ethics in dentistry and research

The word ethics is derived from

Greek word “ethos” meaning

custom or character

DEFINITION• Ethics is the philosophy of human conduct, a way of stating and evaluating principles

by which problems of behaviour can be solved.

• Ethics is concerned with standards judging whether actions are right or wrong.

DENTAL ETHICSDental ethics simply means moral duties and obligations of the dentists towards thepatients ,professional colleagues and to the society.

• It considers how we should act best in the light of our duties and obligations as moral agents.

• Ethics deals with the choices we make and our actions in relation to those choices.

• It deals with choices made by both clinicians and patients.

HISTORYHippocratic oath is the first ethical standards given by Hippocrates, the fatherof medicine, in the 4th century BC

“prescribe regimens for the good of my patients

according to my ability and my judgment and

never do harm to anyone”

ETHICAL PRINCIPLES1. to do no harm [ non-maleficence ]

2. to do good [ beneficence ]

3. respect the person

4. Justice

5. veracity or truthfulness

6. confidentiality

TO DO NO HARM (non-maleficence)

• Considered to be the foundation of social morality.

• Actions of the healthcare provider should not harm the patients in anyway

• Iatrogenic diseases-doctor induced illness.

• Use of unsterilized instruments

• Iatrogenic diseases (underfilling, overfilling etc)

• Doing procedures beyond his competency

TO DO GOOD ( Beneficence )• A practitioner should act in the best interest of the patient.

• Attempts to maximise the benefits and minimize harm.

• Before doing any action, decide whether it would help the patient to recover

or to perform his functions better

• Plan for a treatment or investigation only if necessary

RESPECT THE PERSON

Autonomy Informed consent

AUTONOMY• It is the principle that dictates that health care professionals respects patients right to make

decisions concerning the treatment plan.

• Dentists usually try to direct the patient towards a particular mode of treatment by stressing

only over the advantages rather than mentioning disadvantages.

• Respect patients right to make decisions

• Don’t force decisions on patients

• Paternalism

INFORMED CONSENTTwo step process

• Firstly information is presented to the patient by doctor

• Secondly the patient satisfies himself or herself that she understands and based uponthis understanding either agrees or refuses to undergo the treatment.

• Description of,a. procedures to be carried out

b. foreseeable risks or discomforts to the subject

c. reasonably expected benefits from the treatment

• A statement that the patient has understood the procedure and is willing to undergo thetreatment.

• The signature of the patient and of a witness.

JUSTICE• Provide equal treatment to all without any prejudice

• Violation of justice• Discrimination between patients based on caste, creed, socioeconomic status, health

condition

• Principle of justice is to protect the weak and to ensure equality in rights andbenefits, for both groups and individuals

TRUTHFULNESS• The patient - doctor relationship is based on trust.

• Lying shows disrespect to the patient and threatens relationship.

• Patient expects the dentist/doctor to give true information about treatment and prognosis

• Don’t:• Hide treatment failures• Give false information

CONFIDENTIALITY

• Health is a sensitive issue

• The patient has right to expect that all communications and records pertaining to their

care will be treated as confidential.

• Disclose only if it is beneficial for the patient (with consent)

• Avoid

- Gossiping about the patient

EHICAL RULES FOR DENTISTS [given by DCI]

• Duties of dentist towards patients

• Duties of dentists towards one another

• Duties of dentists towards the public

DUTIES OF DENTIST TOWARDS PATIENTS

• Dentists should be courteous, sympathetic, friendly and helpful.

• Observe punctuality in fulfilling his appointments.

• Should not permit considerations of religion, nationality, race, party politics or socialstanding to intervene between his duties and treatment

Duties of dentists towards one another• Every dentist should cherish a proper pride in his / her colleagues and should not

disparage them with words or act.

• If a dentist is consulted by a patient of another dentist and the former finds that thepatient is suffering from previous faulty restoration , its the duty of the dentist to correctthe treatment at once with few comments as possible so as to avoid reflection on hispredecessor.

Duties of dentists towards the public

• Dentist should take leadership roles in the communities on mattersrelated to dental health.

UNETHICAL PRACTICES• Practicing by unregistered persons employed by the dentist.

• Signing a certificate issued for untrue, misleading and improper reasons.

• Direct or indirect advertising.

• Use of bogus diplomas.

• Undercharging for solicit patients.

NEED FOR RESEARCH ETHICS

“Many prominent medical researchers in the 19th and 20th centuries conducted experiments on patients without their

consent and with little if any concern for the patients well-being”

NAZI EXPERIMENTS

• Testing with infectious diseases

• Killing

• High altitude experiments

• Experimental surgery

• Traumatic experimentation

• Pharmacological

NUREMBERG TRIAL“ 9 Of the 26 doctors were sentenced to death “

“The basis of the judgment is known

as the Nuremberg Code, which has

served as one of the foundational

documents of modern research

ethics. “

NUREMBERG CODE• Totally voluntary informed consent

• Based on prior animal experiments

• Justification of benefit to individuals and society

• No expectation of death/injury from an

experiment

TUSKEGEE TRIALS

• 1932 forty year old study launched by Public

Health Service Alabama.

• 399 African Americans were selected and

infected with syphilis.

• All the men selected were poor, uneducated and

were desperate to receive Hot meals provided by

the commission.

• Ironically they were also offered Burial insurance.

BELMONT REPORT

•Beneficence

•Respect For Persons

• Justice

•Equal Moral Force

•Ethical Conflicts Expected

THE DECLARATION OF HELSINKI

• Declaration of Helsinki is a set of ethical principles regarding human

experimentation developed for the medical community by the World

Medical Association (WMA).

• It is widely regarded as the cornerstone document on human

research ethics

• Right to make informed decisions regarding participation in research

• Research should be based on a thorough knowledge of the scientific

background

• Careful assessment of risks and benefits

• Conducted by suitably trained investigators using approved protocols,

• Subject to independent ethical review

• Information regarding the study should be publicly available

• Experimental investigations should always be compared against the best

methods, but under certain circumstances a placebo or no treatment group

may be utilised

CONCLUSION• Healthcare is not a business.

• Hence, adherence to a code of ethics is important for the continued trust of the society in dentistry.

• Ethics is not a rule or cannot be forced on anyone……………………………… ..…………………………………………………………....It has to be self cultivated.