Professional Ethics

Rest's Four-Component Model of Ethical Decision Making

1.Moral Sensitivity 2.Moral reasoning 3.Moral Courage 4.Moral Integrity

Understand how codes of ethics function

A code of ethics marks the moral boundaries within which professional services may be ethically provided.see 5 Codes of ethics and professional guidelines have quasi-legal force; non-compliance can result in sanctions from censure to loss of professional status

What does Profession mean?

A profession has been defined as an occupation involving relatively long and specialized preparation on the level of higher education and governed by a special code of ethics. The constructive aim of a profession is the public good. Dentistry is recognized as a profession.

What does Professional mean

A professional is a member of a profession. Four qualities have been attributed to those who practice a profession: A professional has respect for human beings; A professional is competent; A professional has integrity; A professional's primary concern is service, not prestige or profit

Ideal Relationship between Dentist and Patient

An ideal relationship is based on mutual respect and recognizes that the dentist and patient both bring important values to the professional setting;

evaluate an ethical dilemma from the perspective of an accepted decision-making model

Assess,Communicate,Decide

elements and principles of ethical decision making

Autonomy, nonmaleficence, beneficence, and justice are four generally accepted ethical principles. These principles require that all actions, including decisions by dentists, demonstrate: Regard for self-determination (respect for autonomy); The avoidance of doing harm (nonmaleficence); The promotion of well-being (beneficence); Fairness in the distribution of goods and the reduction and avoidance of harms (justice

Beneficence

Beneficence, often cited as a fundamental principle of ethics, is the obligation to benefit others or to seek their good. While balancing harms and benefits, the dentist seeks to minimize harms and maximize benefits for the patient. The dentist refrains from harming the patient by referring to those with specialized expertise when the dentist's own skills are insufficient.

Understand obligations to patients

Chief Client Ideal Relationship Between Dentist and Patient Central Values Competence Relative Priority of the Patient's Well-being Ideal Relationships Between Co-professionals Relationship Between Dentistry and the Larger Community Integrity and Education

Compassion

Compassion requires caring and the ability to identify with the patient's overall well-being. Relieving pain and suffering is a common attribute of dental practice. Acts of kindness and a sympathetic ear for the patient are all qualities of a caring, compassionate dentist.

Tolerance

Dentists are challenged to practice within an increasingly complex cultural and ethnically diverse community. Conventional attitudes regarding pain, appropriate function, and esthetics may be confounded by these differences. Tolerance to diversity requires dentists to recognize that these differences exist and challenges dentists to understand how these differences may affect patient choices and treatment.

Examples of Chairty

Dentists decide what they want to give and there are only points added for participation. No one blames others for not going beyond expectations. Charity includes mission trips and volunteering at local health fairs. It is unreimbursed and underreimbursed care (pro bono work), and even general 41 Journal of the American College of Dentists Ethics Fundamentals Leadership good citizenship

Understand ethical issues of disclosures and misrepresentations; emergency care; financial arrangements; harassment; informed consent; managed care; obligation to treat patients; and refraining from treatment

Disclosures and misrepresentations: need to know if affiliated with a product Emergency: should provide emergency care Financial arrangements: need to agree before anything is done; talk with patient about financials Harrasment: Do not make a bad atmosphere for working because this will affect the quality given to patients Informed Consent: Patients should always give there consent Managed care: Managed care is a market mechanism for distributing oral health resources; participation in managed care is usually for economic advantage to the involved parties Obligation to treat patients:The dentist is not obligated to diagnose or treat everyone. However, the dentist must avoid actions that could be interpreted as discriminatory; the dentist must be aware of laws and regulations that govern discrimination. A patient in pain or at health risk from an acute dental condition should be accepted for discussion of the condition, examined if indicated, then either treated or appropriately referred. Refraining from treatment: should refer to someone else. Can refrain from treatment if the procedure is not somethign that should be done for hte patients best interest

Understand ethical issues of abuse of prescriptions by patients; access to dental care; advertising; child abuse; confidentiality; dating atients; delegation of duties

Drug use: do not prescribe if you notice they keep asking unnecessarily for the drugs. Should report and have them seek evaluation. Have to seek with governmetn and pharmacists possibly. Dental Care: Should not discriminate and give care to the community by donating time when possible Advertising: Don't lie about what you can do and the cost Dating Patients: DON'T DO IT; if you do you cant have them as a patient Child Abuse: have to report child abuse but be careful make sure you are sure. May need to break confidentiality in this situation Confidentiality: must not share private information. It is assumed that other health professionals may be told the facts they need to know about a patient to provide effective care. It is also assumed that relevant ancillary personnel, such as record keepers, will need to know some of the facts revealed to them by the dentist to perform their job. Further, relevant facts may be communicated to students and other appropriate health care professionals for educational purposes. Delegation of Duties: Does the use of the auxiliary for the delegated task comply with prevailing laws and regulations?Is the quality of care to patients maintained when duties are delegated to auxiliaries?

