The three ethical dilemmas most frequently encountered in dental hygiene practice are (1) observation of behavior in conflict with standard infection control procedures (66%); (2) failure to refer patients to a specialist such as a periodontist (60%); and (3) nondiagnosis of dental disease (58%). The first step is to identify what the ethical question is, being aware of â¦ An ethical dilemma occurs when one of the above principles conflicts with another.1 For example, a patient decides he or she wants to save money by refusing X-rays for the fourth year in a row. Available at: ada.org/ ~/media/CODA/Files/dh.ashx. She discusses the patient’s options during a few maintenance appointments and stresses he will eventually lose some teeth if further treatment is not considered. (2009) Ethics, professionalism and fitness to practice: three concepts, not one. Many different styles of meditation are available. This worksheet does not have to be anything formal. The ramifications of cheating include not only harâ¦ A new patient is referred to the dental office by a long-standing patient. Dental considerations of neuroendocrine tumors and carcinoid cancer . Too often a war of opinions between hygienists and assistants breaks out in dental offices, which can result in a miserable or even hostile work environment for the entire staff. Inform the patient of his change in periodontal status or complete the maintenance appointment without discussing the periodontal findings. 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. Therefore, the authors concluded that the majority of respondents encountered serious ethical dilemmas in their practices and as a result, found that entry-level education should include more education in solving ethical dilemmas.9. It’s not for the faint of heart, but forensics can be a very rewarding area. The hygienist is beyond frustrated because she feels she is in over her head. Evaluate the action. She addresses patient refusal, as well as offers suggestions about how and when to take radiographs in specific situations. The first step, identify the ethical dilemma, is to pinpoint the ethical problem. Retrieved Dec. 27, 2011 from http://www.merriam-webster.com/dictionary/ethic3. British Dental Journal. Survey of ethical issues in dental hygiene. The patient’s periodontal status is declining. Ethical challenges or problems faced by practising dental hygienists tend to fall into the categories of ethical violations, ethical dilemmas, and ethical distress. The dentist is not in the office while the newly graduated dental hygienist is still treating patients, which is in violation of the state’s dental practice act. He does not want to jeopardize the patient’s care in any manner (nonmaleficence). This is the case with technology, in both the dental hygiene workplace and in academia, especially in the area of social media and information sharing. 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. Commission on Dental Accreditation. 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. Five top ethical issues in healthcare. I found Zen to be the hardest. National Board Dental Hygiene Examination 2017 Guide. 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. (Nov. 2010). What are the cell phone policies in your dental office? The agreement may even state estimates relating to each treatment option. Step five, make the decision, is now apparent by evaluating your pro and con worksheet. 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. However, tooth No. Ethics is a difficult concept to define because it is viewed very differently depending on the particular dilemma. The dentist did not push the patient to consider X-rays and had no intention of dismissing him from the practice. It’s made a very positive difference in the practice. What is the hygienist to do? While a career in dental hygiene is incredibly fulfilling, it is not without challenges. 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. Duley SI, Fitzpatrick PG, Zornosa X, Lambert CA, Mitchell A. Ethical is also defined as “maximizing the good while minimizing the bad,”1 or according to Merriam Webster, ethics is “the discipline dealing with what is good and bad and with moral duty and obligation.”2 Another definition is being professional and being able to deal with morally perplexing situations.3 Regardless of the definition, it is not always easy to do the right thing in a given circumstance because the right choice may not always benefit the hygienist’s best interests. Available at: adha.org/resources-docs/2016-Revised-Standards-for-Clinical-Dental-Hygiene-Practice.pdf. Understanding and applying legal and ethical principles protects the provider (dental hygienist), the client, the employer, and the employee. List alternatives. 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. Dental hygienists will face ethical dilemmas at some point in their careers. He could discontinue the treatment of his patient when he knows the dentist has left the office. These dilemmas can vary depending on the type of practice, specialty, and age of patients in the practice. The consequentialist considers the consequences and â¦ 31 (part of a three-unit bridge). Improving the Nonsurgical Treatment of Periodontitis, ADHA Joins AAP in Support of Pediatric Oral Health. Many documents reinforce this ethical practice directive. Challenges such as balancing quality care and efficiency, improving access to care, and addressing end-of-life issues are frequently encountered in the medical profession.14 Additionally, sometimes patients’ personal or religious beliefs may clash with evidence-based treatment. 