All rights reserved. Understanding ethics and ethical decision-making can help guide dental hygienists in making the best decisions. During an ethical dilemma, we can find ourselves in a tough situation on whether to treat a patient. Gather the facts. Beemsterboer P. (2010). Hamel O et al. © 2020 Endeavor Business Media, LLC. Ethical moment: what ethical responsibilities do I have with regard to radiographs for my patient? Retreived Dec. 9, 2011 from http://jada.info/content/141/6/718.full?related-urls=yes&legid=jada;141/6/7189. 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. Troubleshoot as many options and their full consequences before proceeding to the next step. In some instances, compromises can be made, such as agreeing on a 6-month recare for the example above. Retreived online Dec. 9, 2011 from http://jada.ada.org/content/141/9/1125.full8. Doing the right thing when confronted with a difficult circumstance is one way to define ethical behavior. 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. 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. Hopefully, we all follow it to the best of our ability. 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. 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. 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. In step four, apply the ethical principles to the options. 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. Show the pros and cons of each option and its consequences discussed in step three. Read all about it here! Years ago the “doctor knows best” approach regarding treatment was common. Ethical violations:when dental hygienists fail to meet or neglect their specific ethical responsibilities as expressed in the Code’s standards. In this example, nonmaleficence is the primary ethical principle at issue. 2. 31 is not so lucky. Select the course of action. Act on the decision. Categories of Ethical Dilemmas. The ramifications of cheating include not only har… Ethical Dilemma Situations. She is the dental hygiene product specialist for Maxill. According to Beemsterboer,2 eight categories of ethical dilemmas are most frequently encountered by dental hygienists (Table 3). After reading this course, the participant should be able to: Within the discipline of philosophy, ethics is the branch that focuses on morality. 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. This patient developed a moderate amount of calculus and a suspicious area on the lingual of tooth No. Understanding and applying legal and ethical principles protects the provider (dental hygienist), the client, the employer, and the employee. The dental hygienist decides to look for other employment opportunities and leaves the original office when a new position is secured. 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. Consequentialist thinking is always comparative because it aims to maximize good consequences (thus, diminishing harmful ones). Weighing all outcomes is necessary to reach a fair resolution for each party. The patient has type II diabetes and high blood pressure, which are both controlled with medications. Dental hygienists will face ethical dilemmas at some point in their careers. The book I find most useful on the subject is by Dr. Laurence Le Shan, How to Meditate. Accessed April 18, 2017. Patients deserve to exercise their self-determination, but not at the risk of their dental health. The “hot seat” experience: a multifaceted approach to the teaching of ethics in a dental curriculum. American Dental Hygienists’ Association. 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. Accreditation Standards for Dental Hygiene Education Programs. Dental hygienists should understand and practice ethical behavior consistent with the professional code of ethics throughout educational experiences.”6. 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. 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. 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. "Some ethical issues regarding social media and the dental hygienist are discussing clinical issues," Marsh said. Wentworth R. (Sept. 2010). The treating hygienist explained, once again, the need for X-rays. State the specific conflict, then evaluate and apply the specific health-care principles that conflict with one another. Blue CM. One of those educational tools was a decision-making worksheet. 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 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. 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. Yes, that is seven years without an X-ray! Scenario #2. Accessed April 18, 2017. Dental professionals must weigh options that allow a patient’s autonomy while exercising beneficence and avoiding maleficence. 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. TM is difficult for some folks, as are many other forms of meditation. The hygienist is beyond frustrated because she feels she is in over her head. EDUCATIONAL OBJECTIVES It is predicated on the idea that the rightness or wrongness of any action is determined and justified by its consequences. Here are 10. Gaston MA, Brown DM, Waring MB. Ethical Challenges—Real-World Examples The following examples of ethical challenges in dentistry are taken from my own experience with the exception of the last example. 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. 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. . 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. http://www.merriam-webster.com/dictionary/ethic. The dental hygienist knows he “did the right thing,” even though he truly enjoyed other aspects of the office. 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.”. Improving the Nonsurgical Treatment of Periodontitis, ADHA Joins AAP in Support of Pediatric Oral Health. By holding productive meetings and electronic discussions, this group has tapped into the diversity of its members’ ex-perience, expertise, and knowledge of ethics, law, The American Dental Hygienists’ Association’s Code of Ethics states that dental hygienists have a responsibility to the community and society to “promote access to dental hygiene services for all, supporting justice and fairness in the distribution of healthcare resources.”(4) 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%). Unfortunately, the patient did lose several teeth that had advanced periodontal pocketing, but he is now receiving active periodontal therapy via the periodontist (beneficence). 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. National Board Dental Hygiene Examination 2017 Guide. J Am Dental Assoc. 1. 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. J Am Dental Assoc., 141 (9) p. 1125-1126. (Nov. 2010). The doctor merely picked a course of treatment he or she thought was best for the patient. She gently explains she has done everything she can in her scope of practice, and yet the periodontal disease is still active. Critical Issues in Dental Hygiene. American Dental Hygienists’ Association. 