2) Radiographic refusal is a huge problem in many practices due to the economy and lack of insurance. In addition, he emphasizes if an emergency were to occur or the patient had more questions for the dentist, the dentist needed to be available. Knowing the major principles of health-care ethics and how to use a model to solve an ethical conflict is the best way to solve a dilemma. Step five, make the decision, is now apparent by evaluating your pro and con worksheet. These dilemmas can vary depending on the type of practice, specialty, and age of patients in the practice. J Am Coll Dent., 73(3): 36-39.7. Hopefully, we all follow it to the best of our ability. The specific case examples that follow relate to the ethical principles presented in chart 1, and values that correspond to these principles in our profession. The dental hygiene oath was originally adopted by the ADHA in 1948 and included a reference to Alfred Fones, DDS—the founder of the dental hygiene profession.3 The modern version of this oath was adopted by ADHA Board of Trustees in 1979.2,4 Although the word “ethics” or “ethical” is not specifically mentioned in the dental hygiene oath, dental hygienists have an ethical and moral obligation to uphold the oath and maintain high professional standards. JADA Ethical Moment Articles Since 2004, the Council on Ethics, Bylaws and Judicial Affairs has contributed a series of articles discussing ethical dilemmas confronted in the practice of dentistry. 1 Dental Hygiene; Career Development; Ethics in dental hygiene. The patient’s periodontal status is declining. The objectives of this code are to:1, The ADHA published a second document, Standards for Clinical Dental Hygiene Practice, which was also revised in 2016. Similar to how keeping a food diary can help with nutritional counseling and counting calories, writing down the items in each of these steps can assist with ethical decision making.2. Identify the problem. I found Zen to be the hardest. In this case, there is no mention of possible endodontic treatment or replacing the extracted tooth (if extraction is required) with an implant. The decision making steps are as follows: Following is a different type of ethical dilemma regarding employment issues. She is the dental hygiene product specialist for Maxill. Paternalism violates this patient’s autonomy and self-determination, and ethically involves nonmaleficence due to not giving the patient the right to informed consent; thus, paternalism is the opposite of informed consent. (Nov. 2010). Interestingly, the authors found 86% of respondents received instruction in ethical theory, but only 51% stated they received instruction in solving ethical problems. The patient’s previous six to 12 months of treatment and most current x-rays could be discussed. According to Beemsterboer,2 eight categories of ethical dilemmas are most frequently encountered by dental hygienists (Table 3). Ethical Decision Making Essay 834 Words | 4 Pages. Due to this focus on the teaching of ethics in dental hygiene programs, current ethics education has transitioned from primarily lecture format to more case-based and discussion methods that enhance student learning.13 It is important to work through ethical scenarios in dental hygiene education using ethical decision making so that clinicians are prepared to solve ethical dilemmas when they arise. But her dentist’s enthusiasm was infectious. The patient reports he had a traumatic experience with the previous dentist and periodontist. Complete periodontal and radiographic assessments and ask the patient about any changes in medications or control of systemic conditions that may affect his periodontal status. TM is difficult for some folks, as are many other forms of meditation. Kacerik MG, Prajer RG, Conrad C. Ethics instruction in the dental hygiene curriculum. Apply the ethical principle to the options, Includes “Self-determination, the right to decide what happens or does not happen to us”5, Knowledge of all information regarding treatment, risk, and benefits, Patients make their own decisions, the right to say yes or no to treatment, Patients have a right to confidentiality and privacy regarding their health care, Promote good for the patient; protect the patient from harm, Acting in the best interest of the patient, Do not undertake a procedure without the patient’s consent (informed consent) or do a procedure for which you are not adequately trained, Do not discriminate any patient seeking a dental diagnosis or treatment. Inform the patient of his change in periodontal status or complete the maintenance appointment without discussing the periodontal findings. Careful ethical decisions can be greatly facilitated by the structure of an ethical decision-making model. List alternatives. The dentist did not push the patient to consider X-rays and had no intention of dismissing him from the practice. Step three, state the options, is a step-by-step process or analysis to judge each option and the consequences related to each option. Because dental hygienists are health care professionals, they have a professional responsibility to practice in an ethical manner. The topic of ethics is engrained in dental hygiene students from matriculation through graduation. Tips and tricks: Preventing activation of gag reflex when exposing radiographs. Available at: ada.org/ ~/media/CODA/Files/dh.ashx. Are principles in conflict? Lead dental hygienists to recognize ethical issues and choices and to guide them in making more informed ethical decisions. This allows for patient autonomy, self-determination, and beneficence, thus avoiding paternalism. 