Download Ethics and Cosmetic Dentistry: Beneficence, beauty or

Ethics and Cosmetic Dentistry:
Beneficence, beauty or “bucks”?
Toronto Academy of Dentistry Friday Nov. 12, 2010
Karen E. Faith BSW,MEd,MSc,RSW
Ethics Consultant & Educator
[email protected]
Outline




Ethics 101
Ethical considerations re: cosmetic procedures
Key ethical challenges for dentistry
Value-centered practice and questions for ethical
reflection
Hippocrates, the Oath
I will follow that system or regimen
which according to my ability and
judgment I consider for the benefit
of my patient and abstain from
whatever is deleterious and
mischievous.
Health Care
“health care”: provision of assistance to persons in need of
care, cure, education, prevention, or help related to
trauma, illness, disability or dysfunction by other persons
knowledgeable and skillful in providing such assistance.
Journal of Medicine and Philosophy, 1999, Vol. 24, No. 3, pp. 243-266 (Pellegrino)
Dentistry
Dentistry as a profession is
“based in service, in
preventing and treating
disease, and in restoring
health.” Simonsen, 2007
Cosmetic Dentistry
What is bioethics?

Bioethics involves critical reflection on moral/ethical
problems faced in health care settings toward:



deciding what we should do
explaining why we should do it and
describing how we should do it

(Dr Barb Secker)
Traditional Principlism




Autonomy
Beneficence
Non-maleficence
Justice
RCDS of Ontario Core Values





Autonomy
Beneficence
Compassion
Fairness
Integrity
Autonomy
The right of a competent person to make informed
decisions regarding his/her health options.
“Understanding and respecting patients’ rights to make
informed decisions based on personal values and beliefs.”
RCDS Code of Ethics
Traditional View of Autonomy






Autonomy
Individualism
Contractual nature of helping
relationships
Right to make an ill- advised
decision
People have experience &
skills in exercising autonomy
There are choices through
which to exercise autonomy
Beneficence
“ Every act and every inquiry, and similarly every action and
pursuit is thought to aim at some good and for this
reason the good has rightly been declared to be that
which all things aim.”
Aristotle, Nicomachean Ethics, 1094a 1-3
“Maximizing benefits and minimizing harm for the welfare of
the patient” RCDS Code of Ethics
Non Maleficence
Blair Henry

Do no harm or allow harm to happen




What are the provider’s biases?
What can be done to protect the patient?
Would the action cause harm or make the patient worse?
What negative outcomes are possible with and without action?
Justice





Balancing the rights and well-being of the individual with
the rights and well-being of others
Broader societal considerations in distribution of scarce
health resources
Laws
Health Policy
Public health
Just access to comprehensive dental care
Why ethics matter
Evolution of goals/values
We are faced with a balancing act between fidelity to the
moral wisdom of the past and responsive adaptation to the
circumstances of the present.
Miller & Brody, 2001
Just because we can do it, ought we do it?
October 20, 2009|Kimi Yoshino
The Beverly Hills fertility doctor who treated octuplets mom
Nadya Suleman has been expelled from the American
Society of Reproductive Medicine for a "pattern of
behavior" detrimental to the industry, a spokesman for the
association confirmed Monday. Los Angeles Times
What is the potential for conflict of
interests?
Dentist as health practitioner
and…
 Dentist as business
manager/entrepreneur and…
 Dentist as purveyor of beauty
enhancement procedures

Overtreatment or Good Clinical/Esthetic
Outcome?
What is healthy? What is normal?
Does it matter?
UK Chic
Hollywood update
What is normal? What is healthy?
Does it matter?
Some ethicists, philosophers and policy makers are urging a
reorientation of the physician’s beneficence from an
exclusive focus on the good of individual patients to a
focus on societal good. Pellegrino, 2001
Are dental services a commodity?
Is health care (dental care) sufficiently different from
pantyhose, ocean-front condominiums, or television sets
to set it apart from other consumer goods?

Journal of Medicine and Philosophy, 1999,Vol. 24, No. 3, pp. 243-266 (Pellegrino)
Are dental services a commodity?
Culture, context & commodities


Commodities may be used in the process of providing
care, but the totality of health care itself is not a
commodity.
Journal of Medicine and Philosophy, 1999, Vol. 24, No. 3, pp. 243-266 (Pellegrino)
Sticking with core values
Professionalism, Standards &
Accountabilities

Maintaining core values of dentistry:
Health promotion- disease prevention




Critical analysis of market driven incentives to offer cosmetic
procedures
Where is the ethical tipping point between professionalism and
overtreatment?
Promoting ethics in daily practice
Joint accountabilities: ethical implications regarding cosmetic
enhancement procedures
Key questions for ethical practice



What are my motives in offering this cosmetic option to my
patient? Are these motives consistent with primary clinical
and ethical duties to promote health and prevent disease?
Am I qualified and proficient (training and experience) to
offer this cosmetic procedure?
Have I sufficiently addressed any COI in offering these
treatments to my patient?
Key questions for ethical practice




What personal/cultural bias on gender, beauty etc informs
the way I am assessing my patient’s oral health and/or
appearance?
Has the information shared with the patient included shortterm, long-term and perhaps yet to be discovered risks?
Is the level of risk ethically acceptable/defensible given the
likely health benefits to the patient?
Do I have a means through which to address the “yuk’ factor
(ethical uncertainty) in my work?
Discussion