Transcript The Ethics of Profession

“Man ultimately
decides for himself, and
in the end, education
must be education
toward the ability to
decide.”
Viktor Frankl
Austrian psychotherapist
THE ETHICS OF
PROFESSION
“As A Dentist, Should I Live
Differently Than The
Ordinary Person, And If So,
How and Why?
Terminal Objective
The dentist will choose to apply
the principles of professional
ethics to his or her practice of
dentistry.
Enabling Objectives
The student dentist will be able to:
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define the principle of beneficence and explain the
dentist's role in applying the principle in caring for
patients.
relate nonmaleficence to beneficence.
describe the principle of respect for autonomy.
describe the three ingredients of a valid or informed
consent.
explain the relationship of gaining a valid consent from
patients to the ethical principles of beneficence and
respect for autonomy.
explain "paternalism."
justify a dentist's ethical obligation to "lifelong learning."
apply the three aspects of Rawl's principle of justice to
the practice of dentistry.
explain why there exists a societal expectation for selfregulation in the learned' professions generally, and
dentistry specifically.
Professional Ethics in
Dentistry Based on the
Moral Rule...
“Do Your Duty”
Profession
• Moral Component
• Intellectual Component
Just as in Aristotle’s
Concept of the Virtues,
Based on the Nature of
Human-kind.
Moral Component of
Profession
Primary to the notion of
profession is benefiting society.
The moral component of
profession is doing good for the
oral health of our patients and
society. The moral rule of not
causing harm becomes the
moral ideal of preventing evil or
harm by the promoting the good
of patients in the area of
dentistry’s avowed
expertise…oral health.
The Troika of
Principles of
Professional Ethics
We promote oral health by
observing three principles of
morality:
• Beneficence
• Respect for Autonomy
• Justice
Beneficence
The goal of the relationship in
which one assumes the role of
health care practitioner and the
other patient is the benefiting of
the patient. This benefiting is
accomplished by the dentist
providing the highest quality of
care possible contingent on the
professions current scientific
understanding, the clinical
circumstances, and the patient’s
desires.
Hippocratic Oath
“I will use treatment to
help the sick according to
my ability and judgment,
but I will never use it to
injure or wrong them.”
ADA Principles of
Ethics and Code of
Professional Conduct
“The dentist’s primary professional
obligation shall be service to the
public. The competent and timely
delivery of quality care within the
bounds of the clinical circumstances
presented by the patient, with due
consideration being given to the
needs and desires of the patient,
shall be the most important aspect of
that obligation.”
Principle One
Service to the Public
and Quality of Care
Continuum of
Beneficence
Promote Good
Prevent Evil or Harm
Remove Evil or Harm
Do Not Cause Evil or Harm
(Non-maleficence)
Non-Maleficence
Who Decides About
Goods and Harms-Risks and Benefits?
In providing goods or benefits,
clinicians in dentistry acknowledge
there are inherent risks of harms.
Dentists have the duty to weigh
benefits against possible harms, and
minimize the risk of harms. But the
dentists conception of benefits and
risks may be different from the
patient’s.
Whose values should prevail?
Respect for Autonomy
Autonomy derives from the
Greek and literally means
self-rule, self-governance...
being one’s own person; the
author of one’s life. The
moral rule, “do not deprive
of freedom or opportunity,”
means it is moral or right to
grant self-governance to
others.
Informed Consent
• Adequate information,
with adequate
understanding
• Lack of coercion
• Competence
Adequate Information
with
Adequate Understanding
• The concept of adequate
information/understanding can
deteriorate into a mechanical
rehearsal of data to legally protect
the dentist unless tempered with the
idea of patient comprehension. This
is done by processing information
reciprocally; asking for patient
understanding and validation of the
information.
• Adequate information/understanding
does not require that the patient be
told everything there is to know, but
only the information adequate to
make an ‘informed decision;’
information that a reasonable person
would want to have.
Adequate Information
• Nature of the Problem
(Diagnosis)
• Goals of Treatment
• Alternatives in Treatment
• Advantages/Disadvantages
• Benefits/Risks
• Recommended Treatment
• Prognosis
• Cost
Lack of Coercion
Modifying Behavior
Education
Persuasion
Manipulation
Psychological Coercion
Physical Coercion
Paternalism
Assumptions:
• Acting Beneficently … Doing
Good
• Violating a Moral Rule
• Patient has not given an Informed
Consent
• Patient is Competent to give
Consent
Competence
Groups of individuals
unable to reasonably
deliberate (rationally
consider) on treatment
options and provide and
informed consent are:
– minors
– extremely anxious patients
– mentally ill
– mentally retarded
– patients with dementia
Justice
The Theory of Justice
John Rawls
Concept of Justice
“… When a number of persons
engage in a mutually
advantageous cooperative
venture according to rules, and
thus restrict their liberty in
ways necessary to yield
advantages for all, those who
have submitted to these rules
have a right to similar
acquiescence on the part of
those who have benefited from
their submission.”