8,10,11. Luckily, his calculus formation is now under control, with no subgingival evidence on the X-rays. As society advances, the types of potential ethical concerns increase. St Louis, MO: Saunders Elsevier.2. 1. Dental hygienists are charged with continuing to practice with the highest standards of care, remembering the oath taken prior to becoming a licensed professional, and always “doing the right thing.”. (2009) Ethics, professionalism and fitness to practice: three concepts, not one. Brondani MA, Rossoff LP. What are the cell phone policies in your dental office? This case involves a patient who has refused any type of X-ray since 2005. Beemsterboer recommends, “State how each alternative will affect the ethical principle or rule by developing a list of pros and cons.”1 List each principle violated while considering specific values such as supervised neglect, informed consent, paternalism, and more. Using the following decision-making steps may appear simplistic, but it can be extremely useful in solving ethical dilemmas. The new patient presents with generalized 4 mm to 5 mm probing depths, classified as moderate chronic adult periodontitis, which has been treated in the past. Jenson L. (February 2005). Teaching ethics in dental schools: Trends, techniques, and targets. An effective model for dental health-care professionals to evaluate and solve ethical dilemmas is illustrated in “Ethics and Law in Dental Hygiene” (2010) by Phyllis L. Beemsterboer. The authors concluded that dental hygiene programs should look for ways to improve students’ comprehension of numerous ethical issues. Gather the facts. Larson J. It’s not for the faint of heart, but forensics can be a very rewarding area. The dental hygienist decides to look for other employment opportunities and leaves the original office when a new position is secured. The first core value involves autonomy, in which patients have the right to full disclosure of relevant information so they can make informed choices about their care. The patient is given a treatment plan of extracting a painful tooth and fabricating a three-unit bridge for tooth replacement. List and define the American Dental Hygienists’ Association’s core values. There are conditions when patients slip through the cracks, or long-term patients become so comfortable in a practice they’re allowed a great amount of autonomy, which becomes a detriment to their best interest. Then hygienists can address, analyze, and solve ethical dilemmas properly using their ethical training within the “context of clinical, workplace, and professional situation[s].”4 RDH. Ethical moment: what ethical issues should general dentists consider when the state of the economy affects decisions regarding referral of patients to specialists. Ethical moment: what ethical responsibilities do I have with regard to radiographs for my patient? The decision-making steps are as follows: Many factors should be considered when making ethical decisions. The dental hygienist chooses to inform the patient as she realizes several core values are evident. The dental hygienist could face action by the dental board if the situation came to its attention. Of course, paternalism is not acceptable today because it eliminates patients’ right to choose the treatment they feel is right for them, even if their choice is not what the doctor feels is best. Information collection is necessary to make a balanced ethical decision. The patient feels awful, and the dentist feels terrible for the patient, but he does not see that this as a case of supervised neglect. J Am Dental Assoc., 141 (9) p. 1125-1126. After elaborating on the scenario you could then tackle the question by applying the four pillars of Medical Ethics which applies to dentistry as well. She is the current vice president of education for Camelback Toastmasters in Glendale, Ariz. and recently awarded 2010-11 Outstanding Area Y7 Toastmaster of the year. Beemsterboer outlines the following six-step decision-making model. It is my fervent hope that the 468 readers who responded to an RDH survey about occupational health are the only ones experiencing job-related pain. However, there are some ethical areas that are more common and will be highlighted here. 100 Years of Dental Hygiene. When working through each step, other factors to consider are the professional code of ethics; advice from superiors, peers, and role models; and previous personal experience. In essence, the personalized value system