Professional ethics

“Dental Ethics”
Lecture -3&4

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 Professional ethics
“Dental Ethics”

 Dentist-Patient Relations – ethics

 Dentist-Society Relations – ethics
 Inter-Professional Relations –– ethics
 Dental Education – ethics
 Dentist-Patient Relations –
Dentist-Patient
ethics

Relations – ethics

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Dentist - Patient Relations - ethics
1- Financial issues
2- Informed consent
3- Withholding Dental Information
4- Confidentiality
5- The Care of Infectious Patients
6- Unnecessary services
7- Marketing or sale of products or procedures

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1- Financial issues
FDI principle
“The needs of the patient are the overriding concern”
Dentists will consider the interests of their patients
above their own
Yet, in reality, dentists are not required to provide care
to those who cannot afford it, except in an emergency

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1- Financial issues
How do governments distribute resources:
Libertarian ‫— الحر‬market principles (individual choice
conditioned by ability to pay, with limited charity)
Utilitarian ‫— المنفعي‬greatest good for the greatest
amount of people
Egalitarian ‫— التساوي‬everyone has equal rights
Restorative ‫ — االصالحى‬favor the historically
disadvantaged

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1- Financial issues
Different concepts of justice are followed around the world;
USA favor the libertarian approach
Sweden, admire Egalitarian approach

South Africa, follow a Restorative approach.

Despite their differences, two or more of these approaches
often coexist in national health systems, and in these
countries
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1- Financial issues
Unlike medicine, dentistry has traditionally favored the
libertarian approach,
For many governments, oral health care is a very low
priority.
However, the libertarian approach leaves a segment of the
population with no access to oral health care.
Dentists have a responsibility for these individuals in
addition to their own patients.

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Ways of meeting the dental needs of at least some of the
patients who cannot afford treatment

1. Accepting patients covered by insurance

2. Allowing patients to pay over an extended period
3. Reducing or eliminating fees for some patients
4. Lobbying for better oral health insurance coverage.
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1- Financial issues
Dentists must balance the principles of
compassion and justice
Dentists may be able to choose a practice
setting according to his own personal morality
Wealthy vs poor neighborhood
Urban vs rural community

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2- Informed consent
• “you must get valid consent
before starting treatment or
diagnosis for a patient”
• Informed consent applies
equally to refusal of treatment
or to choice among alternative
treatments.

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2- Informed consent
Explain in simple language
 Diagnoses/ prognoses/ treatment options (including the
option of no treatment)
 Costs
 Advantages/disadvantages of each option
Answer any questions they may have
Understand whatever decision the patient reaches
Competent patients have the right to refuse treatment, even
when the refusal will result in pain or disability.

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Informed
Consent

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2- Informed consent
Dental Paternalism
 Some authorities specify the appropriate substitute decision
makers in descending order As
 Now, patients are given the opportunity to name their own
substitute decision-makers when they become incompetent.
 For children: the parents, grandparents

 For adults; husband or wife, adult children, brothers and

sisters
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2- Informed consent
Dental Paternalism
Previously, the dentist was considered the
appropriate decision-maker for incompetent patients
In such cases dentists make decisions for patients
only when their chosen substitute cannot be found.

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3- Withholding Dental Information
 Dentists should start with the belief that all patients are
able to cope with the facts
 Only in extreme circumstances dentists can withhold
dental information
 If disclosure of information can result in serious physical,
psychological or emotional harm to the patient
 Outright lying, however, is never justified

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4- Confidentiality
The duty to keep patient information confidential has been a
cornerstone of medical ethics since the time of Hippocrates.
The Hippocratic Oath states: “What I may see or hear in the
course of the treatment must be not spread abroad,
I will keep to myself holding such things shameful to be spoken
about.”
FDI “the dentist must ensure professional confidentiality of all
information about patients and their treatment.”