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. The following scenarios involve substandard care and scope of practice. As professionals, dental hygienists often have choices to make in response to issues and dilemmas within their practice settings. She quickly found she wanted to learn all she could about it, and she’s glad she did. 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. The patient is given a treatment plan of extracting a painful tooth and fabricating a three-unit bridge for tooth replacement. 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. Ethical Decision Making Essay 834 Words | 4 Pages. 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. She stressed that she was working blind regarding subgingival calculus detection and removal without the aid of any current X-rays, and “who really knows what is occurring under No. Evaluate the action. TM is difficult for some folks, as are many other forms of meditation. He realized it was not worth jeopardizing his license and learned to discuss general supervision rules with all potential employers before accepting a new position. Ethical violations:when dental hygienists fail to meet or neglect their specific ethical responsibilities as expressed in the Codeâs standards. Ethical dilemmas occur all too frequently in everyday life. As you read through these vignettes, consider how you would handle similar situations. 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). After several years of periodontal maintenance appointments, the dental hygienist notes that probing depths have increased approximately 1 mm to 2 mm over the past two visits to three visits, but knows the patient is adamant about not receiving additional periodontal treatment. Dental hygienists should understand and practice ethical behavior consistent with the professional code of ethics throughout educational experiences.”6. Not surprisingly, this patient did not want to lose his teeth and agreed to see the periodontist for further treatment (informed consent in action). The purpose of the Dental Hygiene Code of Ethics is for its members to achieve "high levels of ethical consciousness, decision-making and practice." 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. Each situation involving human beings will be unique since each problem or dilemma will have distinguishing aspects. In some instances, compromises can be made, such as agreeing on a 6-month recare for the example above. Show the pros and cons of each option and its consequences discussed in step three. 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. The teaching of ethics in the dental hygiene curriculum. American Dental Hygienists’ Association. They can be helpful in many situations, but each office should have rules in place so that all staff are on the same page regarding when they can use them. When faced with an ethical dilemma, using the following steps can aid hygienists in coming to an appropriate conclusion: 1,2. Retrieved from: Academic Search Complete, Ipswich, Ma Accessed December 28, 2011.6. Paternalism is the practice of acting as the “parent,” which is taking it upon oneself to make decisions for the patient. The emphasis on ethics in dental hygiene education resulted from the growing body of evidence demonstrating that ethical issues were occurring in the profession and better preparation to address these issues was needed. Vital [serial online] 7(2): 37-39. 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. 141 (10): 718-720. 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. A 43-year-old male visited a dentist for an initial examination and checkup. J Am Dental Assoc., 141 (9) p. 1125-1126. The treating hygienist explained, once again, the need for X-rays. Critical Issues in Dental Hygiene. Furnari W. The dental hygiene oath or pledge. The patient merely signed a release and spent the money he saved on his next vacation. Gaston MA, Brown DM, Waring MB. 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. Brennan M. (March 2010). 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). Surprisingly, the patient has no pain. Exercises or decision models can help work through each dilemma to reach an ethical decision. With ethical dilemmas, there is no equation to plug into. Gagging in the dental chair is embarrassing and awkward for everyone. Ethical Dilemma Situations. Available at: adha.org/resources-docs/7611_Bylaws_and_Code_of_Ethics.pdf. 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. But I suspect that`s wishing for too much. Do you have a legitimate ethical dilemma? Teaching ethics in dental schools: Trends, techniques, and targets. Jamie Collins, RDH, recently had the honor of treating a medically challenging patient whose autoimmune disorders and multiple risk factors complicated her dental care considerably. Collaborative efforts then be- ... curriculum in clinical ethics. He is a diabetic patient with normal A1C scores. Joint Commission on National Dental Examinations. Consequentialism looks at the end results of any particular act. Accessed April 18, 2017. Review diabetic history and treatment with physician. Ethical moment: what ethical responsibilities do I have with regard to radiographs for my patient? The doctor merely picked a course of treatment he or she thought was best for the patient. Beemsterboer outlines the following six-step decision-making model. 