becomes a “moral code” for that individual. I`d like to add a note about your article on Transcendental Meditation (TM) (March 1999 issue). One patient had a lesion that hurt when she ate, and another felt like she had an infection in her wisdom tooth. The dental hygienist discusses his concern with the dentist but she continues to leave the practice early, even when the dental hygienist has patients to complete. It is true that the ADA ethical code’s first principle is “patient autonomy” [it states in part], “professionals have a duty to treat the patient according to the patient’s desires, within the bounds of accepted treatment.”8 Seven years without X-rays is not within the bounds of accepted treatment. Years ago the “doctor knows best” approach regarding treatment was common. Working through an ethical dilemma does not come easily, but takes practice and careful consideration. Differentiate between ethics and clinical ethical dilemmas. Dental considerations of neuroendocrine tumors and carcinoid cancer . For example, if you are asked about a patient with dental decay who refuses to use fluoride toothpaste you could discuss what your understanding is of both dental decay and the use of fluoride. Wentworth R. (Sept. 2010). 1. Improving the Nonsurgical Treatment of Periodontitis, ADHA Joins AAP in Support of Pediatric Oral Health. 207(2), 59-62.4. While dental hygienists make decisions every day, ethical decision making can be more complex. Beemsterboer P. (2010). “Beneficence and nonmaleficence are often linked because both are found in the Hippocratic tradition, which requires the physician [dentist or hygienist] to do what will best benefit the patient.”1 It is important for the dental hygienist to consider all four ethical principles when weighing a moral dilemma regarding patients. She addresses patient refusal, as well as offers suggestions about how and when to take radiographs in specific situations. One would assume the option with the most pros would be the correct decision, but carefully evaluating the degree of severity regarding the consequences in the con column may have an affect on your decision. 2 For example, a patient requests a 12-month recare schedule due to financial difficulties (autonomy), but the dental hygienist believes that 4-month appointments are what the patient needs to improve his oral health (beneficence). Dental hygiene ethics is an essential component of the dental hygiene curriculum. What? Beemsterboer outlines the following six-step decision-making model.1. Accessed April 18, 2017. National Board Dental Hygiene Examination 2017 Guide. Many documents reinforce this ethical practice directive. In some instances, compromises can be made, such as agreeing on a 6-month recare for the example above. Identify the problem. She can be contacted at nicolerdh03@neo.rr.com. . Act on the decision. Interestingly, many providers do not take into account the pain people will experience as an ethical problem — “for some, pain still seems to be only a technical problem solved by treatment.”6 Pain is an ethical concern for patients and should be incorporated into the informed consent information when presenting options for patients. However, allowing students a personal experience via instruction and role-playing engages students in realistic ethical discernment, which gives them the “tools necessary to deconstruct an ethical dilemma.”4 Continuing and broadening school-setting ethical training instruction is necessary to increase hygienists’ awareness in solving ethical conflicts. Critical Review of Ethical Decision Making In the profession of Dental Hygiene, ethical dilemmas are nearly impossible to avoid, and most hygienists at some point in their professional life will have to face and answer ethical questions. Retreived online Dec. 9, 2011 from http://jada.ada.org/content/141/9/1125.full8. Beneficence now becomes a concern. Troubleshoot as many options and their full consequences before proceeding to the next step. Pain can have a substantial effect on the treatment options patients consider. Ethical issues in health care are common. Ethics and law in dental hygiene (2nd Ed.). Currently, the NBDHE consists of 350 questions, and 18 specifically focus on professional responsibility, including ethical principles, informed consent, regulatory compliance, and patient and professional communication.12. Bylaws and Code of Ethics. When tough decisions need to be made on behalf of our patients, we need the tools to do it. At times, these decisions are clear; other times ethical dilemmas create conflict with employers, colleagues, or clients. The provider needs to make sure patients understand their options, and patients then acknowledge they have all the information, benefits, and risks along with their financial obligation. The dentist does not think the patient will consider a periodontal referral due to his age and advanced periodontal condition; thus no referral is offered (paternalism, nonmaleficence). However, tooth No. 31 is not so lucky. The behavior of the dentist does not