Ethical practice in dentistry is linked to the aspects of informed consent, patient’s autonomy and respecting integrity. Decision-making regarding best treatment has always been an ethical issue in dentistry. Healthcare providers in this field encounter ethical dilemmas in daily practices where they need to brief patients about their rights. Before acquiring consent, the dentist has an ethical responsibility of informing the patient about the benefits and risks of the treatment. The conflicts often arise between what the patient mentioned in the advance directive and the doctor’s views on the patient’s condition. The central confusion depicts the uncertainty if the patient will still want what she wanted previously.
The ADA principles of ethics and code of conduct highlight the principles that dentists must adopt in their practices. This defines that the dentists have a responsibility towards clients and society. They must act in the best interest of the patient by choosing the right treatment. The five common ethical codes that a dentist needs to follow in his profession include, non-malefic, patient autonomy, benefice, justice, and veracity. The principle of benefice allows staff to take a decision when the patient lacks competence. This is most apparent in the situation when the patient is undergoing severe pain CITATION Swi06 \l 1033 (Swick, Bryan, & Longo, 2006). During the last few years, the doctor-patient relationship has been moved to the patient's autonomy. The western medicines give more weight to the principle of autonomy that means considering what the patient wants. Taking any decision against the will of the patient is not acceptable in western medicine. Patients have an active role in making decisions about their treatment. The principle of autonomy allows the patient to refuse any treatment irrespective of the implications. The responsibility of the doctors is to guide the patients about the benefits and risks of the treatment. The patient has the power to refuse treatment even if it causes more harm. The principle of benefice gives more power to the dentist where he can decide to choose or refuse treatment. The dentist can choose treatment when it is favorable for the patient. The client may encounter personally including the pain, pleasure, and discomfort. While the critical interest reflects the assessment of the patient’s conditions CITATION Car142 \l 1033 (Caraiane, Florin, & Cristina, 2014).
Theory of virtue ethics can be applied in dentistry for differentiating between right and wrong. Virtue ethics claims that one must follow a correct motivational structure. The dentist takes an oath that he will use his skills for assuring oral health that indicates that his ethical responsibility is to act in the best interest of the patient. Virtue ethics in a character-based approach that considers morality behind the actions of an individual. Having particular attributes of virtue allow a person to act morally. This motivates a dentist to choose the right decision that lacks evilness. A dentist who value patient's health and safety more than personal gain act according to the philosophy of virtue ethics CITATION Car142 \l 1033 (Caraiane, Florin, & Cristina, 2014).
In real life, dentists encounter many situations where they can choose personal advantage over patient welfare. Such as suggesting a longer treatment for generating income. This is against the ideology of virtue ethics. In such a situation, the dentist is focusing on personal welfare by neglecting patient's welfare. The ethical model of virtue ethics also related internet privacy with human freedom and intellectual autonomy. To solve the ethical dilemma it is critical to consider the role of virtue ethics. Virtue ethics is against the notion of causing harm to an individual. Plutonian views of virtue ethics stress on self-determination depicting the need for respecting one's autonomy. According to the ethical models depriving people of internet privacy is unethical CITATION Car142 \l 1033 (Caraiane, Florin, & Cristina, 2014). The dentist's role according to this theory is not limited to the rules and principles, but he should be able to cultivate good character. Honesty, dedication, and sincerity are common attributed associated with this theory. It indicates that the dentist must be able to integrate these attributes in his practice.
Ethical theory of autonomy
Ethical theory of autonomy presented by Kant states it is, “to think, or not to think; to move, or not to move, according to the preference or direction of his own mind,” rather than according to the preference or direction of any other person” CITATION Guy03 \l 1033 (Guyer, 2003). Patients are unable to make the right decision due to poor or inadequate information regarding treatment. The principle of informed consent ensures that the dentist cannot misguide the patients. Moral implications of the decision that depends on differentiating between right and wrong. Autonomy remains one of the critical concerns in medical ethics. The principles of autonomy are one of the central notions in western medicine. However, the principle of autonomy works when the patient/ person is in the best position to take the decision. Ethics in dentistry claims, “the process of informed consent requires comprehensive knowledge on the part of the practitioner, uncompromising veracity, unbiased presentation of all reasonable alternatives, and consequences including costs and the probability of outcomes” CITATION Kem18 \l 1033 (Vanishree, Ganesh, & Umashankar, 2018). The principle of autonomy states that the patients’ autonomy is vital in all medical decision explicitly regarding his treatment. It is plausible that the patient may not be in a position to decide due to his medical condition, making the principle of autonomy less effective.
