BDS,MPH,MRACDS(DPH),MBA.

Malaysian Dental council

• Upholding and maintaining professional

standards and ethics in the practice of
dentistry; and exercising disciplinary
jurisdiction over any registered
practitioner who violates the code of
professional conduct or who has
committed an offence against the Dental
Act 1971.
• Introduction
• Towards patient
• Towards society
• Towards colleagues
• In dental research
• Ethical Issues
• Introduction
• Towards patient
• Towards society
• Towards colleagues
• In dental research
• Ethical Issues
• A branch of philosophy and theology
• The systemic study of what is right and good
• With respect to conduct and character
• Ethics is pluralistic
• Set of moral principles
• Great deal of freedom to act however one wants
• As long as it does not violate the rights of others
• Respect for autonomy
• Non-malfeasance
• Beneficence
• Justice
Dentistry is both a science and an art
• Science: scientific knowledge
(Diagnosis and treatment)

• Art: application to individual patients

(human individuality, culture, religion, freedom,
rights and responsibilities)
• Something special
• People come for help
- relief from pain and
suffering
- restoration of oral health
and well-being
• They surrender themselves

• They trust their dentists

Compassion
– understanding and concern for another person’s distress

Competence
– A very high degree of competence is both expected and required

Autonomy
– Self determination, clinical and professional autonomy
• Introduction
• Towards patient
• Towards society
• Towards colleagues
• In dental research
• Ethical Issues
 Principles to follow

• PATIENT AUTONOMY (“self-governance”)

• NONMALEFICENCE (“do no harm”)

• BENEFICENCE (“do good”)

• JUSTICE (“fairness”)

• VERACITY (“truthfulness”)
 PATIENT AUTONOMY (“self-
governance”)
• You have a duty to respect the patient’s rights
to self-determination and confidentiality.

• This principle expresses the concept that you

have a duty to treat the patient according to
the patient’s desires, within the bounds of
accepted treatment, and to protect the
patient’s confidentiality.
 PATIENT AUTONOMY (“self-
governance”)

• Under this principle, the your primary

obligations include involving patients in
treatment decisions in a meaningful way,
with due consideration being given to the
patient’s needs, desires and abilities, and
safeguarding the patient’s privacy.
 NONMALEFICENCE (“do no
harm”)
• You have a duty to refrain from harming
the patient.

• This principle expresses the concept that

professionals have a duty to protect the
• patient from harm.
 NONMALEFICENCE (“do no
harm”)
• Under this principle, your primary
obligations include keeping knowledge
and skills current, knowing one’s own
limitations and when to refer to a specialist
or other professional, and knowing when
and under what circumstances delegation
of patient care to auxiliaries is appropriate.
BENEFICENCE (“do good”).

• The dentist has a duty to promote the

patient’s welfare.

• This principle expresses the concept that

you have a duty to act for the benefit of
others.
 BENEFICENCE (“do good”).

• Under this principle, the your primary

obligation is service to the patient and the
public-at-large.

• The most important aspect of this obligation

is the competent and timely delivery of dental
care within the bounds of clinical
circumstances presented by the patient, with
due consideration being given to the needs,
desires and values of the patient.
 JUSTICE (“fairness”).

• You have a duty to treat people fairly.

• This principle expresses the concept that

you have a duty to be fair in your dealings
with patients, staff, colleagues and
society.
 JUSTICE (“fairness”).

• Under this principle, the dentist’s primary

obligations include dealing with people justly
and delivering dental care without prejudice.
•
• In its broadest sense, this principle
expresses the concept that the dental
profession should actively seek allies
throughout society on specific activities that
will help improve access to care for all.
VERACITY (“truthfulness”).

• You have a duty to communicate

truthfully.

• This principle expresses the concept that

you have a duty to be honest and
trustworthy in your dealings with people.
 VERACITY (“truthfulness”).

