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ETHICS I
First Dental Year
6th January 2014
Characteristics of a Profession
High levels of skill required
Long training/educational pathway
Self regulation
Independent
Vocation
Respected in the community
Ethical code or standards
What is Ethics?
Ethics is the science of the morals of
human conduct
Ethics provides principles that rule the
behaviour of society in general
The law is the enactment of custom or
statute which is recognised as permitting
or prohibiting certain actions
Ethics & Law
Ethics identifies the standards of conduct and
behaviour for health professionals expected by
society
Law provides the means to uphold these
standards
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Hippocratic Oath
I swear by Apollo Physician and
Aesclepius and Hygieia and Panaceia
and all the gods and goddesses, making
them my witnesses, that I will fulfil
according to my ability and judgment this
oath and this covenant.
C 500BC
Hippocrates Tree in Kos, Greece
Relevant Sections
I will apply dietetic measures for the benefit of the
sick according to my ability and judgment; I will keep
them from harm and injustice.
What I may see or hear in the course of the treatment
or even outside of the treatment in regard to the life
of men, which on no account one must spread abroad,
I will keep to myself, holding such things shameful to
be spoken about.
Translation from the Greek by Ludwig Edelstein. From The Hippocratic Oath:
Text, Translation, and Interpretation, by Ludwig Edelstein. Baltimore: Johns
Hopkins Press, 1943.
The features of the dentist-patient relationship
Trust
Honesty
Best Interests
Confidentiality
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The Principles of Practice in Dentistry
Putting patients interests first & acting to protect
them
Respecting patients dignity & choices
Protecting confidentiality of patient information
Cooperating with other members of the dental team
Maintaining professional knowledge
Being trustworthy
www.gdc-uk.org
Ethical Principles
Autonomy
Non-maleficence/Above all do no harm
Beneficence/Do Good
Justice
Autonomy
Right to privacy
Freedom of choice
Responsibility for actions
Freedom to think, judge and act
independently without undue influence
These rights & responsibilities underpin the concept
of: Informed Consent
Non-maleficence
Above all do no harm
(Primum non nocere)
Harm means not causing:
pain
disability
emotional distress
damage to property
death
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Beneficence
Do Good
Opposite of non-malficence - Do no harm
Considered to be a cornerstone of the caring
professions
Central to the Hippocratic Oath
Balance between the benefit & harm of treatment
Justice
Treating people fairly
Giving people the care they deserve
Giving people the care to which they are
entitled
Justice has a major role in health policy
Justice in practice
Prioritisation of orthodontic care
DTSS limited treatment
What if the patient cannot afford the ideal
treatment?
Common principles in ethical codes
Responsibility
Autonomy & respect
Confidentiality
Non-maleficence
Beneficence
Justice & fairness
Veracity (being truthful)
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Role of the Dental Council
Section 66 of the Dentists Act 1985
Requires the Dental Council to give guidance
to the dental profession generally on all
matters relating to ethical conduct and
behaviour.
Dental Council Guidelines
Professional Behaviour and Ethical Conduct
(2012)
The Control of Cross-Infection in Dentistry
(2005) under review
Administration of General Anaesthesia &
Sedation & on Resuscitation (1996) under review
www.dentalcouncil.ie
Professional Behaviour and Ethical Conduct
(2012)
CONSENT
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Informed Consent
The patient must be given sufficient information
from which to form a balanced judgement
The patient must have sufficient mental
capacity to understand the procedure to which
s/he is consenting
Consent must be freely given, no undue
pressure
Informed Consent
Explain clearly so that patients understand:
What treatment is proposed & how it will be
carried out
Why treatment is necessary & consequences of
not carrying it out
What risks may be involved in having this
treatment
Types of Consent
Implied
Patient attends for appointment
Expressed
Verbal
Record on chart
Written
Record on chart
Record on consent form
Written Consent Required
Except in an emergency:
Treatment/procedure is complex/involves
significant risks/side effects
Primary purpose of procedure is NOT clinical
care
Significant consequences for personal,
employment or social life
Part of research programme
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Competence and Capacity
Competent patients have capacity to make
treatment decisions if they can:
Comprehend and retain the treatment
information
Believe the information
Weigh the information to arrive at a choice
If not competent then an assent process is
required
Informed Consent in Ireland
7.1 You must get the informed consent of your
patient before you begin any treatment.
7.2 You must obtain verbal or written consent,
including consent to treatment costs, before
starting treatment. Getting written consent is
recommended when the patient is undergoing
extensive treatment.
Informed Consent
7.3 You must get written consent if the treatment is
being carried out under sedation or general
anaesthesia.
7.4 You must get the consent of a parent or guardian
for a patient under 16 years of age. This is required
by law. We recommend, though, that you talk to a
child or young adult about their treatment and give
them enough information to help them be part of the
consent process.
Vulnerable adults
7.5 If you believe that an adult patient does not have the
mental capacity to give informed consent, you should reach an
agreement about treatment with the person who is closest to
the patient for example, a relative or carer.
7.6 This agreement with a third party has no legal basis under
current Irish law. The legal position around consent and
vulnerable adults requires legislation. But in exercising a duty
of care to your patient, you must, at all times, act in the
patients best interests. If its appropriate, you may look for a
second opinion before you begin treating an adult patient who
you believe to have reduced capacity.