Burnout syndrome

Emotional Exhaustion, Decreased Personal Accomplishment, Depersonalization

Understand why ethics are important

Ethics affect virtually every decision made in a dental office, encompassing activities of both judging and choosing. Ethics affect relationships with patients, the public, office staff, and other professionals

Understand what is meant by "ethics"

Ethics are the moral principles or virtues that govern the character and conduct of an individual or a group.The object of ethics is to emphasize spirit, or intent, rather than law.Dental ethics applies moral principles and virtues to the practice of dentistry.

Competence

Every professional is obligated to acquire and maintain the expertise necessary to undertake professional tasks;

Examples of legal situations

Here are some examples of breaking the law. "Upcoding": submitting an insurance claim for more highly reimbursed procedures than the ones actually performed; negligent practice that results in injury to a patient; or failure to report suspected child abuse. The "standard of care"—the minimal level of treatment given patients by dentists in a community—is actually a legal construct. It is defined by the jury in malpractice cases.

Understand the relationship between dentistry and business

However, the level of financial gain to the dentist must never be a consideration in any of the dentist's professional recommendations. A patient's ability to pay for services may be a consideration in these recommendations. If the patient's relevant interests are always considered, the profession of dentistry can ethically exist within a business structure.

Understand paternalism and how it affects patients

In dentistry, it can involve a dentist overriding the autonomous decision of a competent patient for that patient's own benefit. It is the dentist's responsibility to determine the decision-making capacity of each patient with the help of appropriate surrogates. The patient's values may conflict with the dentist's recommendations, and these conflicts may lead to paternalistic decisions.

Integrity

Integrity requires the dentist to behave with honor and decency. The dentist who practices with a sense of integrity affirms the core values and recognizes when words, actions, or intentions are in conflict with one's values and conscience. Professional integrity commits the dentist to upholding the profession's Codes of Ethics and to safeguarding, influencing, and promoting the highest professional standards.

Justice

Justice is often associated with fairness or giving to each his or her own due. Issues of fairness are pervasive in dental practice and range from elemental procedural issues such as who shall receive treatment first, to complex questions of who shall receive treatment at all. The just dentist must be aware of these complexities when balancing the distribution of benefits and burdens in practice

moral courage

Moral courage refers to the interpersonal communication skills and political and personal connections as well as the willingness to take personal risks to engage in moral behavior. This, of course has be understood as direct moral action in support of strong moral reasoning. It does not count to engage in character assassination or bellyaching.

Autonomy

Patients have the right to determine what should be done with their own bodies. Because patients are moral entities they are capable of autonomous decision-making. Respect for patient autonomy affirms this dynamic in the doctor-patient relationship and forms the foundation for informed consent, for protecting patient confidentiality, and for upholding veracity. The patient's right to self-determination is not, however, absolute. The dentist must also weigh benefits and harms and inform the patient of contemporary standards of oral health care.

What does Professionalism mean

Professionalism extends ethics to include the conduct, aims, and qualities that characterize a professional or a profession. Professionalism relates to the behavior expected of one in a learned profession. Professionalism embodies positive habits of conduct, judgment, and perception on the part of both individual professionals and professional organizations. Professionals and professional organizations give priority to the well-being and self-determination of the patients they serve. Professionalism has been viewed as that quality of conduct and character that accompanies the use of superior knowledge, skill, and judgment, to the benefit of another, prior to any consideration of self-interest.

Understand the relationship between risk management and ethics

Risk management processes and decisions that do not include the perspective of the patient may be unethical.

Professionalism

Self-governance as a hallmark of a profession and dentistry will thrive as long as its members are committed to actively support and promote the profession and its service to the public. The commitment to promoting oral health initiatives and protecting the public requires that the profession works toward the collective best interest of society.

Moral Integrity

Some people are known as being especially upstanding. They were troubled by an issue, they worked it through, and then took action. Those who do this predictably, who make a general habit of it, who can be counted on to work for a world that is right and good exhibit moral integrity

Decision Model II

Step 1—After identifying an ethical question facing you, gather the dental, medical, social, and all other clinically relevant facts of the case. Step 2—Identify all relevant values that play a role in the case and determine which, if any, conflict. Step 3—List the options open to you. That is, answer the question, "What could you do?" Step 4—Choose the best solution from an ethical point of view, justify it, and respond to possible criticisms. That is, answer the question, "What should you do, and why?"

