Ethics Review (Practice)

  1. Year the DH oath was modernized by the Board of Trustees of the ADHA
  • 1979

 

  1. Characteristics of a true profession
  • Specialized body of knowledge of great value to society
  • Intensive academic course of study
  • Set standards of practice
  • External recognition by society
  • Code of ethics
  • Organized association
  • Service orientation

 

  1. Models of Professionalism: Commercial, Guild, Interactive
  • Commercial model: describes a relationship in which dentistry is a commodity, a simple buying and selling of services.
  • Guild model: presents dentistry as an all-knowing profession.
  • Interactive model: the patient and the dentist as equals, with roles of equal moral status in the process of dental care delivery. Most preferable model because patient and provider work as partners

           

  1. Professional traits of a dental progressional
  • Honesty and integrity
  • Caring and compassion
  • Reliability and responsibility
  • Maturity and self-analysis
  • Loyalty
  • Interpersonal communication
  • Respect for others
  • Respect for self

 

  1. Year scope of practice was first established
  • First established by law in Connecticut in 1915 at the urging of Dr. Alfred C. Fones. (The father of dental hygiene)

 

  1. Gilligan’s female ethic of care
  • Occurs in the context of two moral orientations, male justice and female ethic of care, and that measurement of moral development in a justice oriented scoring system is biased toward the male.

 

  1. Cognitive development theory
  • Studies link moral perception and moral judgment with actual, real life behavior

 

  1. Principle founded in deontology
  • Autonomy

 

  1. Confidentiality
  • Patients have the right to privacy concerning their medical & dental history, examination findings, discussion of treatment options and choices, and all records pertaining to dental and DH care.

 

  1. Major purpose of the code of ethics
  • Bind the members of a group together by expressing their goals and aspirations,
  • Defining expected standards of behavior
  • The code is the contract the profession makes with society outlining the standards it will adhere to and uphold
  1. Piaget and Kohlberg’s theories of moral development and cognitive development
  • Piaget and Kohlberg both stated that moral development is sequential and dependent of an individual’s level of cognitive development

 

  • Piaget’s Four-Stage Model of Moral Development
  • Stage 1: Amoral stage, ages 0-2 years
  • Stage 2: Egocentric stage, ages 2-7 years, bends rules and reacts to environment instinctively.
  • Stage 3: Heteronomous stage, ages 7-12, accepts the moral authority of others.
  • Stage 4: Autonomous stage, ages 12 and older, a morality of self based on cooperation; rules tested and become internalized.

 

  • Kohlberg’s theory is focused on cognitive processes
  • Level 1: Preconventional reasoning, in which externally established rules determine right and wrong action.
  • Stage 1: punishment and obedience orientation
  • Stage 2: instrumental relativist orientation
  • Level 2: Conventional reasoning, in which expectations of family and groups are maintained and where loyalty and conformity are considered important.
  • Stage 3: interpersonal concordance orientation
  • Stage 4: law and order orientation
  • Level 3: Post conventional or principled, in which the person autonomously examines and defines moral values with decisions of conscience dictating the right action. Reached by few adults.
  • Stage 5: social contract legalistic orientation
  • Stage 6: universal ethical principle orientation

 

  1. Understand: Consequentialist ethics, Non-consequentialists ethics, Virtue Ethics.
  • Consequentialist Ethics (Utilitarianism): predicated on the idea that the rightness or wrongness of any action is going to be determined and justified by the consequences of the act. Aims at MAXIMIZING GOOD and MINIMIZING HARM. John Stewart Mill.
  • Non-Consequentialist Ethics (Deontology): An action is right when it conforms to a judgment or rule of conduct that meets the requirement of some overriding duty; also called deontological ethics (Immanuel Kant)
  • Virtue Ethics: Character or virtue, and the goodness of the person in living a good life, acquired by a person through learning, reflection, and repetition. Plato & Aristotle

 

 

  1. Purpose of the ADHA Code of Ethics

 

