w 10

Foundations of Ethical Decision Making

• Morality, moral problems, and moral judgments are encompassed by ethics.
• Ethics asks what one should do and why.

Ethics and Jurisprudence

• Ethics: branch of philosophy to understand morality, distinguish right from wrong, and regulate behavior.
• Jurisprudence: theory and philosophy of law; foundation and function of law; rights and duties; justice.

Normative Ethics and Descriptive Ethics

• Normative ethics: arrives at moral standards that regulate right and wrong conduct; search for an ideal litmus test of proper behavior.
• Descriptive ethics: what people ought to believe at the present moment based on current principles and arguments; state of a population’s beliefs.

Professional Ethics

• Rules or standards of conduct for a profession.
• RDHs face professional and personal problems; need ethical theories to guide decision making.

Three Broad Ethical Philosophies

• Consequentialism / Utilitarianism: focus on harms and benefits; maximize good outcomes.
• Deontological ethics: duty- and rights-based; actions judged by adherence to duties irrespective of outcomes.
• Virtue ethics: focus on character and virtues; what kind of person one ought to be.

Consequentialism / Utilitarian Ethics

• Maximize good consequences; consider outcomes of each action.
• Rightness depends on outcomes, not the act itself; aim for greatest good for the greatest number.
• Example: fluoridation of public water supply.

Deontological Ethics

• Nonconsequentialist; actions are right or wrong independent of consequences.
• Based on duties and obligations to others; upholds commitments (e.g., contractual duties).
• Example: RDH contract may constrain options (e.g., limited restorative choices).

Virtue Ethics

• Emphasizes virtues and character (benevolence, compassion, conscientiousness).
• Guides what kind of person you ought to be rather than specific actions.
• Example: RDH volunteering as an expression of virtuous character.

Normative Principles in Health Care

• Four core principles: Nonmaleficence, Beneficence, Autonomy, Justice.
• Supporting concepts: Veracity, Paternalism, Informed Consent, Confidentiality, Fidelity, Societal Trust.

Nonmaleficence

• Do no harm; prevent and remove harm; adhere to standards of practice.
• Examples: avoid procedures beyond qualification; follow standard precautions.

Beneficence

• Actively promote good and prevent harm; use reasonable means to benefit the client.
• Examples: minimize radiographs; maintain equipment; participate in health programs.

Autonomy

• Right of individuals to make their own decisions about their health.
• RDH must provide full information for informed choice and consequences of actions.

Justice

• Fairness and equality; treat all clients equally; provide access to care for all.

Supporting Concepts

• Veracity: truth-telling and integrity; foundation of trust.
• Paternalism: acting in the patient’s best interest; can conflict with autonomy.
• Informed Consent: legal and ethical; patient decision-making requires full information and understanding; two parts: information disclosure and voluntary decision.
• Confidentiality: protect client information; exceptions include emergencies, public health, safeguarding others, and legal requirements.
• Fidelity: loyalty and faithfulness; keeping promises.
• Societal Trust: public expects high standards; professionals must maintain trust.

Ethical Dilemmas

• Occurs when two or more ethical principles conflict (e.g., nonmaleficence vs autonomy).

Intellectual Tools for Ethical Decision Making

• Ethical principles guide decision making; balance competing principles in each situation.
• RDH must weigh and balance principles to determine the best course of action.

Fundamental Ethical (Normative) Principles & Supporting Concepts

• Nonmaleficence, Beneficence, Autonomy, Justice
• Veracity, Paternalism, Informed Consent, Confidentiality, Fidelity, Societal Trust

Client’s Bill of Rights (Dental Hygiene Context)

• Right to choose the RDH providing care; know credentials.
• Care based on current standards and code of ethics; confidentiality.
• Treated with respect; understand and participate in care decisions; be referred as needed.
• Have concerns heard by the regulatory body.

Standards Statements (From Week 8)

• 1) Obtain informed consent before initiating care.
• 2) Practice safely.
• 3) Assess the client’s needs.
• 4) Analyze assessment information and diagnose dental hygiene needs.
• 5) Plan care based on assessment data and diagnosis.
• 6) Implement the plan or adjust with client consent.
• 7) Evaluate during and after care to determine outcomes.
• 8) Document the care following practice protocols.

Code of Ethics and Critical Thinking

• Codes of ethics guide but do not provide all answers.
• RDHs must read, assimilate, and apply principles to challenges.

Next Steps in Education

• Week ahead: study BCCOHP and CDHA codes of ethics and dilemmas.