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. Does your office allow them during work hours? Cone-beam computed tomography in pediatrics. Accessed April 18, 2017. Accessed April 18, 2017. Informed consent is highly recommended for today’s progressive medical and dental treatment. 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. -Amanda, the dental hygienist, notices that the new dentist has been over-treating and over-diagnosing patients -The new Dental hygienists face ethical dilemmas that affect themselves and their patients, similar to other health professionals. With ethical dilemmas, there is no equation to plug into. The process. 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. Identify the six steps in applying an ethical decision-making model. Brondani MA, Rossoff LP. Available at: tiki-toki.com/ timeline/entry/55646/100-Years-of-Dental-Hygiene/ #vars!panel=679914!. 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. I found Zen to be the hardest. The patient’s previous six to 12 months of treatment and most current x-rays could be discussed. The dental hygiene profession is taught a code of ethics. 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. 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. 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. While a career in dental hygiene is incredibly fulfilling, it is not without challenges. Available at: ada.org/ ~/media/JCNDE/pdfs/nbdhe_examinee_guide.pdf?la=en. Identify the problem. 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. American Dental Hygienists’ Association. In this case, there is no mention of possible endodontic treatment or replacing the extracted tooth (if extraction is required) with an implant. Retrieved Dec. 27, 2011 from http://www.merriam-webster.com/dictionary/ethic3. 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. But I suspect that`s wishing for too much. Several studies were conducted in the 1980s on how ethical instruction was taught in dental hygiene curricula. 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. The patient is given a treatment plan of extracting a painful tooth and fabricating a three-unit bridge for tooth replacement. 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. 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. Dental Hygiene; Career Development; Ethics in dental hygiene. Jamie explains how she and her practice accommodated this patient and what she learned in the process to make future appointments go more smoothly. List and define the American Dental Hygienists’ Association’s core values. Whatever the outcome, the dental hygienist reflected on the core values used in the decision-making steps and knows she “did the right thing.”. A dental hygienist is hired at a private practice immediately upon graduation from his dental hygiene program. Ethics and law in dental hygiene (2nd Ed.). As society advances, the types of potential ethical concerns increase. Many documents reinforce this ethical practice directive. Beneficence now becomes a concern. 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. Scenario #1. The decision making steps are as follows: Following is a different type of ethical dilemma regarding employment issues. Identify the problem. Ethical challenges or problems faced by practising dental hygienists tend to fall into the categories of ethical violations, ethical dilemmas, and ethical distress. 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. Why our ethics curricula do work. Kacerik MG, Prajer RG, Conrad C. Ethics instruction in the dental hygiene curriculum. J Am Dent Educ., 74(11):1120-1229.5. What is taught in between these ceremonies is designed to help students understand what the oath really means. What are the cell phone policies in your dental office? 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. When tough decisions need to be made on behalf of our patients, we need the tools to do it. 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. Many different styles of meditation are available. 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. 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). From Dimensions of Dental Hygiene. Shaw DD. Bylaws and Code of Ethics. The patient is exercising his or her autonomy. 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. Ethical dilemmas in dental assisting. Jenson L. (February 2005). Beemsterboer (2001) suggests these attributes to be as follows: He could continue to work in the office and treat patients even when the dentist leaves. 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. Ethical reflection in dentistry: first steps at the faculty of dental surgery of Toulouse. 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. 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. 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 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. Here is an example of paternalism. I`d like to add a note about your article on Transcendental Meditation (TM) (March 1999 issue). The following listing provides the general categories that have been acknowledged as ethical dilemmas in the dental ethics literature. 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. 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. 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. 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. Nicole Giesey, RDH, MSPTE, enjoys researching, writing, and educating on topics related to dental hygiene. The authors concluded that dental hygiene programs should look for ways to improve students’ comprehension of numerous ethical issues. 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. 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. He is a diabetic patient with normal A1C scores. The topic of ethics is engrained in dental hygiene students from matriculation through graduation. Vital [serial online] 7(2): 37-39. Ethical Decision Making Essay 834 Words | 4 Pages. Inform the patient of his change in periodontal status or complete the maintenance appointment without discussing the periodontal findings. J Dent Educ., 69(2):225-8. 31 (part of a three-unit bridge). 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. As professionals, dental hygienists often have choices to make in response to issues and dilemmas within their practice settings. 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. Berk NW. Paternalism is the practice of acting as the “parent,” which is taking it upon oneself to make decisions for the patient. 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.
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