Ethics In Dental Management

Fundamental Ethical Principles in Dental Practice

Discuss about the Ethics in Dental Management.

The dental profession holds a notable position of trust within the community. As a consequence of this, the members of the society offer this profession enjoys certain level of professional privileges which are not available to the other members of public at large. In return to this special privilege, the profession makes certain level of commitment to the society that is the members of this profession will adhere to high standards of ethical conduct (DePaola et al. 2012). The following essay aims to analyse the ethical consideration in dental management and professional code of conduct. The essay also attempts to through brief light over the patient protection in dental care and the ethical dilemma in providing dental care across different population.

According to Vujicic and Nasseh (2013), in order to achieve accurate ethical conduct in a dental setting, a dental practitioner first begin via treating each patient as an individual while undertaking true interest in patients’ dental requirement. Apart from this, there are five fundamental ethical principles that guide the practise of the dental profession. Patient autonomy is defined as the right of the patients to make their own decision in domain of treatment that they will receive. Previously the majority of the dental decision was left over the hands of dental practitioner. However, at present it is essential that the patients’ take the final decision on their own before the initiation of the treatment. Dental practitioner is only responsible for providing the patients with patient with all the available options for treatments along the success rate and the hardship associated with that treatment option and thereby providing the patient a fair ability to participate in informed decision making process (Zijlstra?Shaw, Robinson and Roberts 2012). According to Lee, Yang and Han (2012) the doctors and the patients are equal partners in the decision making process and proper communication between the patients and the doctors is essential towards successful decision making. This again coincides with the ethical principle of veracity which vouches for respect and trust among patient-dentist relationship via truthful communication (Laurence et al. 2012). The ethical principal of nonmaleficence states that dental practitioner must not cast unnecessary harm to the patients.

However, in some types of treatment pain is unavoidable in order to achieve the desired outcomes. However, the decision in the domain of the extent of pain that is tolerable by the patient must be carefully accessed by the doctors (Malathi et al 2015). According to Priyanka et al. (2016) the majority of the dental treatment procedures have “double effect” this signifies that while the therapy fixes one issue, it initiates another issue. It is imperative that the dental practitioners keep their knowledge of therapy updated and are aware of the limitations and associated circumstances that may harm the patient. Malathi et al. (2015) further opined that once a dentist initiates the therapy, he or she is required to keep the tract of the treatment up to its completion. If at any point of time, the dental practitioner feels that he or she is unwilling to complete the procedure, it is their duty to refer the patients to another dental practitioner with similar expertise. Moreover, if a dental practitioner is asked to provide consultation, it is important that he or she is devoid of vested interest in the recommended treatment (Priyanka et al. 2016). Under maleficence, it is also the duty of the dental practitioner to inform the patient about any incidence to exposure to infections while at dental clinic along with immediate referral to other qualified health care professions to treat that noscomial infection. Nonmaleficence covers the ethical obligation of dental professional to avoid interpersonal relationship with patients as such relationships can hamper the ability of dentist to employ professional judgement in care plan (Malathi et al 2015). Ethical principal of beneficence signifies principal of doing good. Thus it signifies that dentists provide timely and competent care to the patients. According to Priyanka et al. (2016) the domain of beneficence includes numerous components like community service (discounted dental check-up), reporting of crucial findings which are consistent with the child abuse and domestic violence to respective concerned authority. Each of these domains serves to elevate the esteem of dental profession while addressing the responsibility of a dentist to keep patient’s welfare on priority. Ethical principal of justice defines the responsibility of dentist to be fair while dealing patients and their colleagues. This in turn promote the improve access of care throughout the society (Malathi et al 2015). According to Malathi et al. (2015), practising justice means serving patients without discriminating them in the domain of creed, race, colour, sex and ethnicity. This also includes potential discrimination of doing referrals to other dentists.