Informed consent saves the dentist from future complications. “It safeguards the dentist against misuse by patients. At the same time, patients are also safe from anything done apart from the treatment committed at the beginning” CITATION Kem18 \l 1033 (Vanishree, Ganesh, & Umashankar, 2018). Application of the principles of benefice and nonmaleficence depicts that the healthcare provider cannot take any action that harm’s the patient.
The principle of a benefice in medical professional ethics states that the nurses must take actions that are in the best interest of the patient and is not against the autonomy of the patient. The principle of the benefice is important in a dentistry profession that restricts them from taking actions that are not in favor of the patient. In the present scenario ethical conflict appears as the nurse needs to think what is good for the patient and herself. Any action that is the patient will make nurse unethical and wrong CITATION LAJ00 \l 1033 (Jansen, 2000). The principle of trust depicts that dentists have a role in helping the family to maintain hope. The principle of empathy states that the healthcare provider must try to see things from the patient's perspectives and understand their views. The principles of beneficence and nonmaleficence restrict dentist from taking actions that could deteriorate the condition of the patient CITATION Kem18 \l 1033 (Vanishree, Ganesh, & Umashankar, 2018).
Duty-based ethics is another theory applicable in the field of dentistry. It stresses on, “certain attributes of professionalism, such as altruism, compassion, respect, duty, honor, and integrity, to gain and maintain their specialty certification" CITATION Swi06 \l 1033 (Swick, Bryan, & Longo, 2006). The integration of this theory into dentistry ensures that the dentist fulfills his duty towards patient ethically. Duty-based ethics stresses on professional competency of the dentist depicting that he must be able to provide adequate care to the patient. Competence indicates that the dentist must be able to conduct immediate and accurate diagnosis for identifying the right treatment CITATION SSe19 \l 1033 (Sellars & Wassif, 2019). He offers the best possible treatment for preventing pain, disease and related complications. He must be capable of carrying out practices according to the fundamental principles.
The theory also ensures that the dentist treats the patient with compassion and integrity. Care is essential in the field of dentistry and medicine healthcare providers have a duty of saving the people. The dentist will identify the cause of pain and act ethically for helping the patient in recovering CITATION Swi06 \l 1033 (Swick, Bryan, & Longo, 2006). This theory focuses on the rights of duty and recognizing the rights of others. This means he identifies the needs of the patient and acts in the best possible way that will comfort the patient. The dentist must not neglect the rights of the patients such as the right to choose the treatment. He must also inform the patient about the costs and the benefits of the treatment. The client also has a right to learn about the risks associated with each treatment.
The most suitable decision is to respects precedent autonomy. The principle of benefice means leaving the decision on the doctors, violating the principles of autonomy. Western medicine gives more consideration to the patient's will and autonomy. Virtue ethics, ethics of autonomy and duty-based ethics are three common ethical theories applicable in the field of dentistry. Virtue ethics encourages a density to choose between right and wrong. Under the influence of this theory, he will choose the right course of action that will result in the best interest of the patient. Ethics of Autonomy states that the dentist must inform the patient about the treatment and complications. This means taking informed consent before starting treatment. Duty-based ethics states that the dentist is ethically bound to fulfill his duty of treating a patient with compassion, honesty, and professionalism.
BIBLIOGRAPHY Caraiane, A., Florin, B. F., & Cristina, N. (2014). DENTISTRY AND DENTAL HIGH EDUCATION: ETHICAL ASPECTS. International Journal of Medical Dentistry, 4 (2), 25-29.
Guyer, P. (2003). Kant on the theory and practice of autonomy. Social Philosophy and Policy, 20 (2), 70-98.
Jansen, L. A. (2000). The virtues in their place: virtue ethics in medicine. Theoretical medicine and bioethics, 21 (3), 261-276.
Swick, H. M., Bryan, C. S., & Longo, L. D. (2006). BEYOND THE PHYSICIAN CHARTER: reflections on medical professionalism. Perspectives in Biology and Medicin, 49 (2), 263-75.
Sellars, S., & Wassif, H. S. (2019). Is dentistry the orphaned field of medicine? Ethical consideration for evidence-based dentistry. British Dental Journal, 226 (3), 177-179.
Vanishree, K., Ganesh, P., & Umashankar, K. (2018). The Top 10 ethical challenges in dental practice in Indian scenario: Dentist perspective. Contemporary Clinical Dentistry, 9 (1).
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