  1. Six Pillars of Character (Six Core Ethical Values-Josephson Institute)
  • Trustworthiness: Be Honest
  • Respect: follow the Golden Rule, Be tolerant and accepting of differences, Use good manners, not bad language, Be considerate of the feelings of others, Don’t threaten, hit or hurt anyone, Deal peacefully with anger, insults, and disagreements
  • Responsibility: Do what you are supposed to do, Plan ahead, Persevere: keep on trying!, Always do your best, Use self-control, Be self-disciplined, Think before you act — consider the consequences, Be accountable for your words, actions, and attitudes, Set a good example for others
  • Fairness: Play by the rules • Take turns and share • Be open-minded; listen to others • Don’t take advantage of others • Don’t blame others carelessly • Treat all people fairly
  • Caring: Be kind • Be compassionate and show you care • Express gratitude • Forgive others • Help people in need
  • Citizenship: Do your share to make your school and community better • Cooperate • Get involved in community affairs • Stay informed; vote • Be a good neighbor • Obey laws and rules • Respect authority • Protect the environment • Volunteer

 

  1. Surgeon General’s report on Oral Health
  • First report was published in 2000.
  • “Mouth is a mirror” of the body
  • Addressed disparities and inequalities that affect the most vulnerable populations: poor, children, elderly, disabled and racial and ethnic minorities

 

  1. Social Responsibility and Justice: Role of the Dental Professional
  • Pg 61: All the Bullets

 

  1. ADA five fundamental principles
  • Autonomy
  • Beneficence
  • Nonmaleficence
  • Justice
  • Veracity

 

  1. 7 core values of the ADHA code (pg52).
  • Autonomy
  • Beneficence
  • Nonmaleficence,
  • Justice and fairness,
  • Veracity,
  • Confidentiality
  • Trust

 

  1. Categories of Moral Problems (pg.85-86)
  • Moral weakness: moral responsibilities conflict with personal inclinations.
  • Moral uncertainty: question as to whether a moral obligation exists.
  • Moral dilemma: obligations and responsibilities are in conflict.
  • Moral distress: frustration from perceived powerlessness when what is happening appears to be wrong and are unable to act ethically.

 

  1. Ethical decision-making model (Six steps)
  • Identify the Ethical Dilemma or Problem (This is the most critical step in the process)
  • Collect Information (Decision maker needs to gather information in order to make an informed decision)
  • State the Options (Brainstorm to identify as many alternatives as possible)
  • Apply Ethical Principles to the Options (Focus on ethical principles (autonomy, beneficence, nonmaleficence, and justice) and ethical values and concepts (paternalism, confidentiality, and informed consent)
  • Autonomy-Self-determination, ability to participate and decide a course of action
  • Beneficence-Promoting good or well-being

 

  1. Ethical dilemmas commonly encountered by the DH (Box 6-1)
  • Moral Weakness: Moral responsibilities conflict with personal inclinations
  • Moral Uncertainty: Question as to whether a moral obligation exists
  • Moral dilemma: Obligations and responsibilities are in conflict
  • Moral Distress: Frustration from perceived powerlessness when what is happening appears to be wrong and is unable to act ethically.

 

  1. Statutory Law: Scope of Practice
  • The legislative branch of government is generally responsible for the enactment of the state dental practice act.
  • State laws, Occupations Code and Dental Practice Act
  • State Laws:
  • Licensure requirements
  • Licensure examination requirements
  • Licensure eligibility requirements
  • Licensure by endorsement
  • Approval of educational programs
  • Examination and disciplinary authority
  • Scope of practice
  • Supervision requirements
  • Continuing education requirements

 

  1. Issues that may be regulated by statutory law, but not incorporated into the State Dental Practice Act (pg.101)
  • Abuse reporting requirements
  • Biomedical wastes and hazards management
  • Consent to treatment and informed consent
  • Criminal activity
  • Disability accommodation
  • False health claims
  • Patient confidentiality
  • Public health reporting requirements (contagious or infectious diseases)

 

