B2W6 FTPC Ethical aspects of dentistry
|What is ethics?||Ethics is a study of rational processes for determing the best course of action in the face of conflicting choices|
|There are two elements to an ethical/moral problem - what are they?|| 1. real choice: between possible courses of action|
2. person places a different VALUE on consequences OF ACTION THAN ANOTHER PERSON MIGHT
eg how to treat people who arrive in australia without a passport
|How do you phrase the course of action to a situation?|| in the form of a statement. Eg. |
In situation X, person Y OUGHT to do thing Z. (where ought implies universality)
Three parts to it
1. what is to be done
2. Who is to do it (y)
3. the conditions under which to perform the action (z)
|Ethical statements vs Empirical, Aestehetic, Command statements.||Empirical - in situation X, person Y often does Z. has the quality of being true of False|
Aesthetic - I like to do thing Z
command - Do Z. Applies to a particular listener at a particular time
* Ethics has a statement requiring action a well as a universal statement. No other statements have a universal statement.
| Types of ethical problem: |
Describe "Good vs evil"
|The most simple type of problem|
| Types of ethical problem likely to encounter:|
"Better or Worse"
| Benefit at a cost|
Or a Worse with better other aspects
eg Salary = 80k and stress
Salary = 40k and peace of mind
|"Good" or "Gooder"||Conflict that occurs when one much choose betwen two exclusively 'good' conditions.|
|Steps in ethical decision making||1. Recognise you are dealing with an ethical problem|
2. List possible causes of action
3. Choose one
4. Phrase it as an ethical statement. "In situation X, person Y ought to do thing Z"
5. List the consequences of such action (empirical statements)
6. Value each consequence
7. If 'yes' for each consequences, it can be assumed to be consistent
8. If consistency is found, re-evaluate
|Rights|| - "If x has a right to A, this entails an obligation to X on the part of others"|
- The business of claiming rights is fraught with difficulties- such as their justification and where they are dubious
Treat others as we would have them treat us.
|Law and ethics (compare)|| Law is concerned with adjudicating conflics in such as a way that is preserves the social order|
ethics concerns our relationships with others and how our values and character traits OUGHT best to be expressed in actions
|Ethical questions of special relevance to health workers||- Doctor/dentist patient relationship. |
Eg patient comes in with a toothache but cannot ascertain which tooth due to proximity of maxillary and mandibular nerve fibers. Patient could be convinced that the pain is coming from one tooth when it really is another
- Informed consent. You need to give the patient all information about the treatment - cost, treatment, side effects, etc.
- Terminal care decisions. Compare to what happens if you do not give out proper treatment
- Participation in ethical decision making
|Ethical Q. Teeth of a demented patient deteriorate and extraction of some of them is necessary under General Anaesthetic. |
Dentist recommended that all teeth should be extracted before anathesia, due to difficulties of oral care, as the as likelihood of the other healthy teeth will cause trouble in the future
Relatives are not happy with this suggestion and the ethics committee is asked to comment.
| - should we extract all teeth of demented patients in the future?|
- IRL no real decision could be made
- extract all teeth as there is good future chance of problems in this patient
|* The 8 essential DC questions|| 1. how common is this?|
2. What is the cause?
2. how is it prevented?
5. Evidence for above?
6. What will this mean for my family?
7.What will this mean for society?
8. What is society doing about it?
|Helsinki Declaration||Governs the conduct of clinical trials in human subjects|
- Administered by ethics committees
* Forces Informed consent
* Gives the right to discontinue participation at any time without prejudice
eg (pre-Helsinki) people with Gonhorrea were given treatment and placebo without their knowledge that there was placebo. This was not ethical.
In Australia it is overseen by NHMRC.