‫ﺑﺴﻢ ﺍﷲ ﺍﻟﺮﺣﻤﻦ ﺍﻟﺮﺣﻴﻢ‬

Ethics lecture #2
DR .Haidar Al wa2ely

Today we will continue talking about ethics, what are the principles
of ethics, what are the codes of professional conduct in dentistry.

Principles of ethics by definition are the inspirational goals of the

profession, they are present in every respected profession wether
it was dentistry, medicine or even law .i.e. . I want justice, truth and
honesty in my profession…these principles provide guidance and
offer justification for the code of professional conduct.

So what is the code of professional conduct?

Its expression of specific types of conduct that are either required
or prohibited, every principle of ethics has a certain code of
professional conduct

...‫ ﻣﻤﻨﻮﻋﻪ او ﻣﺮﻏﻮﺑﻪ‬،‫ﻳﻌﻨﻲ اﻟﺘﺼﺮﻓﺎت اﻟﻤﺘﻌﻠﻘﻪ ﺑﻬﺎي اﻟﻤﺒﺎدئ ﻣﻤﻜﻦ ﺗﻜﻮن ﺻﺤﻴﺤﻪ او ﺧﺎﻃﺌﻪ‬

Code of professional conduct is present in every major profession

(law, dentistry, medicine….etc), and as you are working as a
dentist in a country then you should know the code of profession
and ethics that are written and applicated in that country..
The code of ethics are voluntary standards of behavior.. they are
not laws…but they serve as a method of self-policing within a
profession… they were written by dentists who were dental
students.. and we –as dentists- are restricted with code of ethics
more than the law, so law comes secondarily, we by nature
respect the law but we do follow the code of ethics in our
profession voluntarily in a more specific way to save our career
and reputition .

The code of ethics have been provided in several occasions and of

course have been revised as it has been developing and this is
according to the situation and development of what's new in our
profession keeping in mind that idealism and moral conduct never
change till the end of the world even if the codes were changed or
revised…. So standards and behaviors will never change and this
means also that the inspirational goal –which is the moral conduct-
wont change over time and that’s what we want from ethics…

Now, what are the reasons that were beyond the development of
the code of ethics::

1- to demonstrate to the public the standard of conduct that they

expect from us…but what do we benefit from this
Imagine that people you're treating read or know that we have
code of ethics…then their attitude toward you will differ and they
will of course respect you and respect the profession….so it
provides people or community what to expect from members of the
profession.
2- To increase the ethical consciousness and ethical responsibility
of its members.
3- To guide members in making an involved ethical decision.

4- To establish a standard for professional conduct and judgments.

SO its something that guides us to do the right or the correct

behavior….they are not laws…they were written by dentists
(dentists with authority and not written by regular one's and this is
to be respected) and are revised by new situations…

The difference b/w ethics and laws is that: laws are either black or
white.. Wrong or right and there is no in between in law and this is
what gives law its power and strength and respect…also laws are
more specific and strict
Concerning ethics… they are less specific and there are more grey
areas (neither black nor white)
But, what do we mean by a grey area?? They are described as the
changes that occur due to the new situations which are associated
with a very high moral conduct…
Over all conclusion is that ethics are the conscious of the
profession.

Another thing is that law sets the minimum standard of behavior,

minimum Î to set an alarm or a warning to people to warn them
from making mistakes bcoz people are afraid of punishment…

‫ﻳﻌﻨ ﻲ ﻟﻤ ﺎ اﻧ ﺖ ﺗﺸ ﺘﻐﻞ ﻓ ﻲ ﻣﻬﻨﺘ ﻚ ﺣﺴ ﺐ ﻗ ﻮاﻧﻴﻦ ﺻ ﺎرﻣﻪ ودﻗﻴﻘ ﻪ رح ﺗﺸ ﺘﻐﻞ ﺑﻀ ﻤﻴﺮ ﻻﻧ ﻚ رح‬

...‫ﺗﺤﺴﺐ ﺣﺴﺎب أي ﺧﻄﺄ ﺧﻮﻓﺎ ﻣﻦ اﻟﻌﻘﺎب‬
But ethics sets a high standard of behavior to be performed and
we are not afraid from doing them

Ethics have a wide spectrum bcoz its an inspired behavior, while

law has a narrow spectrum bcoz it’s a limited behavior…

We have five principles of ethics that are:

1- Patient autonomy
2- Non malifecience
3-beneficence
4- Justice
5- Veracity

In each principle, you will see what's your duty as a dentist? What
are your primary obligations? And what are the practical conducts
that you are to use in the profession?
**each principle has a code of ethics

The 1st principle

Patient autonomy (self-governance or desire)
It’s the duty of the dentist to respect the patient rights to self
determination and confidentiality. So you have to respect the
patient and treat him according to his desire but within ethical limits
and always putting in mind patient rights and confidentiality –which
is the target of this principle-.
This principle express that professional treatment is a duty with
respecting the patient's desire ….this is true
BUT there is a condition which is respecting desire of the pt should
be within a boundary of accepted treatment and protection of
patient confidentiality??

This is an example to make you understand it better

If a non educated patient came to you with a simple cavity in his
upper central incisor and he told you that he wants to extract the
tooth (this is his desire) and you think about it and suddenly a flash
back in your mind takes you to this lecture and say :"yes Dr haidar
told us to respect the patients desire …" and stop right here ??
This is absolutely wrong becoz if you look to the second part of the
statement you will understand the condition which is the limit or the
boundary.

So if you do extraction this will not be considered as the

acceptable treatment and correct treatment is what we should
do…although we can decide what s best for him but this should be
with the patient himself and not by yourself alone ..so we should
provide the patient with all correct and available options then
sharing the decision of treatment.
If a patient comes to you with missing teeth you don’t tell him that
implants for ex are the best but instead you have to provide all
options.. and this is also applicable when your solutions are limited
for ex , a patient came to you for a bridge and you have only
acrylic-which is cheap- so you have to tell the patient in this case
that it’s the only solution.
That was about the acceptable treatment which is one part of the
boundary, now the second part is the patient's confidentiality

Patient's confidentiality
It does not only mean family secrets, if the patient is married or
not, it means lots of things which may involve nationality, religion
…..
it means not to get an information from my patient and then pass it
to a colleague or a doctor without the permission of the patient or
else people will behave with him in wrong way. Such informations
may be about color, religion, beliefs and if the patient knows that
im not a secret keeper then he wont tell me for ex that he has a
certain disease, and this is a problem bcoz my duty is to treat him
from diseases whatever he or she was and I don’t put in my mind
that I only treat pt's who wear blue jeans and white T-shirts and
swatch watch. . etc.. etc

Patient confidentiality also includes medical history and its

situations that need to be solved or studied according to the laws
of the country that you work in.. this differs from an area to area, in
certain countries, informations about patients regarding some
infectious diseases pass btw people with out patient approval,
other wise in majority of countries there is a prohibition of such
behavior unless the dentist gets an approval or an informed
content that shows that the patient (such as patients with HIV or
hepatitis)is ok with it.
If this patient goes after completion of treatment and visits another
dentist who called me to ask if my previous patient has a certain
problem…..
WHAT SHOULD I DO HERE?

I have to look to the law that im confined to and see if it permits me

to tell the other dentist informations about the patient or not and do
so…if not we should-as we said previously- get an approval from
the patient.

Every thing related to our patient (X-rays, casts, impressions….)

as long as he pays or paid for them they are HIS OWN, and its his
right to have them in any time he needs them (upon demand), if he
wants to go to other dentist –not you- and he wants the records
that are in your clinic then you should give them to him…

BUT in certain situations in which there is prohibition of giving

records to other dentists such as the teaching center in our faculty
where you treat the patient without him paying to you.. and our law
here is to keep these records bcoz they are not the patient's own
and they are the teaching materials for our dental students.

Some students comments were not well heard in the record so I

wrote what the Dr said in regard to each one
1- There is no problem if a doctor tells a story that happened with
him but without mentioning names as long as there is a teaching
purpose. But if he tends to tell to advertise for him self or to get a
benefit.. then this is wrong..
2- some patients tend to keep secrets from doctors or dentists
bcoz of the nature of our society that shows non opened relations
btw people so they don’t easily tell but you have to do your best to
gain his trust and to do every measurement regarding control (e.g
infections control) to protect your self and your patient with keeping
in mind restrictions about confidentiality to gain respect of the
patient..

If the patient gets the idea that you are a part of a community that
does not keep secrets then it will be hard for him to trust you and
tell his problems that should be known and this is a problem bcoz
when your patient tells you this will make your work easier to
manage and treat.