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4- Confidentiality
The Dentist’s Responsibilities
1- Treat information about patients as confidential and only
use it for the purposes for which it is given.
2. Keep information secure at all times.
3. Ensure that all staff respect patients’ confidentiality
4. However, the duty of confidentiality is not absolute. In
exceptional circumstances, it may be justified to make
confidential patient information known without consent if it
is in the public interest or the patient’s interest
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5-The Care of Infectious Patients
 All human beings deserve respect and equal treatment
 Dentists should not discriminate against patients based on age,
gender, religion, disability or sexual orientation
 Some dentists hesitate to perform invasive procedures on
patients with serious infections e.g.
 . HIV/AIDS because of the possibility that they might become
infected.
 FDI, “Patients with HIV and other blood borne infections
should not be denied oral health care solely because of their
infections.”
 “universal infection control procedures should be employed for
all patients irrespective of their health status”

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 6- Unnecessary Services

A dentist who recommends and performs

unnecessary dental services or procedures is
engaged in unethical conduct.

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 7- Marketing or sale of products or procedures
 Dentists who sell products to their patients in their practices
must take care not to abuse their patients trust for their own
financial gain.
 Dentists should not induce their patients to purchase products or
undergo procedures by misrepresenting
 The product’s value
 The necessity of the procedure
 The dentist’s professional expertise in recommending the
product or procedure

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Dentist-Society Relations – ethics

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 Dentist-Society Relations – ethics
 Dentists should support oral health
promotion
 Dentists should act in a manner which
will enhance the prestige and reputation
of the profession

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Dentist-Society Relations – ethics
1- Dual loyalty
2- Professional announcement
3- Advertising

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 1- Dual Loyalty
 Occurs when dentists have responsibilities towards both their
patients and a third party
 FDI “The needs of the patient are the overriding concern”
 But, dentists may in exceptional situations have to place the
interests of others above those of the patient. e.g.
 Governments
 Hospital Managers
 Insurance Companies
 Police
 The ethical challenge is to decide when and how to protect the
patient in the face of pressures from third parties

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 1- Dual Loyalty - Pharmaceutical companies
 Pharmaceutical companies sometimes offer dentists gifts, free
samples, travel and accommodation.
 To convince the dentist to prescribe the company’s products
 however, these products
 May not be the best ones for the patients
 May increase health costs unnecessarily
 Dentists should resolve any conflict between their own interests
and those of their patients in their patients’ favor.

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1- Dual Loyalty
Confidentiality/ Expert testimony
• Dentists may provide expert testimony when
it is essential to a fair legal action.
• It is unethical for a dentist to agree to a contingent fee
(commission) if the lawsuit gets a favorable verdict

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2- PROFESSIONAL ANNOUNCEMENT
• In order to properly serve the public,
dentists should represent themselves in a manner
that contributes to the esteem of the profession.
• Dentists should not
• misrepresent their training in any way that would
be false or misleading.
• Dentists should not announce unearned degrees

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3- ADVERTISING
• Until recently, advertising
was considered unprofessional,
however, now it is no longer
forbidden
• WHO “Although any dentist
may advertise, no dentist shall
advertise in a manner that is
false or misleading in any
respect

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3- Advertising
 Advertising can be used for unethical purposes;
 Attracting patients from other dentists
 Convincing patients to undergo treatment,
 especially cosmetic procedures, that they do not need
 These purposes are harmful to
 Patients
 Other dentists
 The dental profession as a whole, contrary to the
 FDI “dentist should act in a manner which will enhance
the prestige and reputation of the profession

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Dentistry is it a profession or a commercial enterprise?
Dentistry is a profession but at the same time, dentists use
their skills to earn money.
The public’s respect and trust can decrease due to:
 Aggressive advertising
 Specializing in profitable cosmetic procedures
Dentists will be regarded as money makers who place their
own interests above those of their patients Inter-professional
Relation

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Inter-professional Relations - ethics

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Inter-professional Relations - ethics
1- Luring patients from colleagues
2- Fee Splitting
3- Treat dental auxiliaries with respect
4- Responsibility for all treatment undertaken by
dental auxiliaries
5- Disagreements among dentists and/or dental
auxiliaries
6- Unjustified comments on another dentist

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1- Luring patients from colleague
Luring patients from colleagues
Is considered unethical

2- Fee Splitting
• Involves a payment from one dentist to another
simply for referring a patient
• Fee splitting is forbidden in ADA
• Because dentists may refer patients who do not
need a specialist treatment for financial gain.

