ETHICS & JURESPRUDENCEGUIDED BY:

DR.BALAJI MANOHARDR.RAJESH PILLAIDR.RAVIKIRAN NDR.NEEMA SHETTYDR.ADITI MATHURDR MEETU JAINDR. BARKHA MAKHIJANI

Seminar Presented By :Dr. ABHISHEK GAUR

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GOOD MORNINGSMILE BUILDERS

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ETHICS & JURESPRUDENCE

SEMINAR ON

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Contents :Introduction

Meaning of Ethics

Importance of Ethics

Meaning of Profession

Meaning of Professionalism

Guidelines for dental ethical profession

Professional & Personal Ethics

Decisions & Decision Making

Dental Ethics : Primary Goals

Compromising Qualities

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Ethic Committee Goals Additional Goals Members

Jurisprudence

Dental Jurisprudence

Dental Neglect

Malpractice

Responsibilities Of Dentist

Responsibilities Of Patient

Conclusion

References

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INTRODUCTION

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What is meant by “Ethics” ? Ethics is a central component of any Happy, Healthy and mature Life.

There are several reasons to study ethics. All of use ethics on a daily Basis.

Ethics are the moral principles or virtues that govern the character & conduct of an individual or a group.

Ethics is a branch of both Philosophy & Theology, is the systemic study of what is right and good with respect to character and conduct. Ethics seeks to answer two fundamental questions :

1. What should we do ?

2. Why should we do it ?

The object of ethics is to emphasizes spirit rather than Law. Dental ethics applies moral principles and virtues to the practice of dentistry.

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The term ethics comes from the Greek word ‘ethos’ which means ‘character’

Ethics may be divided into four major areas of study :

1. Meta-ethics (how the moral true values may be determined)

2. Normative-ethics (about the practical means of determining a moral course of action)

3. Applied-ethics (about how moral outcomes can be achieved in Specific Situations)

4. Descriptive-ethics also known as comparative ethics

(Study of people’s beliefs about morality)

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Why are Ethics “Important” ?Ethics affect virtually every decision made in a Dental Office, encompassing activities of both judging & choosing.

As a dentist, you have to make numerous decisions. Some decisions are straightforward & easy; others can be very difficult.

Ethics are inextricably linked with these decisions and with the day-to-day activities of your office.

When ethics are ignored, you risk making unethical or less ethical decisions. Unethical decisions can lead to unethical conduct. At a minimum, unethical conduct seriously compromises your service to patients & undermines your ability to function as a professional.

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A profession has been defined as an occupation involving relatively long and specialized preparation on the level of higher education and governed by a special code of ethics.

Aim Of a Profession :

The constructive aim of a profession is the public good.

Dentistry is recognized as a ‘profession’.

What is a “Profession” ?

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What is “Professionalism” ?

Professionalism relates to the behaviour expected of one in a learned profession.

Professionalism embodies positive habits of conduct, judgment and perception on the part of both individual professionals and professional organizations.

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GUIDELINES FOR DENTAL ETHICAL PROFESSION

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THE PRINCIPLES OF PRACTICE

IN DENTISTRYAs a dental professional, you are responsible for doing the following.

1. Putting patients’ interests first and acting to protect them.

2. Respecting patients’ dignity and choices.

3. Protecting the confidentiality of patients’ information.

4. Co-operating with other members of the dental team and other healthcare colleagues in the interests of patients.

5. Maintaining your professional knowledge and competence.

6. Being trustworthy

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STANDARDS FOR DENTAL PROFESSIONALS

PUT PATIENT’S INTERESTS FIRST & ACT TO PROTECT THEM

1. Put patients’ interests before your own or those of any colleague, organisation or business.

2. Work within your knowledge, professional competence and physical abilities.3. Refer patients for a second opinion and for further advice when it is necessary, or if

the patient asks.4. Refer patients for further treatment when it is necessary to do so.5. Make and keep accurate and complete patient records, including a medical history,

at the time you treat them.6. Make sure that patients have easy access to their records.