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. 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. Updated 2016. Why bother with ethics and law? 2) Radiographic refusal is a huge problem in many practices due to the economy and lack of insurance. The topic of ethics is engrained in dental hygiene students from matriculation through graduation. Scenario #2. A dentist usâ¦ Available at: ada.org/ ~/media/JCNDE/pdfs/nbdhe_examinee_guide.pdf?la=en. The patient reports he had a traumatic experience with the previous dentist and periodontist. Dental Hygiene; Career Development; Ethics in dental hygiene. Ethical Dilemma And Dental Hygienist. 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. When tough decisions need to be made on behalf of our patients, we need the tools to do it. Here are 10. At times, these decisions are clear; other times ethical dilemmas create conflict with employers, colleagues, or clients. 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. In step four, apply the ethical principles to the options. He asked about his treatment options for this decayed tooth, which will cost thousands to replace with an implant, as it requires extraction. 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 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. By Jennifer S. Sherry, RDH, MSEd, and Emily E. Arbeiter, RDH, BSDH Dental hygiene students are faced with ethical decisions every day. Jong A, Heine CS. . Ethical reflection in dentistry: first steps at the faculty of dental surgery of Toulouse. 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. Ethics is a difficult concept to define because it is viewed very differently depending on the particular dilemma. In this example, nonmaleficence is the primary ethical principle at issue. (2006). While dental hygienists make decisions every day, ethical decision making can be more complex. In addition, patients assume the dental hygienist is practicing legally and within his scope of practice (trust). As clinicians providing care and services, every dentist and dental hygienist will be faced with many choices, problems and dilemmas. 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. According to Beemsterboer,2 eight categories of ethical dilemmas are most frequently encountered by dental hygienists (Table 3). This patient developed a moderate amount of calculus and a suspicious area on the lingual of tooth No. List alternatives. What are the implications of residual root sockets? Accessed April 18, 2017. With changes in dental hygiene curricula and added questions on the NBDHE, dental hygiene graduates should have sufficient training in ethics to handle dilemmas they may encounter in their professional careers. 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. Unfortunately, the patient did lose several teeth that had advanced periodontal pocketing, but he is now receiving active periodontal therapy via the periodontist (beneficence). If the dilemma has us questioning treatment, we should look back on our education while resolving the ethical dilemma. But the excellent ethical codes for our profession can provide guidance. Jamie explains how she and her practice accommodated this patient and what she learned in the process to make future appointments go more smoothly. The dental hygienist is torn between informing the patient of his periodontal status and potentially upsetting him by recommending more advanced periodontal therapy. Different ethical decisions can be made regarding the same ethical dilemma, resulting in no right or wrong conclusion. The standards state, “Dental hygienists are responsible and accountable for their dental hygiene practice, conduct, and decision making. Step two, collect specific information, is critical to the case in question. The patientâs previous six to 12 months of treatment and most current x-rays could be discussed. Brondani MA, Rossoff LP. Accessed April 18, 2017. Nonetheless, patients do have an involvement in their care, and if the provider feels a patient’s refusal of X-rays is limiting diagnostic capabilities, a dentist “may consider discussing with the patient options regarding consultation with or treatment by another dentist.”8, These ethical dilemmas, though typical, are still difficult to work through in each situation. After receiving root planing, periodontal pocketing is still out of control, with depths ranging from 4 mm to 9mm. 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. Hopefully, we all follow it to the best of our ability. 