Gavin Howe
Dentistry, like medicine, is subject to ethical and moral behaviour and is governed by law. While the law sets a minimum standard of behaviour, ethics can set a higher standard that may be more difficult to attain. Ethical obligations may exceed legal duties, and dentists are expected to consider ethical principles, the patient's needs and interests, and any applicable laws. The purpose of a professional code of ethics is to help members of the profession achieve high levels of behaviour through moral consciousness, decision-making, and practice. Every health professional must realise that there are both right and wrong actions that can be taken and that there is no right way to do a wrong thing.
| Characteristics | Values |
|---|---|
| Law sets a minimum standard that must be obeyed | Ethical standards can be higher and more difficult to attain |
| Law is enforced by the GDC, which protects the public by ensuring only qualified people practice dentistry | Ethics are enforced by professional organisations, which develop codes of ethics for their members |
| Lawsuits can be avoided by keeping good documentation, communicating with compassion, providing adequate informed consent, and following appropriate risk management procedures | Lawsuits can arise when ethical obligations are not met, even if legal duties are fulfilled |
| Law is based on rules, statutes, and judicial decisions | Ethics are based on moral standards of conduct and principles that govern proper behaviour |
| Law is related to integrity, which is formed by honesty and consistency | Ethics are related to integrity, which is formed by morals and values |
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What You'll Learn
The role of the GDC
While ethics and the law are closely related, they are distinct concepts. Ethical obligations in dentistry may—and often do—exceed legal duties. In dentistry, ethics can be understood as a set of rules provided by an external source, such as a professional organisation or the social system. The law, on the other hand, sets a minimum standard that should not be violated. While it is legal for a graduate dentist to perform any phase of dentistry, ethical considerations may come into play.
The General Dental Council (GDC) in the UK is the regulatory body for dentists and other dental care professionals. The GDC's role is to set and maintain standards in dentistry, ensuring that dental professionals provide patients with safe and appropriate care. The GDC's Standards for the Dental Team outline the standards of conduct, performance, and ethics that govern dental professionals. These standards include the Scope of Practice, which details the skills and abilities that each registrant group should possess.
The GDC's guidance also covers various other aspects of dental practice. For instance, it requires dental professionals to have indemnity or insurance in place before practising. It provides guidance on reporting requirements related to health, criminal, and regulatory matters, as well as on handling complaints from patients about dental professionals.
By adhering to the GDC's standards and guidance, dental professionals can ensure they are practising within the ethical and legal boundaries of their profession. This helps maintain patient safety and trust, as well as uphold the integrity and reputation of the dental profession.
In summary, the GDC plays a crucial role in regulating the dental profession by setting standards, providing guidance, and addressing ethical and legal aspects of dental practice. Through its work, the GDC contributes to maintaining the professionalism, accountability, and public confidence in dental care services.
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Patient confidentiality
While ethics and law are closely related in dentistry, as in many other fields, there are some key differences. Law governs our behaviour and outlines the minimum standards of behaviour in a society, whereas ethics focuses on our moral duty and what we ought to do, often exceeding legal requirements. In the context of dentistry, patient confidentiality is a critical aspect where the interplay between ethics and law is evident.
Dentists have a legal and ethical obligation to protect the privacy and confidentiality of their patients' information. Confidentiality is a key principle in medical ethics, and it is also legally protected by laws such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States. This act ensures the protection and confidential handling of patients' health information. Dentists must obtain informed consent from patients before disclosing any personal information for purposes such as billing or sharing medical records with other healthcare providers.
Maintaining patient confidentiality is a critical ethical duty for dentists. Dentists have a special relationship with their patients, who entrust them with sensitive personal information. Ethical guidelines, such as the American Dental Association's Principles of Ethics and Code of Professional Conduct, emphasise the importance of maintaining patient confidentiality. This includes not only medical records but also any personal information disclosed during appointments or obtained during treatment. Dentists have an ethical responsibility to safeguard this information and ensure it is not disclosed without the patient's consent.
