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My View: Ethics is not just jurisprudence

March 03, 2014

By Victor J. Barry, D.D.S.

At our recent House of Delegates, a resolution was passed that "encouraged" the state dental board to accept ethics classes as clinical continuing dental education. I encourage the board to also make them part of our mandatory annual CDE hours. Some say mandating such a rule would make the public think we have a morality problem among our members. That is as logical as saying we shouldn't allow courses on implants because the public will assume we screw them up all the time. Some say a jurisprudence course is all we need. But knowing the law is only the first small step toward understanding the principles of the ethical practice of dentistry. Some say the law has nothing to do with ethics because lawyers typically advise clients on how close their actions can come to the letter of the law before falling over the edge. However, the study of dental professional ethics keeps us toiling in the fields of ideal patient treatment, while that illegal cliff stays far in the distance.

Despite advances in genetic engineering, we still can't make a silk purse out of a sow's ear. Likewise, ethics courses cannot implant a moral compass into someone whose conscience is so devoid. Dental school admissions committees are charged with rooting out the red flags. Thus, when educators refer to "ethics," they are referring to teaching ethical providers how to navigate ethical dilemmas that they will inevitably encounter on a daily basis in practice. It is the first course that will come to mind for a new graduate their first day at chairside.

In dental school, the students start out with the definition of a professional: one who puts the patient's interests above their own. Then they are given the three basics: the state practice act (ignorance of which is still no excuse), the ADA Principles of Ethics and Code of Professional Conduct, and myriad materials from the American College of Dentists, whose core mission is the promotion of ethics. Then, through case studies of different ethical dilemmas, the students soon learn what may be legal is not always ethical. For example, is it in the patient's best interest to take out the easily removed super-erupted upper third molars and refer the lower impacted ones to the specialist? Should a child be prescribed antibiotics at the demand of the parent even though it is not indicated? Should a gold crown be done on a front tooth of a 12-year-old? Of course not. What about age 16? 18? On a virgin tooth? If they're 21, it's clearly legal. Is it ethical? Can a dentist turn away a patient in pain if the patient can't pay? Can a dentist refuse to do a gold crown if the patient's preferred provider organization (PPO) won't pay the metal surcharge? Should veneers on virgin teeth be prescribed prior to an orthodontic consult? Can assistants do digital scans on crown preps? (The state board is silent.)

Even though it may be sunny outside, the atmosphere in the operatory is mostly gray. So students, recent grads and old grads alike all need continued guidance in the practice of ethical care-giving. And mandating such CDE will make it apply to both members and nonmembers alike. A strong commitment to ethics defines us as professionals and differentiates those who provide dentistry from those who just sell it.

A dentist and his/her staff who stay steeped in the principles of professional ethics will be assured of protecting the most valued asset of their practice: the patients' trust. That is the truest form of success.

Dr. Barry maintains a private group general practice near Seattle. He has been teaching professional ethics at the University of Washington Dental School since 1988. He is a past president of the Washington State Dental Association and Seattle-King County Dental Society, and a past ADA 11th District trustee. His comments, which originally appeared in the December 2013 WSDA News, are reprinted with permission.