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. An effective model for dental health-care professionals to evaluate and solve ethical dilemmas is illustrated in âEthics and Law in Dental Hygieneâ (2010) by Phyllis L. Beemsterboer. He could continue to work in the office and treat patients even when the dentist leaves. Careful ethical decisions can be greatly facilitated by the structure of an ethical decision-making model. The two main goals involved in ethics are the ability to discern right from wrong and the commitment to act on a decision. Pain can have a substantial effect on the treatment options patients consider. Patients deserve to exercise their self-determination, but not at the risk of their dental health. After reading this course, the participant should be able to: Within the discipline of philosophy, ethics is the branch that focuses on morality. There is no sense in going through these six steps unless you’re serious about implementing the decision to your ethical dilemma. As professionals, we need be familiar with the code of ethics to help guide our behavior. Lead dental hygienists to recognize ethical issues and choices and to guide them in making more informed ethical decisions. The black, white, and very gray areas of radiology. 31?” Reluctantly, the patient agreed to an FMX the next visit. The dental hygienist could speak to the dentist again, emphasizing the seriousness of the issue and try to resolve the situation. Three organizations have produced ethical guidelines for industrial hygienists: the American Board of Industrial Hygiene, the Joint Industrial Hygiene Ethics Education Committee, and the International Commission on Occupational Health. The dental hygienist chooses to inform the patient as she realizes several core values are evident. Beemsterboer outlines the following six-step decision-making model.1. This patient did not have all the information needed to make an informed decision for care. This case involves a patient who has refused any type of X-ray since 2005. The patient has type II diabetes and high blood pressure, which are both controlled with medications. Scenario #1. Even though Dental Hygiene was not in my top ten strong occupations, it fit in the first two of five top interest areas according to the Strong Interest Inventory. The decision-making steps are as follows: Many factors should be considered when making ethical decisions. Ethics is concerned with studying human behavior and the principles that regulate it.1 Many theories describe ethics and moral reasoning, but when individuals are asked to define ethics, most respond with a version of “doing the right thing.” The core values established by the American Dental Hygienists’ Association (ADHA) are designed to help practitioners “do the right thing.” Table 1 lists these core values.1. 31 is not so lucky. 1 Because dental hygienists are health care professionals, they have a professional responsibility to practice in an ethical manner. Kristin Goodfellow, AS, RDH, explains the importance of taking patient x-rays. An overview of ethical issues in dentistry This Manual is the combined result of interna-tional experts on dental ethics brought together as an FDI Working Group. 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. Shaw DD. Ethical ChallengesâReal-World Examples The following examples of ethical challenges in dentistry are taken from my own experience with the exception of the last example. 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. 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.”. Linda Meeuwenberg was a 17-year-old high school student when she took a job at a general dental practice in her hometown of Fruitport, Mich. She was hired to type, file, answer the phone, and pay the bills. Establish a standard of professional judgment and conduct. 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. Her new setup makes it more comfortable for her to practice, makes it easier to educate patients, and is HIPAA friendly. 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. Dental hygiene students’ attitudes toward ethical dilemmas in practice. Both these situations result in cause for disagreement between the dental hygienist and his or her employer in which an ethical dilemma will ensue. By holding productive meetings and electronic discussions, this group has tapped into the diversity of its membersâ ex-perience, expertise, and knowledge of ethics, law, Dental hygiene ethics is an essential component of the dental hygiene curriculum. Beneficence now becomes a concern. The dental hygienist decides to look for other employment opportunities and leaves the original office when a new position is secured. 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. Read all about it here! 2. The book I find most useful on the subject is by Dr. Laurence Le Shan, How to Meditate. 1. Test your oral pathology and dental hygiene knowledge against these cases. 1. Discuss the evolution of ethics education. Blue CM. 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). 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. Sign up for Registered Dental Hygienist (RDH) Magazine eNewsletters. From Dimensions of Dental Hygiene. © 2020 Endeavor Business Media, LLC. As a clinical consultant, Nancy Miller, RDH, saw plenty of enviable operatories. During an ethical dilemma, we can find ourselves in a tough situation on whether to treat a patient. Select the course of action. The dental hygienist could face action by the dental board if the situation came to its attention. 