Veracity and Nonmaleficence in Dental Practice

The Dental Board of Australia (2017) entails important standards for practitioner behaviours in relation to procuring quality care to the patients including shared decision making. The dental board also emphasize over working in association with patients, their family members and other group of practitioners for improving the quality of care. This comprehensive care for the dental patients can be achieve via maintaining professional performance, ethical code of conduct while minimizing the risk (Professional Code of Conduct 2017). According to the Code of Conduct, Dental Board of Australia (2017), care for patients is the primary concern for the healthcare professionals under the clinical practise. Here procuring quality care encompass process analysis of the patient's past medical history, suitable management plan for the patients while recognising the limits of practitioner's own skills. The Code of Conduct also promotes good care via maintaining high-level of professional competence. This professional competence can be achieved via practising patient-centred care, effective communication, practising in accordance with current evidence based records and facilitating the use the advanced therapeutic products. Code also ask to encourage shared decision making via providing access to the therapy plan and the expected outcomes this in turn will further help to increase the competency of care while increasing the patient participation in the care model. Informed decision making or seeking informed consent is another important approach of professional code of conduct under the Dental Board of Australia. Under this approach, the dental professionals are required to explain the therapy plan to their patients in a manner which is comprehendible for them so that they can provide informed consent. Dental practitioners have their own statutory requirements to ensure that the therapy plan is covered by professional indemnity insurance and is good practise because it encourages a comprehensive dental health check-up of the financially under privileged group of population (Dental Board of Australia 2017).  

Apart from doctors, there is also a separate code of conduct for the patients (Dental Board of Australia 2017). According to Rawson et al. (2013), in an effort to procure safe and quality care under safe environment, the patients and their family members are require to follow certain code and conduct. According in to Rawson et al. (2013), there are certain unacceptable behaviours that the patients and their family members must refrain from and this includes physical assault, possession of firearms, verbal threats emotional harassments and derogatory remarks. Moreover, it is the duty of the adults to supervise the children in care so that they refrain from damaging the medical equipment and other properties of the dental clinic. Moreover, it is also the duty of the guardian to forbid their wards from climbing through the furniture as this may hamper the doctors’ concentration and at the same time can call-on unwanted accidental falls (Rawson et al. 2013).

Double Effect in Dental Practice

The patient protection in the dental care generally deals with the four steps of the ethical decision making process. The first step involves identification of the alternatives and this involves ascertaining the most accurate course of action followed by identification of resulting circumstances of the entire procedure and then relying over the important features of treatment of the patient. The second step is determining what is professionally at stake and this is associated with the professional opinion of the dental practitioners (Little et al. 2017). According to Little et al. (2017) dentist must specifically take into consideration of the normative action undertaken in identical treatment situations and then applying those related consideration in the decision making process. The third step of dental protection in patient care involves determining what else is ethically at stake under each treatment. The fourth and the last step involves determining what else is required to be done via applying different values, rights, rules and virtues of professionals norms (Little et al. 2017).

Another domain of patient protection is maintaining the confidentiality and privacy of the patient. According to the Dental Board of Australia (2017), the dental practitioners have ethical and legal obligations to protect the confidentiality and privacy of their patients. This is because patients have rights to expect that their dentists will hold their personal health data in confidence unless disclosure of the information is required by the legal bodies. So in order practise the confidentiality and privacy, the dental health care practitioners are required to apply appropriate security to the hard copy and electronic copy of the information. Moreover, the health care practitioners are require to seek consent from the patients before disclosing information if required under special public interest consideration (Dental Board of Australia 2017). If under any circumstances, the dental practitioners are required to share patient’s information with other healthcare professionals, they are required to abide by the privacy legislation and professional guidelines about confidentiality. While treating the children or young people, the dental health professionals are required to stay aware about the mandatory reporting requirements like child abuse while recognising the role of the parents and guardians in the domain of shared decision making. Moreover, the dental health professionals are also required to undertake culturally safe practise (Dental Board of Australia 2017). Culturally safe practise deals with proper acknowledgement of economic, social, cultural, behavioural and historical factors that influence the health of the individuals. This patient protection practise approach is extremely relevant for Australian aboriginals and Torres Strait Islanders and other community of people who shares culturally and linguistically diverse backgrounds (Dental Board of Australia 2017). Dental Board of Australia (2017) cited one example in this domain like safer and better outcomes can be obtained for some patients if they are treated by a dentist of same gender.

