ETHICS IN DENTAL MEDICINE

Course content

I.

BASIC CHARACTERISTICS OF DENTAL ETHICS

(5 lectures)

1. 1. Fundamental concepts in ethics

1.1.1. Morality (moral standard, moral judgment, moral sanction)

1.1.2. Ethics (ethical pluralism: Individualism / Subjectivism / Relativism / Liberalism / Neocontractualism / Pragmatism and utilitarianism / Casuistry / Consequentialism / Virtue ethics / Personalism)

1.1.3. Personal ethics

1.1.4. Professional ethics

1.1.5. Medical ethics

1.1.6. Dental ethics and/or ethics in dental medicine

1.1.7. Bioethics

1.1.8. Medical deontology

1. 2. Basic ethical principles in dentistry

1.2.1. General ethical principlism

1.2.1.1. Principle of respect for autonomy (patient involvement, informedness, consultation)

1.2.1.2. Principle of beneficence

1.2.1.3. Principle of nonmaleficence

1.2.1.4. Principle of justice

1.2.2. Clinical and bioethical principles (principle of inviolability of life, principle of totality, freedom and responsibility, social subsidiarity)

1.2.3. Medical confidentiality and the right to privacy

1.2.3.1. Confidentiality (confidentiality with regard to the patient and confidentiality of medical documentation)

1.2.3.2. Privacy

1. 3. Different professional and ethical motivation towards medical career choice

1.3.1. Noble medical professional – philanthropist

1.3.2. Medical professional as a healthcare manager/commercialist

1.3.3. Medical profession as a careerist profession

1.3.4. Medical professional as a “double agent”

1. 4. Oaths to honour ethical compliance in medical professions

1.4.1. Hippocratic Oath

1.4.2. Declaration of Geneva

1.5. Models of doctor-patient relationship

1.5.1. Medical paternalism/sacerdotal model

1.5.2. Informative/scientific/engineering consumer model

1.5.3. Interpretive model

1.5.4. Deliberative model

1.5.5. Model of reciprocal participation

1.5.6. Model of trust

1.6. Classification of physicians

1.6.1. Classification of “good” physicians

1.6.2. Stigmatisation of “bad” physicians

1.7. Stigmatisation of patients

1.7.1. Classification of “good” patients

1.2.2. Stigmatisation of “bad” patients

II.

ETHICAL RESPONSIBILITY FOR PROFESSIONAL CONDUCT IN DENTISTRY

(10 lectures)

2.1. PROFESSIONAL ASPECTS – Capacity to practice

2.1.1. Dental Medicine Act

Basic provisions (Articles 1-5)

Gaining and losing the right to practice dental medicine (Articles 6-9)

Dental medicine organisation (Articles 10-20)

Rights and obligations of doctors of dental medicine in practicing dental medicine (Articles 21-32)

Evaluation of dental medicine (Articles 33-36)

Activities of dental technicians (Articles 36a-36m)

Activities of dental assistants (Articles 36n-36p)

Croatian Dental Chamber (Articles 37-50)

Responsibility of doctors of dental medicine, dental technicians and dental assistants (Articles 51-54)

Dental service quality assurance (Articles 55-64)

Provisions on criminal offences (Articles 65-66a)

Transitional and final provisions (Articles 67-70)

2.1.2. Statute of the Croatian Dental Chamber

General provisions (Articles 1-2)

Name of the Chamber (Article 3)

Head office of the Chamber (Article 4)

Acting for and on behalf of the Chamber (Article 5)

Chamber stamp and seal (Article 6)

Chamber members (Article 7)

Rights, obligations and responsibilities of Chamber members (Article 8)

Tasks of the Chamber (Article 9)

Public authority (Articles 10-11)

Chamber structure (Articles 12-17)

Chamber bodies (Articles 18-69)

Cooperation with government authorities, state administration bodies and other organisations (Articles 70-72)

Cooperation with national and foreign chambers and international organisations (Article 73)

General documents of the Chamber (Articles 74-75)

Transparency of the Chamber’s work (Articles 76-78)

 St. Apollonia Assistance Fund (Article 79)

Chamber registries (Article 80)

Chamber membership card (Article 81)

Professional training of Chamber members (Article 82)

Croatian Academy of Dental Medicine (Article 83)

Issuance, renewal and revocation of licences for independent work (Article 84)

Issuance, renewal and revocation of work permits (Article 85)

Chamber awards (Article 86)

Resources for Chamber’s operation (Articles 87-91)

Transitional and final provisions (Articles 92-98)

2.2. ETHICAL AND MORAL CONCEPTS

2.2.1. Code of Dental Ethics and Deontology of the Croatian Dental Chamber

Principles and code of conduct for preserving the dignity and reputation of dentistry (Article 1)

Solemn oath for conscientious practice of dentistry (Article 2)

Focus on respecting human life and health (Article 3)