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. Dental hygienists face ethical dilemmas that affect themselves and their patients, similar to other health professionals. Available at: amnhealthcare.com/latest-healthcare-news/five-top-ethical-issues-healthcare/. May 2017;15(5):37-40. Available at: tiki-toki.com/ timeline/entry/55646/100-Years-of-Dental-Hygiene/ #vars!panel=679914!. Dental hygiene programs have added individual courses in ethics and/or embedded ethical principles throughout the curricula in both didactic and clinical courses to meet this standard. Dental professionals must weigh options that allow a patient’s autonomy while exercising beneficence and avoiding maleficence. Kacerik et al7 concluded that traditional methods of instruction were primarily used and real-life experiences should be emphasized to a greater degree. Cultivating professional responsibility in a dental hygiene curriculum. An example â¦ Through this, dental hygiene students see “how experienced ethicists reason through problems,” and there are “right answers to ethical problems and that it is not just a ‘matter of opinion.’”9, To date, there appears to be no gold standard in teaching ethics to dental hygiene students. The behavior of the dentist does not change. Hamel O et al. Berk NW. The patient is exercising his or her autonomy. The goal is to bring students together Identify the six steps in applying an ethical decision-making model. Identify the problem and individuals involved. As society advances, the types of potential ethical concerns increase. A dental hygienist is hired at a private practice immediately upon graduation from his dental hygiene program. 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. The process. Another way to prevent this dilemma would be a full office review of each hygiene patient in the daily huddle. Why our ethics curricula do work. The decision making steps are as follows: Following is a different type of ethical dilemma regarding employment issues. 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. Gather the facts. 8,10,11. What? J Am Coll Dent., 73(3): 36-39.7. 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. It is important to work through ethical scenarios throughout dental hygiene education and to use ethical decision-making steps in order to adequately solve dilemmas when they arise. 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. J Am Dental Assoc. Practicing in the dental profession, dental hygienists see an array of ethical concerns while treating patients. Dental hygienists interested in an intriguing side job might want to look into becoming trained in dental forensics. Informed consent requires opening the lines of communication between provider (dentist or hygienist) and patients. Accessed April 18, 2017. 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. St Louis, MO: Saunders Elsevier.2. -Amanda, the dental hygienist, notices that the new dentist has been over-treating and over-diagnosing patients -The new Beemsterboer P. (2010). But her dentist’s enthusiasm was infectious. State the specific conflict, then evaluate and apply the specific health-care principles that conflict with one another. Dianne Glasscoe Watterson, MBA, RDH, provides some tips for temping as a dental hygienist. ... example, dental hygienists trained in a dental school setting often have the opportunity to collaborate with dental students regarding patient care. Gather the facts. Several studies were conducted in the 1980s on how ethical instruction was taught in dental hygiene curricula. Ethical issues in health care are common. But when the practice where she’d worked for 24 years hired a new doctor who also happened to be left-handed, she got an enviable operatory of her own. Categories of Ethical Dilemmas. Instead of being able to rely on external standards, people have to rely on their morals and values to navigate such situations. Purpose. This is why educational ethics programs in dental hygiene schools are important. Dental hygienists make decisions that are influenced by laws and ethics. 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. A dental professionalâs value system is personal, and it can be influenced by cultural values. really? 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. 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. There is rarely a clear answer regarding right and wrong. READ MORE | Ethical dilemma: Dental hygienists who work while sick. Act on the decision. 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. Does your office allow them during work hours? Bylaws and Code of Ethics. 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. During one prophylaxis recall, he stated he could not receive X-rays because he just paid for his rental car to the Bahamas, and besides, he did not have insurance! in the dental field. To illustrate supervised neglect, two case examples show common dental care dilemmas hygienists experience — periodontal disease treated conservatively in high-risk patients, and radiographic refusal. 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. Ethical dilemmas arise when one or more ethical principles or core values are in conflict.2For 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). Differentiate between ethics and clinical ethical dilemmas. Cell phones are here to stay. The authors concluded that dental hygiene programs should look for ways to improve students’ comprehension of numerous ethical issues. Identify the problem. 