change. Several studies were conducted in the 1980s on how ethical instruction was taught in dental hygiene curricula. Instead of being able to rely on external standards, people have to rely on their morals and values to navigate such situations. Establish a standard of professional judgment and conduct. Available at: amnhealthcare.com/latest-healthcare-news/five-top-ethical-issues-healthcare/. Consequentialism looks at the end results of any particular act. State the specific conflict, then evaluate and apply the specific health-care principles that conflict with one another. Available at: adha.org/resources-docs/7611_Bylaws_and_Code_of_Ethics.pdf. Also, ethical situations can involve academic integrity and the ability to “do what is right.” It is the student’s ethical responsibility to report the clinical findings to the patient and to provide accurate assessment of their dental condition. As you read through these vignettes, consider how you would handle similar situations. Paternalism is the practice of acting as the “parent,” which is taking it upon oneself to make decisions for the patient. Retreived Dec. 9, 2011 from http://jada.info/content/141/6/718.full?related-urls=yes&legid=jada;141/6/7189. Nonmaleficence is included in the ADA Code of Professional Conduct description as doing no harm and “… knowing one’s limitations and when to refer to a specialist or another professional.”7. Scenario #1. Here are 10. Brennan M. (March 2010). She quickly found she wanted to learn all she could about it, and she’s glad she did. The dental hygienist chooses to speak to the dentist one more time, being more adamant about the legalities of the situation and how he does not want to jeopardize his dental hygiene license. If the decay had been detected earlier via routine X-rays, a new three-unit bridge could have been fabricated because this tooth had enough bone to warrant a new bridge. In this example, nonmaleficence is the primary ethical principle at issue. After a few weeks of working in the office, the dental hygienist observes that the dentist leaves early upon completion of her own scheduled appointments and after finishing all hygiene exams. Both these situations result in cause for disagreement between the dental hygienist and his or her employer in which an ethical dilemma will ensue. This patient did not have all the information needed to make an informed decision for care. Five top ethical issues in healthcare. 1) A long-term periodontal patient is currently receiving periodontal maintenance recalls every three months. Available at: tiki-toki.com/ timeline/entry/55646/100-Years-of-Dental-Hygiene/ #vars!panel=679914!. She also understands that the patient is trying to comply and is concerned he would be upset if she mentioned that his periodontal status was declining. Select the course of action. 141 (10): 718-720. Without following through and acting on your decision to the ethical dilemma, there will be no resolution for the patient or party affected. An example of a true ethical dilemma is when the principle of nonmaleficence is in conflict with the principle of autonomy in a specific situation. Ethics is a difficult concept to define because it is viewed very differently depending on the particular dilemma. Discuss the evolution of ethics education. In most dental hygiene programs, the dental hygiene oath is either recited during a matriculation ceremony, graduation ceremony, or both. ... example, dental hygienists trained in a dental school setting often have the opportunity to collaborate with dental students regarding patient care. The dental hygienist is familiar with the laws in his state and knows he needs to work 1 year before becoming eligible to practice under general supervision. The agreement may even state estimates relating to each treatment option. He could terminate his employment at the office, although this is not an ideal option because he has a significant student loan debt and he truly enjoys working at the dental practice. The process. He states he will comply with treatment but will refuse any periodontal surgery or future supportive periodontal therapy beyond his 4-month periodontal maintenance visits. A dental hygienist may be faced with a variety of ethical issues and moral dilemmas. © 2020 Endeavor Business Media, LLC. They demonstrate how clinicians can work through the six decision-making steps. Throughout their professional career in any practice setting, a dental hygienist is expected to understand and adhere to the ADHA Code of Ethics.”5, Lastly, the Commission on Dental Accreditation (CODA)—the agency that establishes and applies standards to ensure quality in dental-related education—states in Standard 2-19, “Graduates must be competent in the application of the principles of ethical reasoning, ethical decision making, and professional responsibility, as they pertain to the academic environment, research, patient care, and practice management. Gather the facts. Accessed April 18, 2017. The ADHA maintains a Code of Ethics for Dental Hygienists that was revised