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ETHICS:
A discipline dealing primarily with moral duty, conduct, and judgment.
Prudence: Self interest (don’t touch the stove, brush your teeth—
not moral rules)
Dentistry as a profession is
“based in service, in preventing
and treating disease, and in
restoring health.”
Simonsen, 2007
COSMETIC DENTISTRY
WHAT IS BIOETHICS?
Bioethics involves critical reflection on moral/ethical problems faced in
health care settings toward:
deciding what we should do
explaining why we should do it and
describing how we should do it
(Dr Barb Secker)
CHEATING
Cheating is Endemic in today´s world.
The most serious instances of Cheating in the healthcare world have
involved the fudging of data, or their outright invention, in some of our
scientific publications.
“Big Pharma” has paid a radio host for giving their drug marketing lectures
CHEATING
Andrew Wakefield in an article published in the prestigious Lancet claimed
a possible link between the measles, mumps and rubella vaccine and
autism. This fact was not true and has been proved by other authors, for this
wakefield was found guilty of serious professional misconduct.
CHEATING
In 2009 the world´s largest drug company Pfizer, plead guilty in court to
criminal charges that it broke the law in marketing the drug bextra.
JONSUDBØ
• born on May 3, 1961
• Norwegian dentist / physician / oral surgeon
• renowned researcher in the field of oncology
– articles in NEJM, Journal of Clinical Oncology (IF=18.4), The
Lancet, Journal of Pathology, etc.
• associate professor @ University of Oslo
– until 2006
• consultant oncologist @ Radium Hospital
– until 2006
THEPAPER
– reducedriskof oralcancer
• NSAIDs reducedrisk evenfor heavysmokers(>40packyears)
– noassociationwith overallsurvival
Report in“ “
THEFRAUD
Stein Vaaler, director of strategy @ Radium Hospital:
a. The Harm Principle: A person’s liberty is justifiably restricted only to prevent harm to others caused
by that person.
b. The Principle of Paternalism: A person’s liberty is justifiably restricted to prevent harm to self
caused by that person.
c. The Principle of Legal Moralism: A person’s liberty is justifiably restricted to prevent that person’s
immoral behavior.
d. The Offense Principle: A person’s liberty is justifiably restricted to prevent offense to others by that
person.
BENEFICENCE
“ Every act and every inquiry, and similarly every action and pursuit is
thought to aim at some good and for this reason the good has rightly
been declared to be that which all things aim.”
Aristotle, Nicomachean Ethics, 1094a 1-3
“Maximizing benefits and minimizing harm for the welfare of the patient”
Code of Ethics
BENEFICIENCE
You can choose an esthetic treatment that will obtain a short-term
improvement in appearance but if the result is significant reduction of tooth
structure that later requires endodontic care and/or additional restorative
treatment the patient has not been well served.
NON MALEFICENCE
BLAIR HENRY
Immanuel Kant
German Philosopher
1724-1804
PATIENTS: MEANS OR ENDS ?
As a profession, dentists serve the end of the well-being of their patients.
To place one’s own interest above the welfare of a patient is to treat a patient
as means to the dentist’s ends. The patient becomes an ‘object’ to be used by the
dentist in achieving personal goals. This is reification; treating another as an
object--dehumaning.
“Always treat others as ends in themselves, never as a means to one’s own ends.”
Immanuel Kant’s Moral Imperative.
Clearly we derive financial gain from our life’s work, but it is derivative; a by-
product of us fulfilling our promise to our patients as professionals that they can
always trust us to do what is in their best interest.
PATIENTS: MEANS OR ENDS
Dentistry as a business sees the oral health of patients, not as ends in
themselves, but merely means to the dentist’s personal ends.
Dentistry as a business serves the end of personal profit for the dentist.
Understanding dentistry primarily as a business places dentistry in the
marketplace where oral health care becomes a commodity produced
and sold for a profit.
The business of selling cures undermines the classical professional
model—a model rooted in a tradition of caring.
“Health care is not a commodity, and treating as such is deleterious to
the ethics of patient care. Health is a human good that a good society
has an obligation to protect from the market ethos.”
We are faced with a balancing act between fidelity to the moral wisdom of
the past and responsive adaptation to the circumstances of the present.
Miller & Brody, 2001
JUST BECAUSE WE CAN DO IT, OUGHT WE DO IT?
October 20, 2009|Kimi Yoshino
The Beverly Hills fertility doctor who treated octuplets mom Nadya Suleman
has been expelled from the American Society of Reproductive Medicine for
a "pattern of behavior" detrimental to the industry, a spokesman for the
association confirmed Monday. Los Angeles Times
WHAT IS THE POTENTIAL FOR CONFLICT OF
INTERESTS?
Dentist as health practitioner
and…
Dentist as business
manager/entrepreneur and…
Dentist as purveyor of beauty
enhancement procedures
OVERTREATMENT OR GOOD
CLINICAL/ESTHETIC OUTCOME?
WHAT IS HEALTHY? WHAT IS NORMAL?
DOES IT MATTER?
UK Chic Hollywood update
WHAT IS NORMAL? WHAT IS HEALTHY?
DOES IT MATTER?
Some ethicists, philosophers and policy makers are urging a reorientation of
the physician’s beneficence from an exclusive focus on the good of
individual patients to a focus on societal good.
Pellegrino, 2001
ARE DENTAL SERVICES A COMMODITY?
Is health care (dental care) sufficiently different from pantyhose, ocean-front
condominiums, or television sets to set it apart from other consumer goods?
Journal of Medicine and Philosophy, 1999, Vol. 24, No. 3, pp. 243-266 (Pellegrino)
ARE DENTAL SERVICES A COMMODITY?
CULTURE, CONTEXT & COMMODITIES
Commodities may be used in the process of providing care, but the totality
of health care itself is not a commodity.
Journal of Medicine and Philosophy, 1999, Vol. 24, No. 3, pp. 243-266 (Pellegrino)
STICKING WITH CORE VALUES
PROFESSIONALISM, STANDARDS &
ACCOUNTABILITIES
Maintaining core values of dentistry:
Health promotion- disease prevention
Critical analysis of market driven incentives to offer cosmetic procedures
Where is the ethical tipping point between professionalism and overtreatment?
Promoting ethics in daily practice
Joint accountabilities: ethical implications regarding cosmetic enhancement procedures
KEY QUESTIONS FOR ETHICAL PRACTICE