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Ethics and
responsibilities of dental
care
Aim of the lecture: Students should be able to describe Ethics and
responsibilities of dental care in detail
Objectives of the lecture: Students should be able to enumerate
1) Historical background /evolution of ethics
2) Why code of dental ethics?
3) Ethical rules for dentists
4) Ethical principles
5) Duties and obligations of the dentist towards patients, professional
colleagues and society
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HISTORICAL BACKGROUND
James Lind and his study on scurvy
Edward Jenner and small pox vaccination
NAZI EXPERIMENTS
Freezing/Hypothermia
Sun Lamp
Internal Irrigation
Experimentation Surgery
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Landmark codes, Declarations and Regulations
Nuremberg code 1947 judicial decision
Condemning the atrocities of the Nazi physicians (consent and favorable risk
benefit ratio)
The declaration of Helsinki 1964
Remedy the lacunae in the Nuremberg code (independent review, distinction
between therapeutic and non therapeutic research)
Belmont report 1979 in response to U.S research scandals such as Tuskegee
and Willow brook(informed consent, favorable risk benefit ratio, protection of
vulnerable populations)
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What is Ethics?
“Ethics” is derived from the Greek word ‘ethos’ meaning
custom or character.
It is considered with ideals and values.
Dental ethics would mean moral duties and obligations of the
dentist towards his patients, professional colleagues and to the
society.
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Why Code of Dental Ethics ?
A systematic body of rules is needed "in order that dignity and
honour of the dental profession may be upheld, its standards
exalted, its sphere of usefulness extended and the advancement of
dental science promoted.
And the members of the dental association may understand the
duties and obligations clearly to the dental profession, to their
patients and to the community at large.
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Implied Warranties (Duties) Owed by the Doctor
In accepting a patient for care the dentist warrants that he or
she will do the following:
1. Use reasonable care in the provision of services as measured against
acceptable standards set by other practitioners with similar training in
a similar community.
2. Be properly licensed and registered and meet all other legal
requirements to engage in the practice of dentistry.
3. Employ competent personnel and provide for their proper
supervision.
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Ethical Principles
1. Non-maleficience (primum non nocere) – to do no harm
2. Beneficence – to do good
3. Autonomy – respect for patients rights/decision
4. Justice – treat everyone equally
5. Confidentiality – do not reveal patients records to others
6. Fidelity - faithfulness
7. Veracity - truthfulness
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I. Duties and Obligations of the Dentist towards
patient / population
The first principle of medicine in the Hippocratic Oath is
that the doctor’s first duty is to his or her patient.
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To do no harm (Non-Maleficence)
It is generally attributed to Hippocrates.
It is considered to be the foundation of social morality.
‘Primum non nocere’ – First do no harm.
It is clear that although dental care professionals support
this principle in theory they are at times guilty of
transgressions that go beyond a limitation.
For example : Iatrogenic diseases.
In population based research the investigator has a dual
responsibility, i.e. to the individual and to the population of
which they are a part.
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To do good (Beneficence)
It should be the role of dentists to benefit patients, as well as
not to inflict harm.
The expectation of the patient is that the care provider will
initiate beneficial action and that there is an agreement
between the doctor and patient that some good will occur.
The attempts should be to maximize the benefits and
minimize harm.
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Respect for persons
This incorporates at least two other ethical principles of which
autonomy dictates that health care professionals respect the
patients capacity for self determination in making decision
regarding their treatment and informed consent is an essential
component of a patient’s right to autonomy.
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AUTONOMY
The primary way to respect individuals is to
abide by their choices whether others believe
these choices to be wise or beneficial.
Autonomy is a principle that dictates that health care professionals respect
the patient’s right to make decisions concerning the treatment plan.
An autonomous person is an individual capable of deliberation about
personal goals and acting under the direction of such deliberation.
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Informed Consent
It is the first stated and the largest principle of the Nuremberg
code.
The Nuremberg code has identified four attributes without
which a consent cannot be considered valid.
Voluntary
Legally competent
Informed and
Comprehending
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Informed Consent
Consent should not be obtained with bribery, or
misinformation. If a person cannot give informed consent it
is desirable to obtain proxy consent.
Informed consent holds a central place in the ethical
justification of research involving human subjects.
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Informed Consent
Though the process of informed consent empowers subjects
to pursue and protect their own interests, its an instrument
designed to protect the interests of investigators and their
institutions and to defend them against civil or criminal
liability.
Hence a witness may be required to countersign and attest to
the fact that the subject received the information.
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The informed consent is a two
step process
First information is presented to the subject by the
investigator.
Secondly, the subject satisfies himself or herself that he or
she understands and based upon this understanding
either agrees or refuses to participate in the research
projects.
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Justice
The primary duty of the health professional
is service irrespective of class, creed etc.
Justice demands that each person be treated equally.
It calls for an obligation to protect the weak and to ensure equity in
rights and benefits, both for groups and individuals.
It calls for universal coverage and for care according to need.
The principle of justice in relation to health care calls for community
participation in decisions and care which is effective and affordable.
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Truthfulness
The patient – doctor relationship is based on trust.
Lying shows disrespect to the patient and threatens relationship.
Studies in 1950 and 1960 (on terminally ill patients) had shown that the
physicians had the right, indeed duty to withhold bad news when they
believed it would upset the patient.
It is an example for Hippocratic paternalism, that is, the doctor knows the
best.
Nowadays, in certain areas, there is a reversal of this dominant physician
pattern.
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Confidentiality
Every patient has the right to expect that all communications and
records pertaining to his/her care will be treated as confidential.
Earlier it was widely accepted that confidentiality could be
breached if it was thought it would benefit the patient.
Now patient’s permission has to be sought.
In no instance other than in the court of law or the patient changes
the dentist, should confidentiality be breached.
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II. Towards profession / professional colleagues
Treatment and cure of the disease depends on the skill and prompt
attention showed to the patient.
The dentist has to be sober, courteous, sympathetic, helpful, modest
and punctual.
He has to be morally, mentally and physically clean.
Its obligatory to enroll in societies and be updated in knowledge and
skills.
It is not duty-bound on the dentist to treat the family of his fellow
professionals without charge, but it is professional courtesy.
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III. Towards the society
The dentist has to assume leadership in the community on
matters pertaining to dental health.
People should be urged to seek care without influencing
choice of dentists.
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Duties of Dentist Towards One Another
1. If a dentist is consulted by the patient of another dentist and the
former find that the patient is suffering from previous faulty
treatment, it is his duty to institute correct treatment and in such
a manner as to avoid reflection on his predecessor.
2. A dentist called upon in any emergency to treat the patient of
another dentist, should when the emergency is provided for,
retire in favor of regular or but shall be entitled to charge
patient for his services.
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Some Unethical Practices by Dentists
Practice without a dental qualification
A dentist practicing medicine
A dentist’s clinic termed as hospital
Commercial advertisements regarding practice, but dentists
are allowed to advertise when they need some staff. It should
be in normal type and should state only the nature of vacancy
To sell physicians samples in clinic at a profit
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