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RESPECT PATIENT’S DIGNITY & CHOICES

1. Treat patients politely and with respect, in recognition of their dignity and rights as individuals.

2. Recognise and promote patients’ responsibility for making decisions about their bodies, their priorities and their care, making sure you do not take any steps without patients’ consent (permission).

3. Maintain appropriate boundaries in the relationships you have with patients. Do not abuse those relationships.

4. Listen to patients and give them the information they need, in a way they can use, so that they can make decisions.

5. This will include: communicating effectively with patients explaining options (including risks and benefits) giving full information on proposed treatment and possible costs.

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PROTECT THE CONFIDENTIALITY OF PATIENT’s INFORMATION

1. Treat information about patients as confidential and only use it for the purposes for which it is given.

2. Prevent information from being accidentally revealed and prevent unauthorised access by keeping information secure at all times.

3. In exceptional circumstances, You should get appropriate advice before revealing information on this basis.

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CO-OPERATE WITH OTHER MEMBERS OF THE DENTAL TEAM & OTHER HEALTHCARE COLLEAGUES IN THE INTERESTS OF PATIENTS

1. Co-operate with other team members and colleagues and respect their role in caring for patients.

2. Treat all team members and other colleagues fairly and in line with the law.

3. Do not discriminate against them.

4. Communicate effectively and share your knowledge and skills with other team members and colleagues as necessary in the interests of patients

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MAINTAIN YOUR PROFESSIONAL KNOWLEDGE & COMPETENCE

1. Recognise that your qualification for registration was the first stage in your professional education.

2. Develop and update your knowledge and skills throughout your working life.

BE TRUSTWORTHY

1. Justify the trust that your patients, the public and your colleagues have in you by always acting honestly and fairly.

2. Maintain appropriate standards of personal behaviour in all walks of life so that patients have confidence in you and the public have confidence in the dental profession.

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PRIMARY GOAL OF DENTAL ETHICS

• The Primary responsibilities is to treat the dentist(s), staff members and all patients with dignity & respect.

• The Philosophy of individual worth is belief that

‘Everyone regardless of personal circumstances or personal qualities, has worth & is entitled to respect as a human being.’

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PROFESSIONAL & PERSONAL ETHICS

PROFESSIONAL ETHICS

• Everyone entering into the profession is expected to adhere to these professional standards.

• It serves as a method of self-policing & enforcement of the code is handled within the professional organizations.

PERSONAL ETHICS

• Standards which individuals, sets for themselves are Personal ethics.

• These standards are reflected in the way we act, the decision we make, and the values we Hold.

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Decisions & Decision Making

•  DECISION :– The act of reaching a conclusion or making up one's mind.– A conclusion or judgment reached or pronounced.

• DECISION MAKING :– Decision making can be regarded as the cognitive process resulting in

the selection of a course of action among several alternative scenarios.– Every decision making process produces a final choice.– The output can be an action or an opinion of choice.

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Which Decision ‘is’ Ethical and which is ‘not’ ???

Decision is “not” ethical

“IF” :– It results an illegal actions.– It brings Harms to others.– A Person is exploited & used as an

inhuman Object.– If Human potential is damaged or

Ignored.

Decision ‘is’ ethical

“IF” :– It enhances integrity & self-respect.– Does not bring Harm to others.– Build understandings & dissolve

unreal barriers between people.– It builds a core of genuine

confidence in self & others.

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Is Good risk Management good ‘Ethics’ ?

• Good risk management is not necessarily good ethics.

• Risk management processes & decisions that do not include the perspective of the patient may be unethicalS. NO.

RISK MANAGEMENT DECISION PROCESSES

1) Made for dentist’s or institution’s perspective.

Made for Patient’s Best interests & Perspective.

2) Made for institution’s or Dentist’s benefit.

Made for patient’s Benefit.

3) Made for Institutions Values & Preferences.

Made for Patient’s Values and Preferences.

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What about compromising Quality ?• There are times when dentist may Face the decision to compromise quality.