and re-adopted in June 2016.1 This document specifically delineates its purpose, key concepts, basic beliefs, fundamental principles, core values, and standards of professional responsibility. What is taught in between these ceremonies is designed to help students understand what the oath really means. Dental hygienists will face ethical dilemmas at some point in their careers. Ethical Dilemma Situations. With ethical dilemmas, there is no equation to plug into. The respondents felt that dental hygienists had a strong duty to report, intercede, or educate in areas of abuse, sexual harassment, detection of cancer, and smoking cessation. Beemsterboer (2001) suggests these attributes to be as follows: Doing the right thing when confronted with a difficult circumstance is one way to define ethical behavior. Step two, collect specific information, is critical to the case in question. This dental hygienist admittedly had mixed emotions when she first heard the pediatric practice where she works was purchasing a CBCT unit. Vital [serial online] 7(2): 37-39. Show the pros and cons of each option and its consequences discussed in step three. Ethical dilemmas occur all too frequently in everyday life. The patient was practicing his autonomy; however, the dentist was not considering beneficence for this patient. Commonly encountered issues include substandard care, patient overtreatment, confidentiality breaches, fraud, suspected abuse, sexual harassment, scope of practice challenges, and dealing with impaired professionals.4 Dentistry usually is performed in solo or small group practices where formal groups, such as ethics committees or standard review boards, provide little, if any, institutional oversight. May 2017;15(5):37-40. In 2006, a study was conducted among graduating dental hygiene students to determine their attitudes toward specific ethical dilemmas.10 The findings indicated that many dental hygiene students did not understand their ethical role in addressing behaviors in the practice environment. The patient is exercising his or her autonomy. Practicing in the dental profession, dental hygienists see an array of ethical concerns while treating patients. All rights reserved. This is why educational ethics programs in dental hygiene schools are important. Ethical dilemmas in dental assisting. For that reason, it was a surprise for me that Dental field was not the unique career which corresponds with my interest and personality type. When instituted within the curriculum, hygienists have the opportunity to participate in group instruction and use workshops to role-play. Different ethical decisions can be made regarding the same ethical dilemma, resulting in no right or wrong conclusion. In today’s economic climate, one would assume overselling or overtreatment would be more widespread than supervised neglect, but surprisingly, supervised neglect does occur, even in good dental practices. British Dental Journal. Gagging in the dental chair is embarrassing and awkward for everyone. Joint Commission on National Dental Examinations. Not taking X-rays for so long is a form of nonmaleficence, and it does not benefit the patient and can harm the patient due to undetected periodontal disease, decay, pathology, and more. Hamel O et al. It’s made a very positive difference in the practice. Increase dental hygienists’ professional and ethical consciousness and sense of ethical responsibility. Accreditation Standards for Dental Hygiene Education Programs. The teaching of ethics in the dental hygiene curriculum. The hygienist is beyond frustrated because she feels she is in over her head. Collaborative efforts then be- ... curriculum in clinical ethics. The following listing provides the general categories that have been acknowledged as ethical dilemmas in the dental ethics literature. Why bother with ethics and law? J Dent Educ., 69(2):225-8. The standards state, “Dental hygienists are responsible and accountable for their dental hygiene practice, conduct, and decision making. The black, white, and very gray areas of radiology. In 1990, a survey of ethical issues among dental hygienists was conducted.9 This survey evaluated the type and frequency of ethical issues encountered and asked the participants about the education they received in ethical theory and problem solving. But I suspect that`s wishing for too much. Marcy can be contacted at Ortiz7688@cox.net. In other cases, there is no compromise and a decision must be made. Marcy Ortiz, RDH, BA, is a practicing dental hygienist for 25 years, the last 16 years in a geriatric dental practice in Sun City West, Ariz. She is a 2010 Arizona State University alumna graduating summa cum laude and a member of the Golden Key International Honour Society. Cultivating professional responsibility in a dental hygiene curriculum. Gaston MA, Brown DM, Waring MB. The American Dental Hygienists’ Association’s Code of Ethics states that dental hygienists have a responsibility to the community and society to “promote access to dental hygiene services for all, supporting justice and fairness in the distribution of healthcare resources.”