Ethics 2

‫ﺑﺴﻢ ﺍﷲ ﺍﻟﺮﺣﻤﻦ ﺍﻟﺮﺣﻴﻢ‬

Ethics lecture #2 DR .Haidar Al wa2ely Today we will continue talking about ethics, what are the principles of ethics, what are the codes of professional conduct in dentistry.

Principles of ethics by definition are the inspirational goals of the profession, they are present in every respected profession wether it was dentistry, medicine or even law .i.e. . I want justice, truth and honesty in my profession…these principles provide guidance and offer justification for the code of professional conduct.

So what is the code of professional conduct? Its expression of specific types of conduct that are either required or prohibited, every principle of ethics has a certain code of professional conduct ...‫ ﻣﻤﻨﻮﻋﻪ او ﻣﺮﻏﻮﺑﻪ‬،‫ﻳﻌﻨﻲ اﻟﺘﺼﺮﻓﺎت اﻟﻤﺘﻌﻠﻘﻪ ﺑﻬﺎي اﻟﻤﺒﺎدئ ﻣﻤﻜﻦ ﺗﻜﻮن ﺻﺤﻴﺤﻪ او ﺧﺎﻃﺌﻪ‬ Code of professional conduct is present in every major profession (law, dentistry, medicine….etc), and as you are working as a dentist in a country then you should know the code of profession and ethics that are written and applicated in that country..

The code of ethics are voluntary standards of behavior.. they are not laws…but they serve as a method of self-policing within a profession… they were written by dentists who were dental students.. and we –as dentists- are restricted with code of ethics more than the law, so law comes secondarily, we by nature respect the law but we do follow the code of ethics in our profession voluntarily in a more specific way to save our career and reputition . The code of ethics have been provided in several occasions and of course have been revised as it has been developing and this is according to the situation and development of what's new in our profession keeping in mind that idealism and moral conduct never change till the end of the world even if the codes were changed or revised…. So standards and behaviors will never change and this means also that the inspirational goal –which is the moral conductwont change over time and that’s what we want from ethics… Now, what are the reasons that were beyond the development of the code of ethics:: 1- to demonstrate to the public the standard of conduct that they expect from us…but what do we benefit from this Imagine that people you're treating read or know that we have code of ethics…then their attitude toward you will differ and they will of course respect you and respect the profession….so it provides people or community what to expect from members of the profession.

2- To increase the ethical consciousness and ethical responsibility of its members. 3- To guide members in making an involved ethical decision. 4- To establish a standard for professional conduct and judgments. SO its something that guides us to do the right or the correct behavior….they are not laws…they were written by dentists (dentists with authority and not written by regular one's and this is to be respected) and are revised by new situations… The difference b/w ethics and laws is that: laws are either black or white.. Wrong or right and there is no in between in law and this is what gives law its power and strength and respect…also laws are more specific and strict Concerning ethics… they are less specific and there are more grey areas (neither black nor white) But, what do we mean by a grey area?? They are described as the changes that occur due to the new situations which are associated with a very high moral conduct… Over all conclusion is that ethics are the conscious of the profession. Another thing is that law sets the minimum standard of behavior, minimum Î to set an alarm or a warning to people to warn them from making mistakes bcoz people are afraid of punishment… ‫ﻳﻌﻨ ﻲ ﻟﻤ ﺎ اﻧ ﺖ ﺗﺸ ﺘﻐﻞ ﻓ ﻲ ﻣﻬﻨﺘ ﻚ ﺣﺴ ﺐ ﻗ ﻮاﻧﻴﻦ ﺻ ﺎرﻣﻪ ودﻗﻴﻘ ﻪ رح ﺗﺸ ﺘﻐﻞ ﺑﻀ ﻤﻴﺮ ﻻﻧ ﻚ رح‬ ...‫ﺗﺤﺴﺐ ﺣﺴﺎب أي ﺧﻄﺄ ﺧﻮﻓﺎ ﻣﻦ اﻟﻌﻘﺎب‬

But ethics sets a high standard of behavior to be performed and we are not afraid from doing them Ethics have a wide spectrum bcoz its an inspired behavior, while law has a narrow spectrum bcoz it’s a limited behavior… We have five principles of ethics that are: 1- Patient autonomy 2- Non malifecience 3-beneficence 4- Justice 5- Veracity In each principle, you will see what's your duty as a dentist? What are your primary obligations? And what are the practical conducts that you are to use in the profession? **each principle has a code of ethics

The 1st principle Patient autonomy (self-governance or desire) It’s the duty of the dentist to respect the patient rights to self determination and confidentiality. So you have to respect the patient and treat him according to his desire but within ethical limits and always putting in mind patient rights and confidentiality –which is the target of this principle-.