A Theory of Justice
John Rawls
Justice in Individual
Relationships
• Equity: Giving each his/her due
• Reciprocity: Mutual exchange
• Impartiality: Free of bias or
favoritism
Synonym for Justice is:
Fairness
Justice in
Dentist/Patient
Relationship
• Dentists have an obligation to
treat their patients fairly by:
– providing a quality service based
on the profession’s standard of
care.
– assessing a reasonable fee.
– attending to the patient in time of
need.
– gaining an informed consent
– maintaining confidentiality
Self-Regulation and
Justice
• Professional self-regulation is
an onerous obligation, and
difficult to achieve. The duty to
colleagues seems, at least
superficially, to take precedence
over the obligation to patients in
matters of professional
incompetence.
• To the extent that concern for
other dentists prevails over
concern for the clinical
mismanagement of patients,
professional ethics is reduced to
“courtesy within a guild.”
• However, a cautionary note is
advised. It is a violation of the
autonomy of colleagues, that is
a limiting of their freedom or
opportunity, if comments are
made, or actions taken, without
complete surety of the facts of
the case.
• Documentation of repeated
breaches of professional
behavior by colleagues demands
that the “whistle be blown.”
The profession’s covenant with
society requires the profession
to act vigorously in maintaining
its moral integrity.
“In order to guarantee to the public that
certain standards shall be maintained, the
state limits the license to practice to those
who have completed a course of
professional education. Professionals as a
group profit from this state-created
monopoly. They fall short of their
responsibilities for the maintenance of
standards if they merely practice
competently and ethically as individuals.
The individuals license to practice depends
on the prior license to license, which the
state has, for all intents and purposes,
bestowed on the profession. If the license
to practice carries with it the obligation to
practice well, then the license to license
carriers with it the obligation to judge and
monitor well. Not only the individual, but
also the collectivity (profession) itself is
accountable for standards.”
William F. May
Social Justice
Refers to the Justified
Distribution of Benefits
and Burdens of Society
Three Facets of Justice
1. “Each person will have an equal
right to the most extensive system
of liberties comparable with a
system of equal liberties for all;
2. Persons with similar skills and
abilities will have equal access to
offices and positions of society;
and
3. Social and economic institutions
will be arranged so as to
maximally benefit the worst off.”
Oral Heath As A
Social Good
• Access to basic oral health care
• Any activity of oral health
promotion and disease
prevention:
– Water fluoridation
– Community sealant programs
– Oral health awareness programs
Intellectual
Component of
Profession
Life Long Learning
• Philosophical End
• Psychological End
• Practical End
Philosophical End
• Aristotle’s concept of “intellectual
virtue.” We fulfill one of our vital
functions as human being when we
continue to learn.
• “we must cease conceiving of
education (learning) as mere
preparation for later life, and make
it the full meaning of present life…an
activity that does not have worth
enough to be carried out for its own
sake cannot be effective as
preparation for something else.”
John Dewey
American philosopher
Psychological End
• Maslow’s concept of “being all
you can be.” As we are by
nature learning animals, we
actualize our potential when we
learn.
• Csikszentmihalyi’s concept of
“flow.” Having our
intellectuality exercised and
stretched with new ideas,
challenging concepts, and
exciting understandings is to get
in, and be in, flow.
Practical End
• A competent professional in
dentistry must apply the
profession’s current knowledge
base to patient care with
integrity. Standards of care
must be fulfilled, and those
standards are continuously
changing through research.
• The half-life of dental
knowledge has been estimated
to be 5-7 years.
L’informatique
• 6,000 - 7,000 scientific articles
published every day.
• Now … scientific and
technological information
increases 13% /year -- doubling
every 5.5 years.
• Rates of information expansion
will soon increase 40%/year due
to more powerful information
system and the increasing
population of scientists.
• Then … the scientific
information will double every
twenty months.
“If we indoctrinate our students
in an elaborate set of fixed
beliefs, we are ensuring their
early obsolescence. The
alternative is to develop skills,
attitudes, habits of mind, and
kinds of knowledge and
understanding that will be
instruments of continuous
change and growth. Then we
will fabricate a system that
provides for continuous
renewal.”
John Gardner
in Self-Renewal