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. All rights reserved. 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. 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. Provide a statement of ethical behavior the public can expect from dental hygienists. When instituted within the curriculum, hygienists have the opportunity to participate in group instruction and use workshops to role-play. Standards for Clinical Dental Hygiene Practice. Beemsterboer (2001) suggests these attributes to be as follows: 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. American Dental Hygienists’ Association. They demonstrate how clinicians can work through the six decision-making steps. The three ethical dilemmas most frequently encountered in dental hygiene practice are (1) observation of behavior in conflict with standard infection control procedures (66%); (2) failure to refer patients to a specialist such as a periodontist (60%); and (3) nondiagnosis of dental disease (58%). However, the hygienist realizes this puts him or her in an ethical dilemma. Ethical dilemmas in dental assisting. Patients’ rights to make their own choices/decisions (autonomy) must be weighed against practitioners’ responsibilities to provide the best care (beneficence). One way to improve our ethics is to example arguments on both sides of common ethical dilemmas.. Jong8 and Heine determined that ethics was taught mainly using a lecture format, but that many programs were combining lecture with more active forms of learning, such as the use of ethical dilemmas. The following listing provides the general categories that have been acknowledged as ethical dilemmas in the dental ethics literature. 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. 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. Retreived online Dec. 9, 2011 from http://jada.ada.org/content/141/9/1125.full8. 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. Tips and tricks: Preventing activation of gag reflex when exposing radiographs. 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. The dental hygiene profession is taught a code of ethics. the scenario -The new dental associate in the office has made it known that she is "in charge" and that she has a large student loan balance to pay off. Jenson L. (February 2005). Doing the right thing when confronted with a difficult circumstance is one way to define ethical behavior. Larson J. The tooth is completely decayed from the gingival margin, under the crown, and it continues deep into the apices. 207(2), 59-62.4. EDUCATIONAL OBJECTIVES 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. She can be contacted at email@example.com. One of those educational tools was a decision-making worksheet. In addition, the consequences of the act are judged in comparison with other possible acts that might be performed in the situation. It is predicated on the idea that the rightness or wrongness of any action is determined and justified by its consequences. The medically challenging patient needs compassion and education: A case study. 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. Here are some examples and words of encouragement from the ADAA president. Accessed April 18, 2017. Interestingly, the authors found 86% of respondents received instruction in ethical theory, but only 51% stated they received instruction in solving ethical problems. There are several things that dental hygienists can do to help their patients who gag, including sprinkling with salt. Select the course of action. Instead, the dentist puts the blame on the patient for refusing the care offered. . Whatever the outcome, the dental hygienist reflected on the core values used in the decision-making steps and knows she “did the right thing.”. Weighing all outcomes is necessary to reach a fair resolution for each party. Information collection is necessary to make a balanced ethical decision. 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. She gently explains she has done everything she can in her scope of practice, and yet the periodontal disease is still active. In step six, you are now ready to implement the decision. Ethical dilemmas arise when one or more ethical principles or core values are in conflict. Increase dental hygienists’ professional and ethical consciousness and sense of ethical responsibility. Consequentialist thinking is always comparative because it aims to maximize good consequences (thus, diminishing harmful ones). 100 Years of Dental Hygiene. Working through an ethical dilemma does not come easily, but takes practice and careful consideration. Ethics Definition. Luckily, his calculus formation is now under control, with no subgingival evidence on the X-rays. An abnormally large and misshapen mandibular tooth was noted during the clinical exam. Without following through and acting on your decision to the ethical dilemma, there will be no resolution for the patient or party affected. Years ago the “doctor knows best” approach regarding treatment was common. Dental offices, like medical offices, are able to “provide patients a financial estimate for prostheses and other treatments,” and even have patients sign a document acknowledging their financial agreement.6 This agreement helps patients understand their alternatives regarding treatment. In other cases, there is no compromise and a decision must be made. Wentworth R. (Sept. 2010). 