(4) Commission on Dental Accreditation. Sign up for Registered Dental Hygienist (RDH) Magazine eNewsletters. Ethics is the study of moral values and moral reasoning. While a career in dental hygiene is incredibly fulfilling, it is not without challenges. Dental professionals, including dental hygienists, are confronted daily with difficult choices that require decisive action and judgment calls for which careful deliberation is required.4 To enable a fair consideration for all parties, certain guidelines or health-care principles are available to “weigh the potential consequences (benefits and harm) and the rights and general welfare of all involved.”4 The four principles of health-care ethics are autonomy, beneficence, nonmaleficence, and justice5 (see chart 1). Many different styles of meditation are available. As a clinical consultant, Nancy Miller, RDH, saw plenty of enviable operatories. However, they were less likely to report issues such as fraud, inadequate infection control, exceeding practice scope, and failure to diagnose disease when these incidences could potentially affect their employment. Dental hygienists face ethical dilemmas and perhaps even legal issues throughout their careers, but a strong educational foundation in ethics and ethical decision-making can help guide their actions and behaviors. 31?” Reluctantly, the patient agreed to an FMX the next visit. 2 College of Dental Hygienists of Ontario Besides having a Code of Ethics, the dental hygienist must possess and continue to develop professional traits that are paramount (central) to ethical behaviour, ethical decision-making and the maintenance of ethical standards. . He does not want to jeopardize the patient’s care in any manner (nonmaleficence). Here are some examples and words of encouragement from the ADAA president. The author concluded the changes made in the curriculum were effective.11, Not only did dental hygiene curricula change as a result of the importance of ethics education, a category of “Professional Responsibility” was added to the National Board Dental Hygiene Examination (NBDHE) in 2005. As clinicians providing care and services, every dentist and dental hygienist will be faced with many choices, problems and dilemmas. As professionals, we need be familiar with the code of ethics to help guide our behavior. The “hot seat” experience: a multifaceted approach to the teaching of ethics in a dental curriculum. In 2013, a study at the University of Minnesota looked at the effectiveness of changes made to its curriculum.11 These changes included adding new courses and updating others in an effort to enhance professional identity and responsibility. Each situation involving human beings will be unique since each problem or dilemma will have distinguishing aspects. Instead, the dentist puts the blame on the patient for refusing the care offered. A dental hygienist is hired at a private practice immediately upon graduation from his dental hygiene program. Do you have a legitimate ethical dilemma? American Dental Hygienists’ Association. Evaluate the action. Due to the patient’s age, the dentist feels this is the easiest approach so the tooth will not give the patient any problems in the future. Speaking from her experience as a dental hygienist and former dental assistant, Jamie Collins, RDH, CDA, shares some tips on how to develop healthy relationships in the dental office. The treating hygienist explained, once again, the need for X-rays. Dental assistants will probably face some ethical dilemmas during their careers, and the ADAA upholds the highest code of conduct in any and all cases. Purpose. Ethical challenges or problems faced by practising dental hygienists tend to fall into the categories of ethical violations, ethical dilemmas, and ethical distress. American Dental Hygienists’ Association. (2006). An abnormally large and misshapen mandibular tooth was noted during the clinical exam. This worksheet does not have to be anything formal. What are the implications of residual root sockets? The information can be specific statements of fact and can come from a variety of sources pertaining to how the conflict began, how it proceeded, and what parties are involved. Patients deserve to exercise their self-determination, but not at the risk of their dental health. An example … The dental hygienist discusses the findings with the patient and informs him that she will present these findings to the dentist, so everyone can be involved in the decision about whether to proceed with further periodontal treatment. In step four, apply the ethical principles to the options. Unfortunately, the patient did lose several teeth that had advanced periodontal pocketing, but he is now receiving active periodontal therapy via the periodontist (beneficence). Ethical dilemmas arise when one or more ethical principles or core values are in conflict. J Am Dental Assoc. This patient developed a moderate amount of calculus and a suspicious area on the lingual of tooth No.