• Under this principle, the your primary

obligations include respecting the position
of trust inherent in the dentist-patient
relationship, communicating truthfully and
without deception, and maintaining
intellectual integrity.
• Cornerstone of dental practice
• Traditionally: a paternalistic one
• In which the dentist made the decisions
• Patient submitted to them
• It has been widely rejected in recent years,
both in ethics and in law
“ All human beings deserve respect and equal
treatment”
Disrespectful and unequal treatment of
individuals and groups is no more regarded
as normal and natural

“All human beings are born free and equal in

dignity and rights”
Universal Declaration of Human Rights (1948)
• “Refuse to accept patients into their practice or deny
dental service to patients because of the patient’s race,
creed, color, sex or national origin”
(ADA)

• “To decline to treat a patient, except for the provision of

emergency care, for humanitarian reasons, or where the
laws of the country dictate otherwise
(FDI)
• Informed consent: central concepts-dental ethics
• The right of patients to make decisions about their health
• When dental paternalism was normal
– communication was relatively simple
– it consisted of dentists telling their patients what
treatment they were going to perform
 Three major obstacles are differences of

 Language
 Culture
 Patient speech impairment during Rx
• Young children
• Certain psychiatric or neurological conditions
• Require substitute decision-makers
• Either the dentist or another person
• Competency of patient
• Appropriate substitute decision-maker and his choice
“What I may see or hear in the course of the treatment or even
outside of the treatment in regard to the life of men, which
on no account one must spread abroad, I will keep to
myself holding such things shameful to be spoken about.”

Hippocratic Oath

Autonomy, Respect for others and Trust

 Some patients are very difficult to treat,
not because of their oral health status
but because of their attitudes or behavior
• Oral health care: relatively little financial support
from governments

• Consequently, the costs of dental services are often

a more pressing issue for patients
• Introduction
• Towards patient
• Towards society
• Towards colleagues
• In dental research
• Ethical Issues
• Dentists have various relationships with society.
• Because society, and its physical environment,
are significant factors in the health of patients,
both the dental profession in general and
individual dentists have important roles to play
in public health, health education, environmental
protection, laws affecting the health or well-
being of the community, and testimony at
judicial proceedings.
• libertarian — resources should be distributed
according to market principles (individual choice
conditioned by ability and willingness to pay,
with limited charity care for the destitute)
• utilitarian — resources should be distributed
according to the principle of maximum benefit
for all
• egalitarian — resources should be distributed
strictly according to need
• restorative — resources should be distributed
so as to favour the historically disadvantaged.
• The need for collaboration
• Relationships among Dentist Colleagues,
Teachers and students
• Fee-splitting and adevertising
• Reporting unsafe or unethical practices
• Relationship with other health professionals
• Cooperation
• Conflict resolution
• Importance of dental research
• Research in dental practice
– Phase 1: small group of healthy volunteers
– Phase 2: small group of patients
– Phase 3: large no of patients
– Phase 4: licensed and marketed,
first few years: monitored
• Ethical requirement
• Ethics review committee approval
– Scientific merit
– Social value
– Risks and benefits
– Confidentiality - whistle blowing
– Conflict of roles - un resolved issues
– Honest reporting of results
• Introduction
• Towards patient
• Towards society
• Towards colleagues
• In dental research
• Ethical Issues
• Patient lack resources
– Cannot pay for services as you prescribe
– Insurance doesn’t cover the treatment
• Conflict between clinicians
– Errors in case records
– Difference of opinion
• Practices or policies inconsistent
– Failure to follow universal precautions
– Over prescribing antibiotics
• Appropriate consent and decision maker
– Patient unable to make decision
– No concerned guardian to give consent
• Refusal of treatment plan
– Restoration for grossly decayed teeth
– Extraction due to severe pain where tooth can be
saved
• Difficult patients
– Patients yell at student or staff
– Late or absent for appointments
• Mistakes
– Damage healthy tooth
– Pulp exposure
• Cultural issues
– Communication inadequate (no translator)
– Patients values in decision making
• Breaking bad news
– Disclosure of any negative results
• Breach of confidentiality
– Informal discussion or gossip about patient
among the staff and students