prescription opiods

• three day supply (12 doses) with no refills

• anything beyond three days usually requires a visit

• NSAIDs and tylenol recommended after 3 days

what happens when opiods are mixed with benzodiazepines

respiratory depression

opiods with less abuse potential

tylenol with codeine 3 and tramadol/acetaminophen

can dentists prescribe opiods requested over the phone

no, the patient must be on record

who is at the highest risk of medical harm in terms of opiods

• patients over 65

• patients on opiods and benzos

• patients with co-morbid substance abuse or mental health disorders

• those with underlying kidney or liver disease

• adolescents

indicators of alcohol abuse

• husky voice

• spider vein angiomas

• irritated tissues

• smell on breath

• bleeding

• jaundice

• airline bottles in office

physical signs of psychotropic sbstance abuse

• injection tracks

• emotional lability

• confusion

• slurred speech

• pupil size

• high nitrous oxide tolerance

behavioral clues of substance disorders

• inappropriate behavior

• seductive/ingratiating/needy

• unusual emergency orientation

• unreliable with appointments

• asks for specific drugs

• enraged when frustrated

• needle phobic

• obsessive compulsions

• preoccupation with supply

• heightened perception

management strategies for treating substance abusers

• obtain clear picture of substance used and pattern of use

• complete treatment in one visit

• pay in advance

• patient should demonstrate reliability

• ask probing questions

substances commonly abused by young people

• alcohol

• marijuana

• prescribed amphetamines, benzos, and opiods

• nicotine pouches and vaping

alcohol

• number one drug of abuse

• 39000 death s a year from liver cirrhosis

• hepatic carcinoma due to alcohol is increaing

• most dangerous drug withdrawal

marijuana use

• exhibit amotivational syndrome and short term memory loss

• susceptible to schizophrenic/psychotic episodes

• cannabis hyperemesis syndrome

• resist sedation

heroin

very available, very pure, and often inexpensive compared to prescription narcotics

benzodiazepines

• like xanax and klonopin

• widely abused and highly addictive

• difficult withdrawal

• large relapse potential

cns stimulants

• include cocaine, ecstasy, mdma, and meth

• adderal and vyvanse

• presents as xerostomia, rampant caries, periodnotal disease, bruxism, dilated pupils, and paranoia

• arrythmias

sleeping medications

ambien and propofol (common in orla surgeons)

can we prescribe opiods to substance abusers?

• legally bound not to contribute to addiction

• if absolutely necessary, prescribe for 3-4 days and give to trusted other

• a second round may be necessary ue to tolerance issues

• never a third prescription

doctor shopping

basically come in to get drugs

practical solutions to the opiod problem

• reduce availability

• reduce demand

• refer addicted patients to treatment

disease model of addiction

• defect or impairment of target organ produces symptoms

• occurs in midbrain/mesolimbic system

• presents as involuntary cravings

psycholgical risks for substance abuse in dentists

• high stress profession

• obsessive, compulsive, and driving personalities resulting from high level of training/eduation

• tendency to deny emotional and social problems

• childhood trauma

genetic risks of substance abuse in dentists

-50 or 60 genome markers for alcoholism

oldest sons and daughters have higher risk

professional risks for substance abuse in dentists

• lack of respect for dangers of medication

• tendency to self prescribe or self medicate

• increased pharmocologicla knowledge

• ready availability

substances most commonly abused by dentists

• alcohol

• opiods

• nitrous oxide

• benzodiazepines

treatment of substance abuse

• total abstinence

• 12 step program

• in or out patient treatment

• anticraving medication

what is sobriety

• abstinence

• positive change

• emotional balance

• accepting life on life’s terms

• one day ata a time

• gratitude

Bioethics

multidisciplinary study of the response to various bioethical questions

values

• principles that you live by/hold in high regard

• fundamental beliefs that guide actions and decision making

• standards we use to judge ourselves and others, influencing our priorities and interactions with the world

morals

• the prevailing standards of behvaior that allow people to live cooperatively in groups

• most people tend to act morally and follow social guidelnes

are ethics or the law more important

ethics

stark laws

prevent referrals based on financial interest; kick backs

does NYS require a residency

yes, one year long

Hippocratic Oath summarized

• respect your teachers

• pledge life to service of others

• place patient interest abov your own

• protect patients from harm and injustice

• nondiscrimination

• respect patient decisions

• improve the care you give

• do not become intimate with patients

• prevent and cure disease

• protect patient confidentiality

• impart medical knwoledge to others

autonomy

duty to respect patient’s right to self-determination and confidentiality and involvement of patients in treatment decisions in a meaningful way

patient records

• must be sent to another practitioner upon request within 10 days

• for nominal cost only

• records should be kept confidentiality

nonmaleficence

• doing no harm

• knowing one’s limitations

• keeping knowledge and skills current

• delegating patient care to auxilaries appropriately

beneficence

• acting for the good of others

• obligation is to patient and public at large

• provide competent and timely care

ethical obligation of patient vs. public

obligation to the public procedes that to the patient

justice

• duty to treat patients, colleagues, and society fairly

• deal with people justly and deliver care without prejudice

• actively seek allies to improve access to care

veracity

duty to be honest/trustworthy dealing with people

revising the ADA principlies of ethics code

• adding respect for human dignity

• accomodate advances in genetic science

ADA ethics hotline

• assist ada members in managing ethical challenges

• callers identity and issues kept confidential