Course Outline
The primary goal of this book is to comprehensively present the ethical problems in dentistry and to suggest approaches to their resolution. The text is organized into three parts. Part I introduces the major ethical theories and principles and gives examples that encapsulate their application to dental practice. It also introduces a format for ethical case analysis that is illustrated using the case of a troublesome patient’s request for mood-altering drugs. Parts II and III consist exclusively of ethical analyses of cases. Most of the cases are based on actual events associated with patient care and were solicited from generalists and specialists in various parts of the country, thus providing a national picture of ethical issues in dentistry. Names and details have been modified to provide anonymity and clarity of the issues. A few cases were taken from published reports in dental literature and the public press, in which instances real names and details are provided. In addition, certain cases were written as ethical issues facing the profession at large, rather than an individual practitioner.
Part II discusses ethical principles by using case histories to illustrate the following: beneficence (acting to benefit the patient), nonmaleficence (avoiding harm), fidelity (obligations related to trust and confidentiality), autonomy (including problems of informed consent), veracity (truth-telling), and justice in the allocation of dental resources.
Part III rounds out the discussion with cases representing special topics such as ethical issues in dental schools, third-party financing, HIV-infected patients and dentists; and incompetent, dishonest, and impaired dentists.
Altogether, the organization and contents of this book give the reader both the basic fundamentals of ethics and a broad perspective of the types of ethical issues that dentists encounter. In addition, the examples of ethical reasoning illustrated in the case and analysis sections provide useful guidelines for the resolution of ethical problems encountered in professional life.
About Authors
James T. Rule, DDS, MS, is Professor Emeritus at the University of Maryland Dental School, where he was Chair of the Department of Pediatric Dentistry from 1978 to 1998. His interest in ethics was stimulated by a sabbatical leave at the Kennedy Institute of Ethics in Georgetown University in 1989 and 1990, which culminated in the first edition of Ethical Questions in Dentistry. He subsequently initiated a course in professional ethics for dental students and co-founded a graduate course in research ethics for the University of Maryland at Baltimore. Dr. Rule is now retired and lives in Deer Isle, Maine, where he is working on a book on moral exemplars in dentistry.
Robert M. Veatch, PhD, is Professor of Medical Ethics and former Director of the Kennedy Institute of Ethics, Georgetown University. He also serves as Professor in the university’s Department of Philosophy and School of Medicine. Dr. Veatch’s background is in pharmacology (MS, University of California, San Francisco). He has served on the boards of the Journal of the American Medical Association, Journal of Medicine and Philosophy, Hospice Care of DC, and the Washington Regional Transplant Consortium. His books included The Basics of Bioethics and Transplantation Ethics.
Learning Objectives
After completing this course you’ll be able to:
- Discuss the re-evaluation of ethics from the 1960s.
- Discuss the technological advances and disparities.
- Describe the growth of dental ethics.
- Compare the terms ethical and legal.
- Discuss several ethical issues faced by dentists.
- List the six values in dentistry according to Ozar and Sokol.
- Define values.
- Discuss the meaning of “profession.”
- Compare the definition of profession according to the American College of Dentists and Paul Starr.
- Describe a fiduciary relationship.
- State the two elements of trust.
- Discuss the scholarly viewpoint of a profession according to Freidson.
- List the functions of codes.
- Compare collective and individual autonomy.
- Describe how self-regulation occurs.
- State examples of an occupation and profession.
- Discuss specialized knowledge and state the most obvious problem.
- Define collegiality.
- Discuss knowing facts and how it affects clinical dentistry.
- Describe five characteristics of moral and ethical evaluations.
- Compare morality and ethics.
- Define descriptive relativism and normative relativism.
- Define personal relativism.
- Discuss professional codes.
- Define normative ethics.
- Describe the three kinds of judgments in normative ethics.
- Describe autonomy, nonmaleficence and beneficence.
- List the three ideas of justice.
- Define distributive justice.
- Discuss the three theories of justice.
- Define veracity, fidelity, gratitude, and reparation.
- Discuss the four steps when resolving an ethical dilemma after clarifying and arguing on facts).
- State the dentist’s primary obligation according to the American Dental Association’s Principles of Ethics and Code of Professional Conduct
- Discuss the philosophy of Immanuel Kant.
- Compare “contract” and “covenant.”
- Discuss how autonomy is a psychological term and a moral term.
- Discuss the findings of Hirsch and Gert regarding informed consent and competency of patients.
- Compare the professional standard with the reasonable person standard.
- Describe durable power of attorney.
- Discuss the acceptance of lying to patients around 1975.
- Discuss justice in relation to allocation of resources.
- Discuss the welfare of clinic patients for “teaching material.”
- Compare dental insurance and medical insurance.
- Compare capitation programs and fee-for-service programs.
- Discuss judgments regarding benefit and harm from interventions.
- Discuss the transmission of AIDS, HIV, and hepatitis between dentists and patients.
- Discuss the obligation of the dentist who observes an incompetent, dishonest or impaired colleague.