Ethical Decision-making

Ethical problems arise for the clinician in professional practice when the dentist or hygienist is caught between two or more competing obligations. Throughout their lifetimes, health care professionals face situations that require carefully weighing options. Often no right or wrong answer exists. Instead a variety of answers may be possible, each of which may have an element of rightness about it. Most decisions must be made in the context of professional, social, and economic pressures, which may be in conflict with values and principles. Determining what to do when faced with an ethical dilemma can be an easy problem or a daunting challenge. Making such decisions can be greatly facilitated by the structure of an ethical decision-making model.

Teaching about ethics in dental and dental hygiene educational programs has been acknowledged as an essential part of the education of the dental health care professional since 1989 when the American Dental Education Association (ADEA) established guidelines for all dental-related educational programs that stated curriculum should provide opportunities for refining skills of ethical analysis so students are able to apply ethical principles to new and emerging problems in the profession. The goal of these curricula was to develop a commitment by the students to the moral principles that are the basis of the profession’s contract with society. Moreover, students should be encouraged to develop an attitude that ethical decision-making is a process involving lifelong learning and commitment.1 The ADEA policy has been revised since that time to include expanded statements on professional behavior, societal obligations, access to care needs, and community service.2 Intellectual and clinical skills are essential to the competent provision of oral health care, which is why ethics and professionalism content are required in educational curriculum.

A health care professional is influenced by a number of factors including age, education, training, family, experiences, religious beliefs, culture and societal norms. What is different for the health care professional in decision-making is that he or she has professional obligations and duties – placing the best interests of patients foremost in the diagnosis and treatment process. Each patient is unique and thus a case by case evaluation is appropriate when carefully reflecting and reasoning a course of action.