Decision Model I

Step 1—Determine the Alternatives Determine that there is clarity and agreement on all relevant facts. Step 2—Determine the Ethical Considerations Consider the ethical implications of each alternative. Identify the ethical principles involved and determine the role of beneficence, nonmaleficence, autonomy, and justice. Determine the balance of good over harm. Step 3—Determine the Considered Judgments of Others Consider what your colleagues have concluded in similar situations. Consider codes of dental ethics, other codes, and views of other organizations. Step 4—Rank the Alternatives

Decision Model III

Step 1—Identifying the Alternatives What courses of action are available? What are their likely outcomes? To what other choices are they likely to lead? How likely are such outcomes and such future choices? Step 2—Determining What Is Professionally at Stake What ought and ought not to be done professionally? Step 3—Determining What Else Is Ethically at Stake What other ethical considerations apply to the action being considered? Step 4—Determining What Ought to be Done Rank the successful alternatives. The best alternative is done; equal alternatives require choice.

Relationship between dentistry and larger community

The activities of every profession also involve relationships between the profession as a group or its members and the larger community and non-professional groups and others within it;

Chief Client

The chief client is the person or set of persons whose well-being the profession and its members are chiefly committed to serving;

Competence

The competent dentist is able to diagnose and treat the patient's oral health needs and to refer when it is in the patient's best interest. Maintaining competence requires continual self-assessment about the outcome of patient care and involves a commitment to lifelong learning. Competence is the just expectation of the patient.

Central Values

The focus of each profession's expertise is a certain set of values, and each profession is obligated to work to secure these values for its clients;

Understand the ethical issue of compromising quality

The goal should be to perform each treatment step to its highest standards. For example, if the final decision, considering all limitations, is to place a less costly type of restoration instead of a more durable or esthetic (but more expensive) restoration, then the dentist is obligated to place the less costly restoration competently.

moral reasoning

The second component is the familiar skill of sorting through what is at stake in an ethical problem, locating the relevant principles, finding whose interests are at stake, tracing out consequences, narrowing down the alternatives, and deciding which is the preferred course of action

Ideal Relationship between co professionals

There does not seem to be any one account of ideal relationships between dentists and their co-professionals because so many different categories must be considered, but there are professional obligations to co-professionals;

Integrity and Community

These are subtle components of conduct by which a person communicates to others what he or she stands for, not only in the acts the person chooses but also both in how those acts are chosen and in how the person presents to others in carrying them out.

Veracity

Veracity, often known as honesty or truth-telling, is the bedrock of a trusting doctor-patient relationship. The dentist relies on the honesty of the patient to gather the facts necessary to form a proper diagnosis. The patient relies on the dentist to be truthful so that truly informed decision-making can occur. Honesty in dealing with the public, colleagues, and self are equally important.

Understand the difference between being legal and being ethical

When conflicts do arise, the choice between being legal and being ethical can be difficult. For any legal, legislative, or judicial resolution to a problem, one should ask, "Is the law a good one?" or "Was the court right?" It is often argued by ethicists that ethics, not law, establishes the ultimate standards for evaluating conduct. It is a professional obligation to work with colleagues to overturn unjust laws, i.e., those that are in conflict with the best interests of patients and the public.

Relative priority to a patients well being

While the well-being of the patient is to be given considerable priority, it is not to be given absolute priority;

Moral Sensitivity

a person's ability to recognize the presence of an ethical issue and determine its relative importance

Professional (Dr.B definition)

adjective 1 a: of, relating to, or characteristic of a profession b: engaged in one of the learned professions c (1): characterized by or conforming to the technical or ethical standards of a profession (2): exhibiting a courteous, conscientious, and generally businesslike manner in the workplace 2 a: participating for gain or livelihood in an activity or field of endeavor often engaged in by amateur (a professional golfer) b: having a particular profession as a permanent career (a professional soldier) c: engaged in by persons receiving financial return (professional football) noun : one that is professional (especially : one that engages in a pursuit or activity professionally)

The two groups we said we need to work on

communication and excellence

Social traits judged initially by first

hello

Self monitoring alone led to

increased adherence

How long does it take to make a first impression

less than one second

Morals

patterns of action that are consistent with the best theories of ethics. It is about individuals and particulars.Ethics defines the theoretical context; moral behavior is the evidence. When con artists, cops, and politicians go bad, they are countingon everybody else following the rules. Morality is about action, not knowledge of the rules

The two groups we said comes naturally to us

respect/Altruism and caring

is burnout present in dental students

yes; at least 1/4 of dental students experience burn out