Dental Ethics: A Decision-making Framework Helps Define Solutions

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We all took that class. It was the class where we tried not to fall asleep during our first year as dental hygiene students. We knew there was important information during the lectures, but we hoped that we would never have to experience an ethical dilemma.

Now here you are in your dental office faced with a situation that needs to be resolved. What do you do? What did you learn so many years ago in school? Remembering the core values that we promised to uphold will help you navigate some of the ethical dilemmas that may arise.

Ethical dilemmas will arise in any office and could happen at any time. How you or your office handles them may be different. Being on the same page as a team, though, is very important. An office can prepare for such situations with several approaches. One of those ways is having a mission statement for your office. Whether or not you are just starting with a new office or have been with one for many years, it is important to set aside time as an office to come up with a mission statement.

Agreeing on Core Values

A mission statement is a summary of what your office values in patient care and how they will aim to uphold those values. Just like our core values, we should aim always to uphold the mission statement agreed upon by the dental team. As new team members come into your practice, they should also be informed of the mission statement and agree to uphold the values of the office.

A very common situation is when patients refuse to have periodontal therapy completed; they just want their “teeth cleaned.” As hygienists, we understand the importance of periodontal therapy in the presence of active disease. Some patients, however, see it as an unnecessary procedure. Patients are allowed to practice their right to autonomy (self-determination), but as providers, we are also allowed to practice autonomy.

If we feel that our core values of nonmaleficence (to do no harm) and beneficence (doing what will benefit the patient) are not upheld, then we have the right not to see the patient. We have core values that we promised to uphold for our patients. But we also should have core values that we have promised to ourselves while providing proper care for our patients.

A List of Possible Decisions

During an ethical dilemma, we can find ourselves in a tough situation on whether to treat a patient. If the dilemma has us questioning treatment, we should look back on our education while resolving the ethical dilemma. One of those educational tools was a decision-making worksheet.

This worksheet does not have to be anything formal. But it can be a way of listing the problem and possible solutions down on paper, helping us come up with a solution to our problem. To begin coming up with a solution, we should identify the problem, followed by gathering the facts about the problem.

The next step would be to list alternatives to the problem, as well as the pros and cons of each alternative. Once the alternatives have been decided on, a single alternative should be chosen and justified. The most important step to the decision-making should be acting on that decision, and the action should be followed through.

In the days or weeks ahead, you should reflect on your decision and evaluate whether the action you took resulted in the best care for your patient. If it could have been modified, then this final step can help you better prepare for similar future dilemmas.

Some ethical dilemmas that we face are not always this easily resolved, or even must be resolved quickly. Knowing the decision-making process and being familiar with the steps can help us come up with a solution in a timely manner. You should always reflect on your dilemmas and solutions with your fellow team members since this can help with future dilemmas and alternatives for resolution.

Ethics in dentistry can be a very tricky and tough road to go down. We all have different morals and values when it comes to treating patients. Having a good dental team with the same or similar core values can help to make those decisions easier.

Be vocal with your team members on what is important to you for treating patients properly. Having their support in following through with the tough dilemmas can make treating our patients easier. Stay true to your values, and you will be a better provider for it.

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Stacie Neely, RDH, BSDH
Stacie Neely, RDH, BSDH, graduated from Oregon Institute of Technology in Klamath Falls, Oregon in 2011 with a Bachelor’s of Science in Dental Hygiene. Stacie has worked in general practice since graduating from college, and she currently works four days a week. Since 2016, Stacie has also worked as an adjunct faculty member at Oregon Institute of Technology as a clinical instructor and teaches dental ethics. Stacie currently lives in Klamath Falls, Oregon with her husband, Josh, step-son, Tyler, and her 2-year-old French bulldog, Loki. She enjoys reading, spending time with her family, camping and, four-wheeling on the Oregon Coast.