This principle express that professional treatment is a duty with respecting the patient's desire ….this is true BUT there is a condition which is respecting desire of the pt should be within a boundary of accepted treatment and protection of patient confidentiality?? This is an example to make you understand it better If a non educated patient came to you with a simple cavity in his upper central incisor and he told you that he wants to extract the tooth (this is his desire) and you think about it and suddenly a flash back in your mind takes you to this lecture and say :"yes Dr haidar told us to respect the patients desire …" and stop right here ?? This is absolutely wrong becoz if you look to the second part of the statement you will understand the condition which is the limit or the boundary. So if you do extraction this will not be considered as the acceptable treatment and correct treatment is what we should do…although we can decide what s best for him but this should be with the patient himself and not by yourself alone ..so we should provide the patient with all correct and available options then sharing the decision of treatment. If a patient comes to you with missing teeth you don’t tell him that implants for ex are the best but instead you have to provide all options.. and this is also applicable when your solutions are limited for ex , a patient came to you for a bridge and you have only acrylic-which is cheap- so you have to tell the patient in this case that it’s the only solution.

That was about the acceptable treatment which is one part of the boundary, now the second part is the patient's confidentiality

Patient's confidentiality It does not only mean family secrets, if the patient is married or not, it means lots of things which may involve nationality, religion ….. it means not to get an information from my patient and then pass it to a colleague or a doctor without the permission of the patient or else people will behave with him in wrong way. Such informations may be about color, religion, beliefs and if the patient knows that im not a secret keeper then he wont tell me for ex that he has a certain disease, and this is a problem bcoz my duty is to treat him from diseases whatever he or she was and I don’t put in my mind that I only treat pt's who wear blue jeans and white T-shirts and swatch watch. . etc.. etc Patient confidentiality also includes medical history and its situations that need to be solved or studied according to the laws of the country that you work in.. this differs from an area to area, in certain countries, informations about patients regarding some infectious diseases pass btw people with out patient approval, other wise in majority of countries there is a prohibition of such behavior unless the dentist gets an approval or an informed content that shows that the patient (such as patients with HIV or hepatitis)is ok with it.

If this patient goes after completion of treatment and visits another dentist who called me to ask if my previous patient has a certain problem….. WHAT SHOULD I DO HERE? I have to look to the law that im confined to and see if it permits me to tell the other dentist informations about the patient or not and do so…if not we should-as we said previously- get an approval from the patient. Every thing related to our patient (X-rays, casts, impressions….) as long as he pays or paid for them they are HIS OWN, and its his right to have them in any time he needs them (upon demand), if he wants to go to other dentist –not you- and he wants the records that are in your clinic then you should give them to him… BUT in certain situations in which there is prohibition of giving records to other dentists such as the teaching center in our faculty where you treat the patient without him paying to you.. and our law here is to keep these records bcoz they are not the patient's own and they are the teaching materials for our dental students.

Some students comments were not well heard in the record so I wrote what the Dr said in regard to each one 1- There is no problem if a doctor tells a story that happened with him but without mentioning names as long as there is a teaching purpose. But if he tends to tell to advertise for him self or to get a benefit.. then this is wrong..

2- some patients tend to keep secrets from doctors or dentists bcoz of the nature of our society that shows non opened relations btw people so they don’t easily tell but you have to do your best to gain his trust and to do every measurement regarding control (e.g infections control) to protect your self and your patient with keeping in mind restrictions about confidentiality to gain respect of the patient.. If the patient gets the idea that you are a part of a community that does not keep secrets then it will be hard for him to trust you and tell his problems that should be known and this is a problem bcoz when your patient tells you this will make your work easier to manage and treat.