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Confidentiality
10.1 All dental healthcare workers and staff within your
dental practice must respect patient confidentiality. Disclosing
information about a patients attendance or any other aspect
of their care should only happen with the patients consent,
except in the following circumstances:
when disclosure is required by law;
when it is directed by a court of law, tribunal or other body
established by an Act of the Oireachtas;
when it is necessary to protect the interest of the patient; or
in exceptional circumstances, when it is necessary to protect the
public interest.
Professional Behaviour and Ethical Conduct 2012
Tricky Situations
A wife phones to enquire if her husband is
there having treatment, as he told her that he
had a dental appointment.
A school Principal Teacher phones to enquire if
a student has attended for his dental
appointment
A Garda phones to check a suspects
statement, he says he was attending the dentist
when a serious crime was committed
Questions to ask
Who needs to know?
Why to they need to know?
What grounds can justify the release of such
information?
How do we decide what to do about ethical
issues in our work?
Using our own value system
The legal system of the country
Ethical codes of the professions
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Protocol for Ethical Decision Making
Be sure that there is no misunderstanding of the
facts
List the possible alternatives
Consider the ethical implications of each
alternative
Find out about the generally accepted view of
the profession
Rank the alternatives
Guiding Principle
Section 66 of the Dentists Act 1985 requires the
Dental Council to guide the dental profession on
everything to do with ethical conduct and behaviour.
As a practising dentist, we expect you to meet the
highest standards of professional practice and
behaviour and to uphold the good reputation of the
profession in the community.
If you fail to comply with this guidance, it may result
in fitness to practise proceedings being taken
against you under the Dentists Act 1985
General Principles- Section 2
To promote confidence and trust between you, your patients
and the wider community, you should aim to:
safeguard the health and safety of your patients;
promote the dental welfare of the community;
maintain appropriate standards in all aspects of your life,
both personal and professional.
Additionally, you should never knowingly give false, incorrect
or misleading information to a patient, the Dental Council or
any third party.
Professional Behaviour and Ethical Conduct 2012
Professional Standards
A dentist must adhere to the appropriate standards of
personal as well as professional conduct.
Any behaviour or activity by a dentist which is liable to bring
the profession into disrepute or to undermine public
confidence in the profession may lead to a charge of serious
professional misconduct.
Behaviour which reflects adversely on the profession such as
dishonesty, indecency or violence, may also lead to a charge
of serious professional misconduct even if such behaviour is
not directly connected with the dentists professional practice.
Maintaining Standards-General Dental Council (UK)
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Whistle Blowing
A dentist must act to protect patients
when there is a reason to believe that a
colleagues conduct, performance or
health threatens them. The safety of
patients must come first at all times and
should over-ride personal and
professional loyalties
GDC Maintaining Standards
Whistle Blowing
As soon as a dentist becomes aware of
any situation which puts patients at risk,
the matter should be discussed with senior
colleagues or an appropriate
professional body
Respecting Other Dental Health Professionals
16.2 You must not make disrespectful or derogatory comments
about the skills and services of other dental health professionals
or about the profession in general.
16.3 You must not criticise the treatment offered by a colleague
simply because there is a difference of clinical opinion between
you and it is not the treatment you would provide.
16.4 If in the course of your work you believe that the
treatment provided by another dentist is unsatisfactory, you
should inform the patient using factual and objective terms.
Concern about a Colleague
17.2 If you are concerned that a
colleague may be putting a patients
safety at risk or may be unable, because
of physical or mental problems (either
temporary or permanent), to provide a
competent service to patients, you must
report the matter to the Dental Council.
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Communications
5.1 It is essential that you maintain good communication with your patients.
Before you begin any treatment, you must be satisfied that your patient
understands:
the diagnosis;
treatment plan;
likely outcomes;
the costs involved.
This is particularly important if your patients first language is different to
your own.
Patients questions
5.2 You must be prepared to respond to your patients questions:
professionally;
openly;
Responsibility to the Community
15.1 As a practising dentist, you should take on a responsible
role in the community and try to promote measures to improve
the health, and especially the oral health, of the community. You
should be prepared to get involved in oral health promotion
programmes, but in so doing, you must not promote your own
practice or canvass for patients.
15.2 Your conduct should not lower the publics opinion of the
profession. The abuse of alcohol and other drugs by a dentist is
not acceptable and could leave you liable to proceedings for
professional misconduct.
Social Media
15.3 Your use of social media (such as
Facebook, Twitter and so on) should be
responsible and discreet. Indiscretion in
the use of social media is not acceptable
and could leave you liable to Fitness to
Practise Committee proceedings.
Emergency Care
3.4 We expect you to make reasonable
arrangements to give your patients access to
emergency out-of-hours care.
3.5 You must always respond to a dental
emergency even if the emergency involves
patients who do not normally attend your
practice.
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Seven Deadly Sins
Arrogance
Denial
Blame
Messenger Shooting
Averting-gaze
Failure to consider systems
Passive Learning
Sir Liam Donaldson, Chief Medical Officer, England
Reading Material
Dental Law & Ethics
Edited by Lamben, Radcliffe Medical Press
Ethical Questions in Dentistry
Rule & Veatch, Quintessence Books
Dental Ethics at the Chairside
Ozar & Sokol, Mosby
Professional Behaviour and Ethical Conduct
(2012)
Dental Council of Ireland

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