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Ethical and Legal Responsibilities of Healthcare Workers

1. Give a definition of the ‘Code of Ethics,’ as it applies to a dental assistant.

The Code of Ethics is an ethical decisions and conduct guideline that is used by dental assistants when carrying out their duties. The code is a reflection of the profession's values with regard to dental assisting and is founded on principles of respect, integrity, and veracity. The code of ethics is intended for use and application in all institutional, administrative, educational, and clinical settings. All dentist assistants are required to familiarize themselves with the code.

2. How many (number) aspects make up the dental assistant’s code of ethics?

Twelve in number. The aspects were developed by members of the Dental Assistants Association and are a set of standards whose aim is to improve and maintain the dental assisting status within the healthcare industry.

3. What is the difference between ‘ethical responsibility’ and ‘legal responsibility’?

It is the responsibility of healthcare workers to demonstrate legal and ethical responsibility when performing their duties. Failure to do any one of these results in the suffering of patients. Ethical responsibility is doing what is right for the patient.  Ethical responsibility calls for practitioners to accord to their patients: privacy, confidentiality, service response that is reasonable, being informed on their right to accept or reject research involvement, among others.

Legal rights and responsibilities extended to a patient are the formal rules and regulations that act as a guide on what the patient is entitled to legally. The key difference between legal and ethical rights is that legal rights are founded on written law while ethical rights of a patient are founded on values and principles. The legal responsibilities of a dental assistants include: providing information to the patient with regard to the proposed options of treatment, obtaining informed consent from a patient, and respecting the patient's right of choice and autonomy.

4. Anne, a dental assistant you work with, has been telling her colleagues, that the dentist she has been allocated to assist on a Wednesday, does terrible dentistry and treats his patients badly. List the steps you could take to do something about Anne’s unethical behaviour?

The Ethics and Complaints Rule requires that a complaint be filed on time against Anne. A screening committee will review the complaint. The committee will determine the worthiness of the complaint and once it is found worthy of consideration, a copy will be sent to Anne for a reply. If Ann does not reply, the charges will be assumed to be true; if she does reply, the copy will be sent to the committee. The ethics committee will review the case and render a decision. The committee will then notify the parties and a deadline set for a hearing. Based on the evidence, the decision made by the committee will be binding and final. If Ann or I request for a hearing, the date will be set and the decision made by the panel will be final.

Examples of Patient Needs

5. Patients have rights and expect a certain level of behaviour from the people they are paying to treat them. As a dental assistant you should ‘try to recognise the different needs your patients have.’ An example of a patient need might be a patient confined to a wheelchair.

From your own experience, list five ‘patient needs’ that you have been aware of with some of your patients.

1. Patient with primary or secondary thrombocytopenia caused by leukaemia, radiation, or medication. Prior to a tooth extraction, the patient will need to be managed in an in-patient healthcare facility. This will allow for the patient to have platelets replacement procedure prior to having the tooth extraction.

2. Diabetic patient in need of extensive oral surgery. The extent and level of brittleness of the disease will need to be determined prior to commencing the surgical procedure.

3. Cultural beliefs (Aborigine). Some societies believe that illnesses are as a result of the spiritual or supernatural forces working against their bodies. Compliance to a dental procedure in this case, is largely determined by a patient's cultural beliefs as illness is viewed as an alteration in balance of the person and the supernatural/natural forces and that wholeness can only be regained when the balance is restored.Some culture believe that ofr one to maintain health, they have to be in complete harmony with the natural and supernatural as well

4. Age. Young children will require soothing and cajoling and at times bribery with healthy snacks in order for them to comply with a dental procedure.

5. Foreigners. If a patient is a foreign national from a non- English speaking country, an interpretor will be required if the said patient does not come with a relative or friend to assist in communication. Where an interpreter is unavailable, use of gestures and visual aids (flash cards) will be utilized to communicate with the patient.

6. Briefly explain the difference between being employed under the ‘Health Professionals and Support Services Award’, and being employed under an ‘Enterprise Agreement.’

A HPSSA is an enforceable document that outlines the minimum conditions and terms of employment as well as any additional legislated minimum terms. It generally applies too specific occupation or industry employees and is used in benchmark enterprise agreement assessment prior to approval. The awards cover hours of work, special allowance, special leave arrangements, overtime conditions and rates, and pay

Employment under HPSSA and Enterprise Agreement

Enterprise agreements are those made between employees and employers at an enterprise level and involve the employees' union and cover employment terms and conditions. A group of employees can make an agreement with multiple employers. They cove r a wide range of maters including pay rates, employment conditions, when and how to consult employee representatives, procedures for dispute resolution, wage deductions, among others. In other words, working under an enterprise agreement means you are a Unionized Employee while under HPSSA you are employed directly by the healthcare facility you work for. As a unionized worker, the modern award is not applicable. Everything in and an Award is a minimal standard in an Enterprise Agreement.