Now we come to the 2nd principle which is: Nonmaleficence (do no harm) The dentist has a duty to refrain from harming the patient.. usually and by nature we are not treating the patient to harm him and the primary obligation about this is keeping knowledge and skills current, knowing one's limitations and when to refer to a specialist or an experienced dentist and to know when to use skills of auxiliary personnel who works with him.. Dentist is a part of a community that have a duty of refraining from harming the patients…its not as simple as that

bcoz dentist's

primary obligation is to achieve a difficult aim which is not to harm.. so if you don’t study hard and train very well in a clinic and attend

lectures and understand what's going on and practice very well… then you are HARMING the patient.. Many of 4th year students are not good in treating patients bcoz they still haven’t practiced enough but by the time of graduation they will be better, but if you don’t train your self and keep your knowledge current Î Î Î then you will harm the patient.. /// For example…..if you are a doctor and if you don’t update your knowledge and follow the medications (what's new, what's prohibited….) then you may prescribe an impression material for ex that has been proven to be a carcinogenic and harmful., and if you are a dentist that god gave you lots of money,you open a clinic and get a laser machine but if you don’t train ur self on it then surely you will harm the patient. Primary obligations of this principle are 1Îkeep knowledge and skills current. 2Îknowing one's own limitations and when to refer to an experienced dentist or a specialist.

If you are a general practitioner who just graduated and you faced a case of impacted 3rd molar you SHOULD NOT say :'this is ok I have taken 2 or 3 lectures about this and its enough to help in treating such a case…'….,this is wrong bcoz its not a regular case and needs a specialist (oral surgery department in our case) so we refer it to the specific depart. Provided with a gentle request from

you to treat the case Î Î this is the right ethical way for treatment and its very important to gain the patient's respect bcoz he sees you doing the right behavior. The code of ethics of this principle: Knowing when and under what circumstances delegations of patient's care to auxiliaries is appropriate. Ex.. if I am a dentist just opened my clinic recently and I brought our neighbor hajj Abdullah to help me clean the clinic, he watches most of your work.. Is this enough for him to be considered experienced in your work? (Keep in mind that he is non educated)? The answer is no and you should be careful not to let him work with you and you should only let people who carry a medical certificate to work with you such as assistants or hygienists, even those people shouldn’t also do all the work (not every dental procedure can be assigned to them), for ex dental hygienists can do polishing, scaling, fissure sealing, but they cant do anesthesia (for inferior alveolar nerve block)

The code of professional conduct for this principle: 1- Education, keep knowledge updated, attend lectures… 2- Consultation and refer. a- use of auxiliary aids b- personal impairment

When a dentist (Dr.A) (general practitioner) has a case of periodontal problem he refers it to a periodontist (Dr.B)… if Dr B was so mean then he will start making rumors about Dr A and tell the patient bad things about him and this is wrong.. What's right?? The periodontist should do only the work that has been referred to him and if he sees any health problem in the patient then he should tell (but not treat) the patient about it so that the patient can tell it to Dr A about it IF he wants to complete his treatment there. **personal impairment 20 years later to the previous case if Dr A notices that some of Dr B work is not correct and cozez trauma to the patient due to an impairment in Dr B which could be due to Alzheimers disease or alcohol addiction or etc… here what's the ethical response?? Shall Dr A respect Dr B as an older more experienced person?? Shall he inform the authority about him?? Answer: if Dr B keeps harming the patients then Dr A has the right to INFORM AUTHORITY about him to prevent harming the patients…

Regarding this point Dr haidar told us a story about a Dr of his in his practice Dr haidar had a Dr who was 75 years old by the year 1995, and he had an accident which lead to injury of one of his eyes and then he couldn’t see with it (so he was seeing with only one eye)…

once he was doing an RCT session for a patient and while he was filing, OUR doctor noticed that the patient of HIS doctor seemed to be hurt despite a necrotic pulp that was in that tooth.. Dr wa2el bent down over the patient to see what's going on and he found out that his doctor was doing an RCT IN GINGIVA INSTEAD OF ROOT CANAL ///

Next time Dr will continue what's left from the principles…. Our exam will be held on the 16th of july in the same hall and time of the lecture and it will include different types of questions (fill in the blanks, essay, MCQ?)

Thank you Your colleague: Razan M.Alshehab..