Dilemma
- problem where solution is grounded in laws or standards of care
- 2 ethical principles are in conflict
- regardless of decision, an ethical principle will be violated
DH Code of Ethics
- describes professional conduct and duties toward patients, colleagues, and society
- assists dental hygienists in achieving high levels of ethical consciousness, decision making and practice
- describes the basic beliefs on the importance of oral health and the role of dental hygienist in prevention and treatment of disease
Legal Issues and Roles of the DH
- dependent practitioner
- independent practitioner
- independent contractor
- educator
- administrator or manager
- consumer advocate
- researcher
Utilitarian Ethics
- end justifies the means
- consequences
- not providing care to patient with poor prognosis
Deontologic Ethics
- means separate from the end
- principle rather than consequence
- always tell whole truth
Virtue Ethics
-emphasis on excellence of character
Fundamental Ethical Principles that Underlie HealthCare
- autonomy
- beneficence
- nonmaleficence
- justice
- veracity
- fidelity
Autonomy
- include patient in decision making
- respect patient
- signed consent/refusal
- appropriate communication
Beneficence
- providing benefit and preventing harm
- doing what is best for patient
- contributing to health and welfare of others
- replacing worn instruments so they won’t break in patient’s mouth
- referring patients
Nonmaleficence
- above all, do no harm
- preventing/removing harm or potential harm
- providing treatment in which she is not qualified XXX
Justice
- giving patient’s their due
- no discrimination
- providing substandard care to nursing home because they are institutionalized
Veracity
- bring truthful
- refrain from deception or misrepresentation
- disclose information to patients
- informing patient you have removed all calculus from tooth with 11mm pockets that you know you could not remove
Confidentiality
- protecting patient information
- patient charts in locked cabinets/secure server
Fidelity
- faithful to promises and obligation
- follow COE and law
- promising patient that you will call to provide information on implants and never do
3 Common Dilemmas in DH
- observation of behavior in conflict with standard infection-control procedures
- failure to refer patients to a specialist
- non-diagnosis of dental disease
Ethical Decision Making
- define the problem
- identify the ethical issues
- gather relevant information
- identify the ethical alternatives
- establish an ethical position
- defend your alternative (answer)
Civil Law
- breach of legal duty against a person
- preponderance of evidence
Criminal Law
- fines, prison terms, other punishments based on criminal violation
- beyond a reasonable doubt
Most Common Malpractice Suit
abandonment
Tort
interference with another’s right to enjoy person, property, or privacy
Malpractice
individual must actually be harmed due to lack of standard of care
Negligence
failing to do something that a reasonable person would do or doing something that a reasonable person would not do
Jurisprudence
COMMON MALPRACTICE LITIGATION
- violation of standard of care, negligence
- failure to diagnose, refer, or treat perio
- use of defective products
- failure to maintain proper records
- incorrect med or dental history taking