  1. Know functions of the legislative branch, executive branch, and judicial branch
  • Legislative
  • Enactment of the state dental practice act.
  • Laws specifically with dental professionals
  • General laws that protect the well-being of the state’s citizens
  • Ex: Abuse reporting, consent to tx, informed consent, criminal activity, disability accommodations, confidentiality
  • Executive:
  • Implementing statutory law
  • Provide more specific guidance and regulation regarding dental professional practice.
  • Includes Dept of Health, Dept of Professional Regulation
  • Regulation body: Board of Dental examiners, Board of Dentistry, State Dental Board

 

  1. Types of DH licenses
  • Full license: granted on basis of examination or endorsement of credentials.
  • Temporary license: granted on the basis of licensure in another jurisdiction, permits practice for a limited period of time while the DH pursues full licensure status.
  • Volunteer license: granted on the basis of licensure in another jurisdiction, permits practice for the purpose of public service.
  • Faculty license: granted on prior licensure in another jurisdiction, permits faculty member to practice within the scope of his/her educational responsibilities.

 

  1. Understand scope of practice
  • Includes educational, assessment, preventive, clinical, and other therapeutic services.
  • Each specific function is defined by state law.
  • Some states allow for DHs to administer local anesthesia and perform restorative procedures (Expanded Functions).
  • It is the DH legal responsibility to stay within the scope of practice for that state; if asked to do something outside your scope, you are obligated to decline that request.

 

  1. Understand different levels of supervision (pg.112-114)
  • Direct supervision generally requires prior diagnosis of the patient’s condition and authorization of a procedure by a dentist, presence of dentist on premises, and dentist approval of work prior to patient dismissal.
  • Indirect supervision requires prior diagnosis of the patient’s condition and authorization of a procedure by a dentist, and the presence of the dentist on the premises.
  • General supervision requires that the services to be delivered are authorized by the dentist; however, the presence of the dentist in the treatment facility is not required.

 

  1. Know requirements for keeping a Texas DH license active
  • 12 hrs: 6 of them in class once a year
  • CPR
  • Jurisprudence: every 3yrs

 

  1. What part of the statutes does the Texas Dental Practice Act come from?
  • Occupational Code

 

  1. Differences between civil and criminal law
  • Criminal law is a violation of a societal rule outlined by statutory law.
  • EX: Physically harming someone with a weapon is a criminal offense, as is practicing DH without a license
  • Civil offense is a wrongful act against a person that violates his/her person (body), privacy, or property or contractual rights
  • EX: A dental hygienist who fails to provide appropriate periodontal therapy, resulting in a condition of increased severity

 

  1. Two categories of civil law
  • Contract Law: A contract is a legally binding agreement to keep a promise in exchange for something of value.
  • Tort is a civil wrong that results from a breach of a legal duty that exists by virtue of society’s expectations of performance, rather than a contract or private obligation.

 

  1. Intentional and Unintentional torts
  • Intentional tort: deliberate and purposeful act that has substantial certainty of consequences from the act. Relates to persons and property.
  • Unintentional tort: no intent to harm, although harm or injury does occur.

 

  1. Responsibilities of DH and pt. (Boxes 8-1 and 8-2)
  • Table 8-1 DH responsibilities (Pg 126)
  • Possess proper license for the state in which they practice, comply with all laws, practice within the scope of practice for that state.
  • Exercise reasonable skill, care, and judgment in the assessment, diagnosis, and treatment of patients.
  • Use standard drugs, materials, and techniques recognized by the profession.
  • Complete treatment within a reasonable time.
  • Charge reasonable fees.
  • Never abandon a patient, and always arrange for care during absence.
  • Refer unusual cases to a specialist.
  • Maintain patient privacy and confidentiality.
  • Keep accurate records.
  • Give adequate instructions to the patient.
  • Maintain a level of knowledge and practice within the code of ethics.

 

 

 

  • Table 8-2 Patient responsibilities:
  • Pay a reasonable fee in a reasonable time period.
  • Cooperate in care and keep appointments.
  • Provide accurate answers about dental or medical history and current health status.
  • Follow instructions, including home care instructions.

 

  1. Informed Consent (pg.128-133)
  • Based on the premise that it is the basic right of every citizen to be free from invasions of their body without permission.