There are, however, some exceptions and limitations to confidentiality in dentistry, as outlined by both legal and ethical frameworks. For instance, in cases of child abuse or neglect, dentists may be legally required to breach confidentiality and report their concerns to the appropriate authorities. Similarly, if a patient presents a serious risk of harm to themselves or others, confidentiality can be overridden to ensure the safety of the patient or the public. In such cases, dentists must follow legal guidelines and ethical principles to determine the appropriate course of action, which may include disclosing information to protect the welfare of the individual or the wider community.
Dentists must also be aware of the limitations of confidentiality in the context of electronic communication and record-keeping. With the increasing use of digital technologies in dentistry, ensuring the security and privacy of patient data is essential. Dentists have both a legal and ethical duty to protect patient information from unauthorised access or disclosure. This includes implementing secure record-keeping systems, encrypting sensitive data, and ensuring that any third-party vendors handling patient information adhere to privacy and confidentiality standards.
In summary, patient confidentiality is a fundamental aspect of the ethical and legal framework governing dentistry. Dentists have a duty to protect the privacy of their patients' information and to ensure that it is handled with discretion and respect. While there may be exceptions and limitations to confidentiality, both law and ethics emphasise the importance of maintaining trust and safeguarding patients' personal information. By adhering to these principles, dentists can build trust with their patients and ensure that legal and ethical standards are upheld in their practice.
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Education and training
The GDC also has a duty to remove any member from the Dentists' Register or the Dental Care Professionals' Register if they are shown to have behaved in a manner unsuitable for continued registration. The GDC's mission is to protect the public by ensuring that only qualified, competent, and ethical people practise dentistry. It also supports dentists and dental auxiliaries (DCPs) in their practice and encourages their continuing professional development (CPD).
To register with the GDC, candidates will need to provide evidence of good standing. The GDC has advised that, prior to working in NHS dental practice, those who have passed the Overseas Registration Exam (ORE) may also be required to undertake up to a year of vocational training in the UK. Dentists from outside the EU require a work permit to practise in the UK.
Dental education and training are also subject to various laws and ethical guidelines. The 1921 Dentists' Act prohibited the practice of dentistry by unregistered persons and set up the Dental Board of the UK, administered by the GMC. This Act established the requirement for a degree or diploma in dentistry from a recognised university or college to apply to join the register. However, it also allowed those who had completed apprenticeship dental training and met age requirements to be admitted to the register.
The Dentists' Act was amended in 1956, establishing the independent GDC to govern the dental profession. This Act also introduced the title of 'Dental Surgeon' and permitted the registration of ancillary dental workers. All previous laws relating to the practice of dentistry were consolidated into the Dentists' Act 1957. The Dentists' Act was further amended in 1984, giving the GDC the responsibility to supervise all stages of dental education, including postgraduate and undergraduate programmes.
In addition to legal requirements, dental professionals must also adhere to ethical principles and guidelines. The American Dental Association (ADA) has developed a Code of Ethics with five fundamental principles: patient autonomy, nonmaleficence, beneficence, justice, and veracity. These principles provide guidance and justification for the Code of Professional Conduct and Advisory Opinions. When facing ethical dilemmas, dentists should consider these principles, the patient's needs and interests, and any applicable laws.
Dental professionals can also enrol in courses such as Ethics in Dentistry, which covers ethical principles, values, and common ethical dilemmas in the field. It is important for dentists to stay informed about ethical guidelines, such as patient confidentiality under the Health Insurance Portability and Accountability Act (HIPAA) of 1996, to ensure that they are practising within legal and ethical boundaries.
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Advertising and promotion
In India, for instance, advertising by dentists is banned, and rules against it are stringent. Despite this, some dentists have resorted to advertising to promote their services, reflecting a shift in attitude, especially among younger dentists. This shift may be attributed to increasing industry competition, evolving societal norms, and a greater familiarity with advertising and media.