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 3- Treat dental auxiliaries with respect
All healthcare providers,
assistants and Laboratory Technicians are not equal in
terms of their education,
but they do share
• A basic human equality
• Similar concern for the well-being of patient

• Non-discrimination is a passive
characteristic of a relationship.
• Respect is more active and positive.
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 4- Responsibility for all treatment undertaken by
Dental Auxiliaries
FDI “dentists should behave towards all members of the oral
health team in a professional manner and
should be willing to assist colleagues professionally and
maintain respect for divergence of professional opinion.
”
FDI “The dentist must accept full responsibility for all
treatment undertaken”

FDI “the dentist is responsible for the support, guidance and

supervision of auxiliaries within the dental team.”
4- Responsibility for all treatment undertaken by Dental
Auxiliaries

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5- Disagreements Among Dentists and/or Dental Auxiliaries
Conflicts should be resolved as informally as possible by
direct negotiation between the persons who disagree
If, agreement or compromise cannot be reached, the decision
of the person with the responsibility for making the decision
should be accepted.
Moving to more formal procedures only when informal
measures have been unsuccessful.

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6- Unjustified Comments on Another Dentist

 ADA “Patients should be informed of their present oral health

status without critical statements about prior services.”

 When informing a patient of the status of his/her oral health,

the dentist should not imply mistreatment by another dentist

 Unsupportable unjustified comments on another dentist can

initiate a disciplinary proceeding against the dentist

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Dental Education - ethics

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Dental Education – ethics
Dental students owe a debt of gratitude to their teachers, without
whom dental education would be reduced to self-instruction.
 Teachers have an obligation to treat their students respectfully
and to serve as good role models in dealing with patients.
 The ‘hidden curriculum’ of dental education is much more
influential than the explicit curriculum of dental ethics
 If there is a conflict between ethics and the behavior of their
teachers, dental students are more likely to follow their teachers’
example.

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Dental Education - ethics
  Students should avoid engaging in any form of
 academic dishonesty
  Cheating in exams
  Forging faculty signatures on patients charts
  Performing unnecessary procedures on patients to complete
requirements
  A student who has cheated his way through dental school
  Lacks the knowledge that is crucial for treatment of patients
  Is more likely to cheat in patients care after graduation

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CASE STUDY #2
 Dr. Hairy is one of only two dentists in her community.
 Recently, her colleague has changed his practice to focus on
advanced esthetic services that only upper class patients can
afford.
 Dr. Hairy is overwhelmed by patients requiring basic care.
 There is no way she can treat all the patients coming to her
office.
 She wonders what is the fairest way to give appointments to
the huge numbers of patients.
 Which patients would she favor Header 01/28/2025 42
She could remind her former colleague of the ADA
dental code of ethics “Once a dentist has undertaken a
course of treatment, the dentist should not discontinue
that treatment without giving the patient adequate
notice and the opportunity to obtain the services of
another dentist.”
 Dr. Hairy may try to recruit an additional dentist to
share the patient load.
 Dr. Hairy can consider which one of the approaches

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Dr. Hairy can consider which one of the approaches to justice she
prefers in her choice of patients.
1- Libertarian: Favoring rich patients by raising her fees
2. Utilitarian: trying to treat as many patients as she possibly can
3. Egalitarian: by establishing a waiting list so that all get treated
eventually, everyone has equal rights
4. Restorative: Favoring emergency cases
5. Favoring : her previous patients

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