Now we come to the 2nd principle which is:

Nonmaleficence (do no harm)
The dentist has a duty to refrain from harming the patient.. usually
and by nature we are not treating the patient to harm him and the
primary obligation about this is keeping knowledge and skills
current, knowing one's limitations and when to refer to a specialist
or an experienced dentist and to know when to use skills of
auxiliary personnel who works with him..

Dentist is a part of a community that have a duty of refraining from

harming the patients…its not as simple as that bcoz dentist's
primary obligation is to achieve a difficult aim which is not to harm..
so if you don’t study hard and train very well in a clinic and attend
lectures and understand what's going on and practice very well…
then you are HARMING the patient..

Many of 4th year students are not good in treating patients bcoz
they still haven’t practiced enough but by the time of graduation
they will be better, but if you don’t train your self and keep your
knowledge current Î Î Î then you will harm the patient.. ///

For example…..if you are a doctor and if you don’t update your
knowledge and follow the medications (what's new, what's
prohibited….) then you may prescribe an impression material for
ex that has been proven to be a carcinogenic and harmful., and if
you are a dentist that god gave you lots of money,you open a clinic
and get a laser machine but if you don’t train ur self on it then
surely you will harm the patient.

Primary obligations of this principle are

1Îkeep knowledge and skills current.

2Îknowing one's own limitations and when to refer to an
experienced dentist or a specialist.

If you are a general practitioner who just graduated and you faced
a case of impacted 3rd molar you SHOULD NOT say :'this is ok I
have taken 2 or 3 lectures about this and its enough to help in
treating such a case…'….,this is wrong bcoz its not a regular case
and needs a specialist (oral surgery department in our case) so we
refer it to the specific depart. Provided with a gentle request from
you to treat the case Î Î this is the right ethical way for treatment
and its very important to gain the patient's respect bcoz he sees
you doing the right behavior.
The code of ethics of this principle:
Knowing when and under what circumstances delegations of
patient's care to auxiliaries is appropriate.
Ex.. if I am a dentist just opened my clinic recently and I brought
our neighbor hajj Abdullah to help me clean the clinic, he watches
most of your work.. Is this enough for him to be considered
experienced in your work? (Keep in mind that he is non
educated)?
The answer is no and you should be careful not to let him work
with you and you should only let people who carry a medical
certificate to work with you such as assistants or hygienists, even
those people shouldn’t also do all the work (not every dental
procedure can be assigned to them), for ex dental hygienists can
do polishing, scaling, fissure sealing, but they cant do anesthesia
(for inferior alveolar nerve block)

The code of professional conduct for this principle:

1- Education, keep knowledge updated, attend lectures…
2- Consultation and refer.
a- use of auxiliary aids
b- personal impairment
When a dentist (Dr.A) (general practitioner) has a case of
periodontal problem he refers it to a periodontist (Dr.B)… if Dr B
was so mean then he will start making rumors about Dr A and tell
the patient bad things about him and this is wrong..
What's right??
The periodontist should do only the work that has been referred to
him and if he sees any health problem in the patient then he
should tell (but not treat) the patient about it so that the patient can
tell it to Dr A about it IF he wants to complete his treatment there.

**personal impairment

20 years later to the previous case if Dr A notices that some of Dr

B work is not correct and cozez trauma to the patient due to an
impairment in Dr B which could be due to Alzheimers disease or
alcohol addiction or etc… here what's the ethical response?? Shall
Dr A respect Dr B as an older more experienced person?? Shall
he inform the authority about him??

Answer: if Dr B keeps harming the patients then Dr A has the right

to INFORM AUTHORITY about him to prevent harming the
patients…

Regarding this point Dr haidar told us a story about a Dr of his in

his practice
Dr haidar had a Dr who was 75 years old by the year 1995, and
he had an accident which lead to injury of one of his eyes and then
he couldn’t see with it (so he was seeing with only one eye)…
once he was doing an RCT session for a patient and while he was
filing, OUR doctor noticed that the patient of HIS doctor seemed to
be hurt despite a necrotic pulp that was in that tooth.. Dr wa2el
bent down over the patient to see what's going on and he found
out that his doctor was doing an RCT IN GINGIVA INSTEAD OF
ROOT CANAL ///

Next time Dr will continue what's left from the principles….

Our exam will be held on the 16th of july in the same hall and time
of the lecture and it will include different types of questions (fill in
the blanks, essay, MCQ?)

Thank you

Your colleague: Razan M.Alshehab..