Beneficence and Justice in Dental Practice

There are numerous ethical dilemmas of dental health practitioners while treating patients of mental disabilities. According to the Marks et al. (2012), people who are suffering from mental health complications are known to encounter several dental problems. Globally different treatment strategies are utilised for providing optimised treatment to this group of patients. In addition to the diversity in the treatment policy, cultural aspects also seem to play an important role in the choices made to treat these patients. According to the reports published by Marks et al. (2012), the dental health practitioners are required to practise physical restrain in a frequent manner in order to provide optimal dental care to the mental-health patients. This may bridge the ethical norms of justice and autonomy but falls in accordance with the ethical principle of beneficence, safety of patients and dental health care practitioners (Ye et al. 2017). However, the dental professionals have sometimes recorded that they pass through emotional dilemma while treatment mental-health patients as majority of the practitioners feels that such application of physical restrain is a continuous physical challenge in order to obtain optimal outcome in the dental care (Marks et al. 2012). According to the Dental Board of Australia (2017), while addressing a patients with additional needs (impaired decision-making capacity) it is the duty of the dentists to pay particular attention towards communication while making the guardian or the family members involved in the care.

Thus from the above discussion it can be concluded that there exists numerous ethical dilemma while providing dental care to the patient's however, it is the duty of the doctors to indulge in effective communication in order to encourage informed decision making and thereby dodging ethical complications. Moreover, it is the duty of a dentist to maintain the confidentiality of the patient information and at the same time it is also the duty of the patients to refrain themselves from indulging into verbal and physical aggression with doctors.

References

Dental Board of Australia. 2017. Code of Conduct. Accessed on: 4^th April 2018.Retrieved from: https://www.dentalboard.gov.au/Codes-Guidelines/Policies-Codes-Guidelines/Code-of-conduct.aspx

DePaola, D.P., 2012. The evolution of dental education as a profession, 1936–2011, and the role of the Journal of Dental Education. Journal of dental education, 76(1), pp.14-27.

Laurence, B., Bertera, E.M., Feimster, T., Hollander, R. and Stroman, C., 2012. Adaptation of the Communication Skills Attitude Scale (CSAS) to dental students. Journal of dental education, 76(12), pp.1629-1638.

Lee, S., Yang, J. and Han, J., 2012. Development of a decision making system for selection of dental implant abutments based on the fuzzy cognitive map. Expert Systems with Applications, 39(14), pp.11564-11575.

Little, J.W., Falace, D., Miller, C. and Rhodus, N.L., 2017. Dental Management of the Medically Compromised Patient-E-Book. Elsevier Health Sciences.

Malathi, N., 2015. Dental ethics education: A responsibility of an academician. Journal of Education and Ethics in Dentistry, 5(1), pp.1-1.

Marks, L., Adler, N., Blom-Reukers, H., Elhorst, J.H., Kraaijenhagen-Oostinga, A. and Vanobbergen, J., 2012. Ethics on the dental treatment of patients with mental disability: results of a Netherlands-Belgium survey. Journal of Forensic Odonto-Stomatology, 30.

Priyanka, S.G., Singla, H., Lawrence, D. and Veeresh, D.J., 2016. Ethical dilemmas among dental professionals in Davangere city–a cross-sectional survey. Indian journal of medical ethics, 1(2), pp.87-90.

Rawson, J.V., Thompson, N., Sostre, G. and Deitte, L., 2013. The cost of disruptive and unprofessional behaviors in health care. Academic radiology, 20(9), pp.1074-1076.

Vujicic, M. and Nasseh, K., 2013. Accountable care organizations present key opportunities for the dental profession. Health Policy Resources Center Research Brief. American Dental Association.

Ye, J., Xiao, A., Yu, L., Wei, H., Wang, C. and Luo, T., 2017. Physical restraints: An ethical dilemma in mental health services in China. International Journal of Nursing Sciences.

Zijlstra?Shaw, S., Robinson, P.G. and Roberts, T., 2012. Assessing professionalism within dental education; the need for a definition. European Journal of Dental Education, 16(1).