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Law vs Ethics

• Law: statutes/regulations/rules + judicial decisions; defines the lowest acceptable behavior; regulates social conduct.
• Ethics: higher-order conduct; promotes good for others; guided by morals and ethical theories.
• Relationship: Ethics guides actions beyond legal minimum; law enforces minimal societal standards.

Key Ethical Principles in Healthcare

• The four core principles: $1\,Autonomy,\;2\,Beneficence,\;3\,Nonmaleficence,\;4\,Justice$
• Additional normative concepts: Veracity, Paternalism, Informed Consent, Confidentiality, Fidelity, Societal Trust.

Values and Concepts in the Code of Ethics

• Supports normative principles that guide practice.
• Code provides clear direction to avoid ethical violations; may not resolve every dilemma.

How the Code of Ethics Guides Dental Hygienists

• Provides direction for professional conduct and public trust.
• In ethical distress/dilemmas, the Code may not yield a single clear answer.

Why the Code of Ethics matters for RDH

• Sets expectations for professional behavior in all practice settings.
• Supports accountability to clients and the public.

Professional Jurisprudence: Legal vs Ethical Roles

• Law defines minimum standards; Ethics promotes higher ideals and care for others.
• RDHs must navigate both to protect clients and uphold the profession's integrity.

Ethical Awareness and Moral Sensitivity

• Ethical awareness influences how RDHs respond to issues arising in practice.
• Four categories of ethical issues: $1\,Moral\,Weakness,\;2\,Moral\,Uncertainty,\;3\,Moral\,Dilemmas,\;4\,Moral\,Distress$

Moral Weakness

• Personal inclinations overpowering professional responsibilities.
• Example: forgoing education to save time; undermines professional obligation.

Moral Uncertainty

• Question whether a moral obligation exists and its scope.
• Example: handling non-compliant patient when guidance is resisted.

Moral Dilemmas

• Obligations conflict; often a win-lose scenario.
• Example: autonomy vs beneficence in patient choices.

Moral Distress

• Feeling powerless to act according to one’s conscience due to systemic constraints.
• Leads to distress, anger, guilt; balance conscience with professional duties.

Addressing Moral Distress: The Four A's

• Ask: become aware of the problem and its emotional impact.
• Affirm: commit to self-care and professional obligation to act.
• Assess: identify distress sources; analyze risks/benefits.
• Act: prepare to take appropriate action.

Professional Traits for Dental Hygienists

• Clinical Competence
• Interpersonal Communication
• Ethical and legal understanding
• Critical thinking ability
• Honesty & Integrity
• Caring & Compassion
• Reliability & Responsibility
• Maturity & Self-Analysis
• Loyalty

Code of Ethics: CDHA (Canadian Dental Hygiene Association)

• 5 Principles:
  • I. Beneficence
  • II. Autonomy
  • III. Integrity
  • IV. Accountability
  • V. Confidentiality
• Standards provide specific conduct expectations under each principle.
• Applies to RDHs and students in all practice settings.

CDHA Standards by Principle (highlights)

• Beneficence: promote client health and fair access to services.
• Autonomy: support informed decision-making; provide relevant information.
• Integrity: consistency, fairness, honesty; protect vulnerable clients.
• Accountability: take responsibility; practice competently; self-evaluate.
• Confidentiality: protect client privacy; disclose only in defined exceptions.

Code of Ethics: BCCOHP (British Columbia College of Oral Health Professionals) rdH

• 12 statements forming the ethical framework; general principles of ethical conduct.
• BCCOHP online resource for the full code.

BCCOHP Code of Ethics: Key Statements

1. Hold paramount the health and welfare of those served.
2. Provide competent and appropriate care.
3. Practice confidentiality.
4. Treat clients with respect for individual needs/values.
5. Respect clients’ rights to control their care.
6. Inform clients of available care; advise consequences; respect informed choice.
7. Recognize expertise of colleagues and other disciplines.
8. Ensure fair and equitable access to services.
9. Maintain high skill level through continued study.
10. Report illegal or unethical decisions/practices by others to licensing bodies or appropriate agencies.
11. Avoid conflicts of interest; disclose when they arise.
12. Represent the values and ethics of dental hygiene and maintain public trust.

CDHA vs BCCOHP: Key Differences (summary)

• CDHA focuses on five principles and associated standards for practice across Canada.
• BCCOHP emphasizes health/welfare, competence, confidentiality, client rights, informed choice, collaboration, access, reporting misconduct, ongoing skill development, conflict of interest disclosure, and public trust.
• Both advocate client-centered care, confidentiality, accountability, and public trust, but BCCOHP provides a province-specific framework with explicit statements.

Ethical Dilemmas: Decision Making Models

• An ethical dilemma arises when principles conflict and no single right answer exists.
• An ethical decision-making model helps structure analysis.
• Eight-step model (CDHA):

Eight-Step Ethical Decision-Making Model (CDHA)

• Step $1$ Identify the problem
• Step $2$ Gather information
• Step $3$ Clarify the problem
• Step $4$ Identify options
• Step $5$ Assess options
• Step $6$ Choose a course of action
• Step $7$ Implement the action
• Step $8$ Evaluate outcomes

Applying the Model: Sample Case (Mrs. White)

• Scenario: Long-time patient with a 2 x 1 cm white, hyper-keratinized area on buccal mucosa found during intra-oral assessment; dentist dismisses it; patient is worried.
• Use the 8-step model to decide how Rosemary should respond and act.
• Suggested steps:
  • Identify the problem: potential lesion requiring timely evaluation; patient concern; dentist’s limited time.
  • Gather information: lesion characteristics, patient concerns, clinician observations, standard referral protocols.
  • Clarify the problem: ensure patient safety; determine urgency; what is within the RDH’s scope to address.
  • Identify options: discuss with patient; request Dr. Black’s evaluation now; document concerns; refer to another clinician; escalate to supervisor.
  • Assess options: weigh patient safety, ethical duty to inform, potential harm of delay, risk of overstepping scope.
  • Choose course of action: escalate and seek timely evaluation; ensure patient understands next steps.
  • Implement: communicate concerns to Dr. Black and patient; document discussions and outcomes; arrange follow-up.
  • Evaluate: follow-up results; whether lesion was appropriately addressed; reflect on decision quality for future cases.

Final takeaway

• Codes of Ethics guide practice but do not replace professional judgment.
• Develop moral sensitivity, use structured decision-making, and uphold public trust in dental hygiene.
• Regularly align actions with the core principles: Autonomy, Beneficence, Nonmaleficence, Justice, Beneficence, Integrity, Accountability, Confidentiality, and the values embedded in the CDHA and BCCOHP codes.