FDASU-REC

MEMBER OF ACCREDITED
ENREC BY NAQAAE
Professional ethics
“Dental Ethics”
Dr. Mary Medhat Farid
Prof. Oral and Maxillofacial Radiology
Co-chair FDASU-REC
 What is Ethics?

Ethics are
Ethics is the study and analysis “Morals” that provide standards
of human decision-making.
to determine whether actions
are right or wrong
 • No absolute right and wrong
• No laws
• No punishments

What is Ethics?

• Voluntary controls within a

profession
• Methods of self-polishing/ self
improvement
• You raise your own bar
 Medical Practice?
Research??
– Medical Practice
• Subject welfare
– Research
• Advancement of science
• Subject welfare
What are we going
to discuss today?
The core
values of
dentistry

Case Decision
Studies Making
 What is Dental Ethics?

Every day dentists are faced with

situations that call for ethical
judgment

Ethics helps dentists deal with

these questions
 Being a dentist is
SPECIAL
• People come to you for relief from
pain and restoration of oral health
• They allow you to see, touch and
treat their bodies
• They disclose information about
themselves that they would not
want others to know
• They do this because they trust
their dentists to act in their best
interests.
 What are the core
values of dentistry?
Compassion
Competence
Autonomy
 1- Compassion

• Understanding and concern

for another person’s
distress
• Patients respond better to
treatment if they feel that
the dentist appreciates
their concerns.
 2- Competence

• A very high degree of

competence is both expected
and required of dentists
• Dentists undergo long training to
ensure competence
• But, the rapid advance of dental
knowledge, makes it is a constant
challenge for them to maintain
their competence.
 3- Autonomy (self-
determination)

• Until recently, Dentists

decided how patients
should be treated
• This allowed Dentists to
provide optimal treatment
for patients.
 3- Autonomy (self-determination)
• Recently, patient autonomy is gaining widespread
acceptance.
• The patients have the right to determine what happens to
their own bodies
• “Dentists must get consent before starting treatment or
clinical examination for a patient”.
“All that is done for
me without me
is made against me”

Nelson Mandela
DECISION ▪ Non-rational
MAKING approaches

▪ Rational
approaches
 Decision making
Non-rational approaches
1- Obedience
• A common way of making ethical
decisions
• Especially by children and some
strict organizations
• Morality is following the
instructions of those in authority,
whether or not you agree with
them.
 Decision making
Non-rational approaches
2- Imitation
• Like obedience, you substitute your
judgement about right and wrong
to that of another person, a role
model
• Morality is following the example
of the role model
• One of the common ways of
learning dental ethics by observing
and imitating senior dentists.
 Decision making
Non-rational approaches
3- Feeling or Desire
• is a subjective approach to moral
decision-making
• What is right is what feels right
• What is wrong is what feels wrong
• Feelings can vary greatly from one
individual to another, and even
within the same individual over
time.
 Decision making
Non-rational approaches
4- Intuition
• Is an immediate perception of the right
way to act in a situation.
• The decision comes from the mind not
the heart
• However, it is not systematic but the
moral decision comes through a flash of
insight.
• Like feeling and desire, it varies greatly
from one individual to another, and even
within the same individual over time.
 Decision making
Non-rational approaches

5- Habit
• There is no need to repeat a
systematic decision-making process
each time the same moral issue
arises.
• Bad habits? good habits?
• Situations that appear similar may
require different decisions.
• Habit is useful but one cannot place
all his confidence in it.
 Decision making
Rational approaches
• Ethics recognizes the
usefulness of non-rational
approaches to decision-
making
• However, it is primarily
concerned with rational
approaches.
 Decision making
Rational approaches
1- Deontology
• Search for the foundation rules
of making moral decisions.
• e.g. “Treat all people as equals.”
• However, there is disagreement
about how to apply the rules
• e.g. does the equality of all
human beings entitles them to
basic oral health care?
 Decision making
Rational approaches
2- Consequentialism
• Bases ethical decision-making on an analysis of
the likely consequences of different actions.
“The right action is the one that produces the
best outcomes”
• Do evil that good may come from
• What counts as a good outcome in healthcare
decision making; cost-effectiveness? or quality
of life?
• Supporters of consequentialism generally do
not have much use for principles; ‘the end
justifies the means’
 Decision making
Rational approaches
3- Principlism
• Use ethical principles as the basis for
making moral decisions.
• Take into account both rules and
consequences
• Recently, principlism is the most influential
ethical approach
• The four important principles for ethical
decision making in health care are; respect
for autonomy, beneficence, non-maleficence
and justice.
 Decision making
Rational approaches
4- Virtue
• A virtue is a type of moral excellence
• Ethics focuses less on decision making and
more on the character of decision makers
• Virtues that are especially important for
dentists are compassion, honesty and
dedication.
• Dentists who possess these virtues are more likely to make
good decisions
• However, even virtuous individuals often are unsure how to
act in particular situations
 Decision making
Rational approaches
• None of the rational/non-rational
approaches has been able to win
universal assent
• Because each approach has both
strengths and weaknesses.
• However, principlism takes into account
both rules and consequences, it may be
the most helpful for making clinical
ethical decisions at the chairside.
• Virtue ethics is especially important for
ensuring that the behaviour of the
decision maker is admirable.
 Decision Making
NON-RATIONAL RATIONAL
APPROACHES APPROACHES

1. Obedience 1. Deontology
2. Imitation 2. Consequentialism
3. Feeling or Desire 3. Principlism
4. Intuition 4. Virtue
5. Habit
 Assess

What do I
do when
faced with
a problem ACD
???
Comm-
Decide
unicate
What do I do ASSESS
when faced • Is it fair?
• Is it quality?
with a • Is it legal?
problem • Does it follow the Principles?
??? • What are the likely Consequences?
• What are the alternative solutions?
ACD
 COMMUNICATE
What do I do • Have you listened?
• Have you consulted dental
when faced association codes of ethics?
with a • Have you consulted respected
colleagues?
problem
• Have you informed and discuss your
??? proposed solution with the people your
decision will affect ?
ACD
• Have you explained outcomes?
• Have you presented alternatives?
What do I do
when faced DECIDE
• Is now the best time?
with a • Is it within your ability?
• Is it in the best interests of the patient?
problem • Is it what you would want for yourself?
??? • Make your decision
ACD
What do I do
when faced
ASSESS
with a • Evaluate your decision and be
prepared to act differently in the
problem future.
???
ACD
 • Dalia Hussein is a
healthy 45 years old
patient
• She comes to your office
for regular dental care
• She had bad experiences
from dentists as a child
• Dalia complains from pain
in the upper right
quadrant
• You performed careful
assessment using
radiographs, trans-
CASE STUDY #1 illumination, percussion
and probing.
 • She had a small filling in
the UR7, you removed it,
checked for cracks and
refilled it.
• In your summer holiday,
Dalia went to another
dentist
• He told her that she has
to extract the UR6 and 7
because they have cracks.
• Dalia refuses treatment
by the other dentist,
returns back to you and
CASE STUDY #1 insists that you extract
her 2 molars.
1. Extract the 2 molars 4. Refer Dalia for a
2. Do RCT for the 2 molars neurologist
3. Prepare the 2 molars for 5. Insist that she needs no
crowns treatment
• Deontology principles involved:
– The needs of the patients are the over-riding concern
– Do no harm
– Respect patient's autonomy
• Consequentialism:
– Do nothing: patient remains in pain + extract somewhere else
– If you extract her 2 teeth, you are harming her
• Principlism
– Attempt to relief pain without harming the patient
– Diagnose; CBCT/ TMD/ Sinus
Respect your subordinates