Provision of universal health services respecting human rights (Article 4)

Preserving the noble tradition of high standards in professional work and ethical conduct (Article 5)

Obligation of conscientious conduct in dentistry (Article 6)

Humane promotion of human dignity (Article 7)

Obligation of providing adequate health services (Article 8)

Obligation of continuous professional training (Article 9)

Health education for improving the quality of life (Article 10)

Responsibility towards conscience, patient and society (Article 11)

Duty of providing emergency aid (Article 12)

Working in extraordinary emergency circumstances (Article 13)

(Un)authorised provision of treatments (Article 14)

Applicability of the provisions of the Code (Article 15)

Professional confidentiality in dentistry (Articles 16-20)

Provision of free health services to socially vulnerable persons (Article 21)

Relationship of the doctor of dental medicine with society (Articles 22-25)

Relationship of the doctor of dental medicine with patients (Articles 26-41) Wellbeing, professional and ethical integrity, acquiring material benefits, application of professional standards, improving the health of patients, notices and informing, cooperation, authenticity and rationalisation of medical services.

Biomedical research of new diagnostic, therapeutic and preventive procedures (Articles 42-43)

Collegial relationships and professional solidarity (Articles 44-55) Respect, cooperation, professional assistance, decency, honesty, exchange of experiences, transfer of skills, pointing out oversights, preserving professional reputation.

Relationship of the doctor of dental medicine with the Chamber (Articles 56-59)

Transitional and final provisions (Articles 60-65)

2.2.2. Act on the Protection of Patients' Rights

2.2.2.1. Right to shared decision-making and right to information

2.2.2.2. Right to accept/refuse medical procedure or treatment

2.2.2.3. Right to confidentiality

2.2.2.4. Right to privacy

2.2.2.5. Right to maintain personal contacts

2.2.2.6. Right to voluntarily leave a health institution

2.2.2.7. Right to access medical documents

2.2.2.8. Right to protection during participation in clinical trials

2.2.2.9. Right to damages

2.3. Holistic concept of health as unitotality of constitutive dimensions

2.3.1. Physical and organic dimension of health

2.3.2. Psychological dimension of health

2.3.3. Social and environmental dimension of health

2.3.4. Ethical and moral dimension of health

2.3.5. Spiritual dimension of health

2.4. Challenges of medical ethics and bioethics in the context of biomedical progress

2.5. Role and significance of international and national regulations in solving current issues in the area of medical ethics and bioethics

2.6. Function, status and structure of Ethics Committees

2.7. Conscientious objection in dental medicine

III.

(BIO)ETHICAL DILEMMAS IN DENTAL MEDICINE

(Practical examples from dental medicine

– analysis based on codes of ethics in dental medicine/exercises)

(15 lectures + exercises + presentations)

1) Questioning moral behaviour and conduct in dental medicine

2) Bioethical dilemmas in dental ethics

3) Social justice and accessibility of oral healthcare (basic needs and fair distribution of basic oral health protection)

4) Professional risks in dental medicine (biological, static and dynamic, chemical, physical, psychogenic)

5) Occupational burnout

6) Professional and ethical responsibility for mistakes and oversights of medical professionals in diagnoses and therapies

7) Abuse of position and actions in dental medicine

8) Responsibility for medical errors under criminal law

9) Medical sensationalism in the media

10) Symptomatic vs personalised approach to the patient

11) Routine vs individualised approach to the patient

12) Commercialisation of health services

13) Medical corruption of medical services

14) Overtreatment and deception of patients

15) Advertisements and specialist marketing

16) Ethical challenges in restorative and/or defensive dental medicine

17) Breaching medical confidentiality, principle of confidentiality and the right to privacy

18) (Dis)honesty in the patient-physician relationship

19) (Dis)honesty in collegial relationships of co-workers

20) Patient satisfaction and dissatisfaction

21) Pedagogical and psychological (in)adequacy of communication

22) Issues of private healthcare

23) Issues of politicised healthcare

24) Stigmatisation of patients

25) Paternalism as a problematic or adequate approach in dental ethics

26) Cooperation with patients (encouraging informedness and collaboration)

27) Empathic approach to a personalised physician-patient relationship

28) Ending the treatment of non-cooperative patients

29) Research ethics

30) Ethicality of preventive dental medicine research involving children

31) Role of the doctor of dental medicine in recognising negligence and abuse

32) Use of coercive measures

33) (Ab)use of opioid therapy

34) Approach to patients suffering from pathogenic diseases with high-risk diagnoses (HBV, HCV, HIV, etc.)

35) Treatment of persons with reduced abilities ((in)ability to make autonomous decisions – the role of parents/caregivers)

36) Aesthetic dentistry – domains and limitations

37) Waste disposal in dental offices

38) Dental profiling in forensic science

39) Conscientious objection in dental medicine

40) Open-ended topic