7. Define what is meant by ‘a conflict of interest.’ Give one example of an improper action.

A conflict of interest is where the circumstances that one operates in or finds him/herself in risks their professional judgment with regard to a primary interest which can be influenced unduly by a second external interest.

An example of conflict of interest is involving students, trainees , or post doctoral students, in projects that could benefit a company directly in which the faculty member is in charge of supervising the students has personal financial benefits he/she derives from the company. Involving students or post-doctoral students and trainees in work that could directly benefit a company in which the faculty member supervising the students has a personal financial interest.

Choose two people, one patient and one work colleague, with whom you had ‘memorable’ or ‘significant’ communication (include both positive and negative). It may have been a pleasant chat, an argument, an unavoidable issue, a query, or any example you have experienced. Now using the following framework, write an account of your experience in the spaces provided.

1. Give details of the persons profile for example their age range, ethnicity, first name or other pertinent details.

Patient (memorable communication) Name: Priscilla, 64 year old, African decent.

Work Colleague (significant communication) Office coordinator responsible for booking patients and scheduling follow ups

2. What form did the communication take and what was the time of the day? For example, face to face, telephone, email etc. and early morning etc.

Patient: face to face communication. Took place in the morning around 10:30 am

Work Colleague: face to face. Took place during the weekly in-house clinic meeting. The meeting takes place on Tuesdays, 07:00 am-08:00 am

Understanding Conflict of Interest

3. Describe the surrounding environment and conditions during the communication. For example, noisy, hot, others present interruptions etc.

Patient: Cool day, one other person was present (a work colleague), there were no interruptions

Work Colleague: cold morning, other work colleagues were present at the meeting, other colleagues made their contributions to the conversation

4. Give a description of your own feelings, emotions, opinions or any other personal influence that you experienced at the time.

Patient: the patient offered words of motivation that were very uplifting and encouraging. I was challenged to live a more balanced and healthier life

Work Colleague: I felt some level of anger and was finding hard to believe that a person can refuse to take responsibility over a mistake but would rather offer flimsy excuses

5. How do you believe the other person felt at the time? Describe it.

Patient: She seemed happy and content with her life. She offered advice on principles of life that she adheres to.

Work Colleague: He felt cornered and attempted to put blame on me and other work colleagues for a mistake he had committed

6. What was the content or subject of the communication?

Patient: The patient was giving me advice on how to live a healthier life. She had come in for a routine oral check up. At her age, she had no dental issues and often came for checkups. She exercised regularly and did not look a day older than 35years. I jotted down some key points which I have now incorporated into my daily routine.

Work Colleague: He had a late night out, came to work all shabby, forgot to follow up on re-schedule and by noon, there were three patients all waiting to be seen at the same appointment time. The colleague said that the IT department was to blame for not ensuring the email he sent to me had reached. He blamed me for not reading my mails. When these two failed, he blamed me for not alerting him of the pending appointments.

7. Do you believe the communication was successful?

Patient: Yes.  

Work Colleague: Yes

8. Explain why it was successful, or if it wasn’t, what could you or the other person have done to make it so.

Patient: Yes it was successful because Priscilla explained herself in a simple manner and gave me practical examples from her own life. I was able to adopt new lifestyle changes based on what she told me and so far I am glad with my personal results.

Work Colleague: Yes it was successful although at first he was pointing fingers at anyone he thought he could put the blame on. The colleague got a warning letter from the Head of Department and another one from HR. He has  since reformed and is keener with his work 

Bruscino, T (2012) Basic Ethics In Dentistry. Academy Of Dental Learning and OSHA Training.

Communication Workers Union. What Is An Enterprise Agreement?

Dental Assistance Professional Association.

Euromed Info How Culture Influences Heath Beliefs.

Mc Laughlin, L., & Braun, K. (1998). „Asian and Pacific Islander cultural values: Considerations for health care decision-making.“ Health and Social Work, 23 (2), 116-126.

Partners Healthcare. Description and Examples of Conflict of Interest.

Wray, L (2011) The Diabetic Patient And Dental Treatment. British Dental Journal 211, 209 - 215 (2011) 

Zimmermann, C Maria Inês Meurer, Liliane Janete Grando, Joanita Ângela Gonzaga Del Moral, Inês Beatriz da Silva Rath, and Silvia Schaefer Tavares, (2015) “Dental Treatment in Patients with Leukemia,” Journal of Oncology, vol. 2015, Article ID 571739, 14

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