• This may be because of limited financial resources of the patient, reimbursement restrictions imposed by dental insurance plans, patient values or preferences, or other factors.

• These limitations or restrictions may divert the direction of the overall case from “Ideal”, but they should never affect the quality of the separate components compromising the final treatment plan.

• The goal should be ‘to perform each treatment step to its highest standards’.

• The dentist is also obligated to collaborate with the patient during the decision-making process.

• It is unethical to knowingly provide substandard care.

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ETHICS COMMITTEE• Most hospitals are now required to have an ethics committee.

• Historically, ethics committees involve individuals from diverse backgrounds who support health care institutions with three major functions: providing clinical ethics consultation, developing and/or revising policies pertaining to clinical ethics and hospital policy and facilitating education about topical issues in clinical ethics.

• Ethics committees or select members often help resolve ethical conflicts and answer ethical questions through the provision of consultations.

What does an ethics committee or program do ?

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The underlying goals of traditional ethics committees are:

• to promote the rights of patients;

• to promote shared decision making between patients (or their surrogates if decisional incapacitated) and their clinicians;

• to promote fair policies and procedures that maximize the likelihood of achieving good, patient-centered outcomes; and

• to enhance the ethical environment for health care professionals in health care institutions.

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More recently, some ethics committees, particularly those affiliated with

academic institutions and large health care systems, have expanded their

traditional functions to become more comprehensive ethics programs.

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 The additional goals of expanded ethics programs include:

• Integrating ethics throughout the health care institution from the bedside to the boardroom,

• Ensuring that systems and processes contribute to/do not interfere with ethical practices, and

• Promoting ethical leadership behaviours, such as explaining the values that underlie decisions, stressing the importance of ethics, and promoting transparency in decision making.

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Who becomes a member of an ethics committee or program?

Committee members include :A. Clinicians (physicians and nurses) from :

1. Medicine

2. Surgery

3. Psychiatry

4. Social workers

5. Chaplains

6. Community

B. A quality improvement manager.

C. An individual responsible for the education program at the facility.

D. A lawyer.

E. At least one individual with advanced training in ethics.

All members of the ethics committee take responsibility for learning techniques of ethical analysis and the arguments surrounding most of the ethically charged issues in clinical practice.

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• Some ethics committees allow Guests.

• Here, Guests can include :1. health sciences students2. Philosophy graduate students3. Physician trainees4. Facilitators5. Patient representatives

•Guests need to maintain the confidentiality of the information discussed at the meetings, often signing oaths to that effect.

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Under what circumstances should I call the ethics consultant/service ?

When two conditions are met :1. You perceive that there is an ethical problem in the care of patients.

2. Health care providers have not been able to establish a resolution that is agreed upon by the patient/surrogate and the clinicians caring for the patient.

While a communication breakdown is often a factor in ethics consultation, an ethical dilemma (a situation in which a difficult choice has to be made between

two or more alternatives, especially ones that are equally undesirable) occurs when two courses of action may both be ethically defensible.

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How do I contact the ethics committee or request an ethics consultation?

• Check with your hospital to identify the pager number to reach the ethics consultant.

• There should be an individual at each hospital that carries a pager for responding to ethics consultations.

-ETHICS IN MEDICINE  (University of Washington School of Medicine)

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JURESPRUDENCE

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JURISPRUDENCE‘Juris prudencia’ = the knowledge, wisdom of Law

Comes from Ancient Rome.

Exclusive Power of Judgement on Facts.

Jurisprudence is the study/the explanation of the nature of Law and the manner of its Working.

It is ‘Aimed’ at a wise, pertinent & just solution of problems.

It is also the science which protects the rights.

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DENTAL JURISPRUDENCE

It is the science of systemic study which deals with all the laws, rules & regulations as well as legal principles and doctrines governing & regulating the practice of dentistry.

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The application of the principles of Law to the practice of Dentistry and of Dental Hygiene and the relations of Dentists & Dental Hygienists to patients, to study and to each Other.