The controversy surrounding advertising in dentistry centres on the potential benefits and drawbacks. Supporters of advertising argue that it can increase community awareness of dental healthcare, encourage better quality services, reduce industry unemployment, and empower consumers in choosing a dentist. On the other hand, critics worry that advertising could undermine the reputation of the dental profession and its perception as a medical field.
To navigate this ethical landscape, dentists must adhere to ethical guidelines provided by organisations such as the General Medical Council (GMC) and the FDI World Dental Federation. These guidelines emphasise patient trust, respect, and wellbeing. For example, the FDI's principles of patient autonomy, beneficence, non-maleficence, and justice closely align with the ADA's ethical principles. Dentists are advised to promote oral health, undertake continuous professional development in ethics, and seek support from professional organisations to understand and comply with ethical frameworks.
Additionally, specific guidelines have been issued by regulatory bodies to ensure ethical advertising practices. For instance, the GDC's guidance, effective from March 2012, stipulates that dentists must ensure the accuracy of their personal information in any advertising material. They are also advised to refrain from making claims that could create unjustified expectations of results and to use appropriate terminology based on their specialisation and scope of practice.
In conclusion, while advertising and promotion can be powerful tools for dentists, they must be navigated with careful consideration of ethical guidelines and legal boundaries. Dentists must strive to uphold the profession's ethical foundation, centred on patient trust and wellbeing, while also adapting to shifting patient demands, digitalisation, and technological advancements that shape the dental landscape.
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Patient expectations
While the law sets a minimum standard that must be obeyed, ethics can set a higher standard that may be more challenging to achieve. Ethical obligations may exceed legal duties, and dentists must consider ethical principles, the patient's needs and interests, and any applicable laws when resolving ethical problems not explicitly covered by the ADA Code.
The dental profession has a special trust in the community, and the dentist-patient relationship should be based on trust, honesty, the provision of high-quality and appropriate treatment, and keeping the patient safe and healthy. The patient has the right to be fully and adequately informed, as well as to participate in decisions about treatment. The dentist must provide dental care without discrimination or prejudice and treat the patient with their wishes in mind as long as these expectations are within the limits of accepted treatment.
Dentists must also respect the position of trust inherent in the dentist-patient relationship, communicating truthfully and without deception, and maintaining intellectual integrity. They should know their limitations and practice only within the scope of their license. For example, a dentist may be legal because of their dental degree but may lack integrity by not recognizing their limitations and performing procedures that require a higher level of training or expertise. In such cases, there is an ethical obligation to refer the patient to a capable dental specialist.
Furthermore, patients today often come to consultations with information from the media, which can add complexity to the dentist-patient relationship. Healthcare professionals should know how to manage situations related to the patient's wishes and expectations. They should consider all treatment options, prioritize the best treatment for the patient, and optimize current research in the development of treatment plans.
In summary, patient expectations in dentistry are shaped by ethical principles such as patient autonomy, nonmaleficence, beneficence, justice, and veracity. Dentists must strive to provide the best quality of dental services, maintain honest relationships, and ensure that patient needs and expectations are met within ethical guidelines and the scope of their practice.
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Frequently asked questions
Ethics and the law are closely related but distinct concepts. While the law sets a minimum standard of behaviour, ethics can set a higher standard. Ethical obligations may exceed legal duties. For example, it is legal for a graduate dentist to perform any phase of dentistry, but is it ethical? Dentists should consider ethical principles, the patient's needs and interests, and any applicable laws.
The GDC (General Dental Council) is the regulatory body of the dental profession. It ensures that only qualified, competent and ethical people practise dentistry. It supports dentists and dental auxiliaries (DCPs) and encourages their continuing professional development.
Ethics and morals are the basic ingredients of integrity, which moulds character. Morals are derived from one's upbringing and beliefs, while ethics are learned through education as a framework for acceptable behaviour. Morals are considered voluntary personal commitments to a set of values, while ethics are the aspirational goals of a profession.