 

  1. Understand the definition of malpractice
  • Dental malpractice is the failure of an oral health care provider to exercise the degree of care, skill, and learning expected of a reasonably prudent oral health care provider, in the class to which he or she belongs within the state, acting in the same or similar circumstances

 

  1. Know what can/cannot legally be asked during a job interview
  • The following are permissible questions:
  • Full name and different names to verify employment history
  • DOB
  • Length of residency in state or city
  • Name of relatives already employed by employer
  • Abilities to perform the duties of the position with or without accommodation
  • Ability to meet specified work schedules and attendance requirements
  • S. citizenship or legal residency status
  • Languages that can fluently be spoken and written
  • Educational and employment history

 

  • The Following are NOT permissible questions
  • Original name when changes by court order or marriage
  • Marital status or related questions
  • Number or children and their ages, or related questions
  • Gender
  • National origin, ancestry, and descent
  • Religion
  • Race or color of skin
  • Height and weight
  • Disability status
  • Arrest record
  • Required list of affiliations and memberships
  • Garnishment of wages 
  1. Understand employment laws:
  • Civil Rights Act of 1964: protects against discrimination on the basis of race, color, religion, sex, or national origin; applies to employers 20 or more
  • Americans with Disabilities Act of 1990: Person who has a physical or mental impairment that substantially limits one of more major life activity; applies to employers 15 or more
  • OSHA Act of 1970: Ensures safe and healthful working conditions for employees, Places responsibility upon employers and employees to comply with established standards and training requirements intended to minimize the number of personal injuries and illnesses that arise out of employment.

 

  1. Understand sexual harassment
  • Sexual harassment is often discussed in terms of a “power” relationship, meaning one individual has authority over another
  • Unwanted sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature when submission to such conduct is made either explicitly or implicitly a term or condition of an individual’s employment; submission to or rejection of such conduct by an individual is used as the basis for employment decisions affecting such individual; or such conduct has the purpose or effect of unreasonably interfering with an individual’s work performance or creating an intimidating, hostile, or offensive working environment

 

  1. Definition “Quid pro quo” & Hostile environment harassment
  • Quid pro quo: means “something for something”
  • Occurs when: an individual’s submission to or rejection of sexual advances or conduct of a sexual nature is used as a basis for employment decisions affecting the individual, or the individual’s submission to such conduct is made a term or condition of employment
  • Hostile environment:
  • Occurs when any type of unwelcome sexual behavior creates an offensive or hostile environment.
  • An important criterion to prove hostile environment is that the employer had actual knowledge and took no remedial or prompt action.

 

  1. Dimensions of Quality Improvement (Box 10-1)
  • Strategy for risk identification is the implementation.
  • Structure: considers physical plant factors (facilities, equipment, organization, administration, personnel, dental records).
  • Process: considers patient care issues (diagnosis, sequence of care, technical skills).
  • Outcomes: considers the result of care (improvements in oral or general overall health).

 

  1. What are two strategies used to minimize risk in the dental office? (Pg.157)
  • Good documentation
  • Careful communication

 

  1. What should be included in a dental record? (Pg.158)
  • Demographic data on the pt should be updated routinely (address, phone #, contact info, insurance info).
  • Health history– must be updated at each visit.
  • Dental history– previous and current and the pt’s response to tx.
  • Care and txt– informed consent, anesthetics used, post operative care, and pt. education.
  • Notes from conversations regarding the pt and request for consultations.

 

  1. How should errors in a dental chart be corrected?
  • Have a single line drawn through the entry, followed by a note that an error was made. Correct info recorded and entry signed and dated.

 

  1. Double effects:
  • The health care provider to consider the risks and benefits whenever treatment is provided.
  • Classification system: what comprises harm and good.
  • One ought not to inflict harm
  • One ought to prevent harm
  • One ought to remove harm
  • One ought to do or promote good
  • Most to least in importance. Not inflicting harm takes precedence over preventing harm and removing harm is a higher priority than promoting good.

 

  1. Vocabulary Chapter 7 and 8 and fill in the blank from midterm
  2. Define: Beneficence, Autonomy, Paternalism, Justice, Informed consent, Veracity
  3. Define: Virtue, Double Effect, Self-determination, Risk/Benefit effect, Beneficence