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DENTAL NEGLECT

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DENTAL NEGLECT• The purposeful denial of the minimum amount of Oral health or

maintenance required to sustain functioning periodontium & teeth.

• The caretaker may exhibit a disregard for the patient’s health may focus primarily on Pain relief for the Patient.

• It is considered a “Warning Sign” of possible ‘Child or Elder Abuse’.

• The dentist must be cautious when drawing conclusions or making accusations, as an error in judgement may cause irreparable harm to the reputation & quality of the life of those involved.

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MALPRACTICE

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MALPRACTICE•Malpractice : Professional misconduct or branch of Duty that

results in injury or Damage to an individual.

• Some of the Malpractice problems are rare, but most of the periodontal missteps occur repeatedly. Recognizing these common problems will help to avoid them.

•When practicing periodontics, it is best for dentists to stay within their reasonable level of competency.

• The most common Periodontal malpractice issue is :1. Failure to Diagnose2. Treat, or refer periodontal disease process.

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• The other main cause of malpractice actions usually involves General Dentists attempt to treat beyond their level of competence.

• Although Periodontal Surgical Procedures are taught in Dental schools; it is important for dentists to be able to discriminate between surgical procedures they ‘are’ qualified to perform & those they are ‘not’ qualified to perform.

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MALPRACTICE

• Done by Duty Licenced Professionals.

• Plaintiff (Culprit) who seeks to recover Damages.

• Burden of proof in showing negligence of defendant.

ILLEGAL PRACTICE

• Committed by a person who practices the profession without the professional License issued by proper authorities.

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DENTIST’S RESPONSIBILITIES TO THE PATIENT

1. Dentist must be properly Licenced.

2. Must exercise reasonable skill, care & Judgement.

3. Must do only those things consented to the patient.

4. Must refer unusual cases to a specialist.

5. Must use standard drugs, materials & Techniques.

6. Must complete agreed upon Treatment within a reasonable Time.

7. Must hold inviolate instructions to the Patient.

8. Must give adequate instructions to the Patient.

9. Must make a reasonable charge for the treatment services rendered.

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PATIENT’S RESPONSIBILITIES TO THE DENTIST :

1. Must follow instructions during & after treatment.

2. Must Pay a reasonable fee or a fee agreed upon between The Dentist & The Patient.

What to Do of the Dentist is Sued ?1. Say Nothing

2. Be supportive

3. Be cooperative

4. Ask before acting

Who may be sued?•A dental assistant who is guilty of negligence is responsible for

his or her own actions, and the injured party may sue both the dentist and the assistant.

• The dentist’s liability insurance will not cover the auxiliary if they are sued for negligence!!

“Happy patients don’t sue

their doctors.”

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CONCLUSION Ethics need to be more fully integrated across the dental school

curriculum, including carryover into the clinical years, and assessing and ensuring competence also is needed, the researchers concluded.

Individuals who practice ethical behavior also practice self-honesty.

The dental profession holds a special position of trust within society.

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• Untoward or Unsatisfactory outcomes can occur when treating dental or periodontal patients.

• Dental practioners must be aware of the legal elements of malpractice, and they must strive to prevent their treatment from falling beneath the standard of care.

• The Legal Processes are difficult and distressing is navigate, so it’s best to avoid them when Possible.

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A system of Jurisprudence exists to determine Liability &

to award damages.

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References :1. Clinical Periodontology; Carranza (10th edition)2. Journal of Education and Ethics in Dentistry; January-June 2011 • Vol. 1

• Issue 13. CDA code of ethics. Adopted by the California Dental Association Journal

2006;34:604. Dentist (Code of Ethics) Regulations. Gaz. India 1976;2:2223-7.5. ETHICAL GUIDELINES FOR BIOMEDICAL RESEARCH ON HUMAN

PARTICIPANTS (INDIAN COUNCIL OF MEDICAL RESEARCH NEW DELHI-2006)

6. Ethics and Jurisprudence for Dentists BY EDMUND NOYE St D. D. S.7. Human Dignity And Fundamental Rights by Dr Paulina Taboada

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