1) A long-term periodontal patient is currently receiving periodontal maintenance recalls every three months. List and define the American Dental Hygienists’ Association’s core values. Wentworth R. (June 2010). Without a conflict of principles, there is no ethical problem but merely a right or wrong type of predicament. In most dental hygiene programs, the dental hygiene oath is either recited during a matriculation ceremony, graduation ceremony, or both. The American Dental Hygienistsâ Associationâs Code of Ethics states that dental hygienists have a responsibility to the community and society to âpromote access to dental hygiene services for all, supporting justice and fairness in the distribution of healthcare resources.â(4) 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. Here is an example of paternalism. Are principles in conflict? Here’s one hygienist’s story. Ethical moment: what ethical issues should general dentists consider when the state of the economy affects decisions regarding referral of patients to specialists. 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. American Dental Hygienists’ Association. These three documents help guide the education and training that dental hygiene students receive in their respective programs throughout the country, to pass their national board examinations, obtain licensure, and become competent dental hygiene professionals. Identify the problem. The CDHA Code of Ethics sets out the ethical principles and responsibilities which apply to all members of the dental hygiene profession across all practice areas including clinical care, education, research, administration and any other role related to the profession of dental hygiene. Accessed April 18, 2017. The “hot seat” experience: a multifaceted approach to the teaching of ethics in a dental curriculum. J Am Dent Educ., 74(11):1120-1229.5. However, there are some ethical areas that are more common and will be highlighted here. Yes, that is seven years without an X-ray! Step three, state the options, is a step-by-step process or analysis to judge each option and the consequences related to each option. Understanding ethics and ethical decision-making can help guide dental hygienists in making the best decisions. Using the following decision-making steps may appear simplistic, but it can be extremely useful in solving ethical dilemmas. Nicole Giesey, RDH, MSPTE, enjoys researching, writing, and educating on topics related to dental hygiene. J Dent Educ., 69(2):225-8. Retreived Dec. 9, 2011 from http://jada.info/content/141/6/718.full?related-urls=yes&legid=jada;141/6/7189. Troubleshoot as many options and their full consequences before proceeding to the next step. Informed consent is highly recommended for today’s progressive medical and dental treatment. Marcy can be contacted at Ortiz7688@cox.net. In this particular state, dental hygienists are required to have at least 1 year of experience before becoming eligible to treat patients under general supervision. Accreditation Standards for Dental Hygiene Education Programs. 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. This dental hygienist admittedly had mixed emotions when she first heard the pediatric practice where she works was purchasing a CBCT unit. Kacerik MG, Prajer RG, Conrad C. Ethics instruction in the dental hygiene curriculum. Act on the decision. "Some ethical issues regarding social media and the dental hygienist are discussing clinical issues," Marsh said. “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. Ethics is the study of moral values and moral reasoning. Cone-beam computed tomography in pediatrics. In essence, the personalized value system becomes a âmoral codeâ for that individual. This allows for patient autonomy, self-determination, and beneficence, thus avoiding paternalism. The dental hygienist knows he “did the right thing,” even though he truly enjoyed other aspects of the office. 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. She is the dental hygiene product specialist for Maxill. http://www.merriam-webster.com/dictionary/ethic. Also, ethical situations can involve academic integrity and the ability to âdo what is right.â It is the studentâs ethical responsibility to report the clinical findings to the patient and to provide accurate assessment of their dental condition. 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. A dental hygienist may be faced with a variety of ethical issues and moral dilemmas. Ethics and law in dental hygiene (2nd Ed.). In this case, there is no mention of possible endodontic treatment or replacing the extracted tooth (if extraction is required) with an implant. What is taught in between these ceremonies is designed to help students understand what the oath really means. The patient was practicing his autonomy; however, the dentist was not considering beneficence for this patient.
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