ETHICS CASE

 

The motivation to be ethical

 

 

WG Evans

Correspondence

 

 

Dentistry is indubitably regarded as an ethical profession, and one in which society has confidence will perform and behave in an ethical manner. Dental Ethics has been defined as:

• "The moral duty and obligation of a dentist towards his/her patients, professional colleagues and society."

The FDI have adopted the International Principles of Ethics for the Dental Profession:

• The professional dentist will practice according to the art and science of dentistry and the principle of humanity.

• Will safeguard the oral health of patients irrespective of individual status.

The definitions are evocative and compelling but perhaps lack a little in precision, relying on broad concepts of ''morality" and 'humanity". Indeed it was probably because the definition always was a mite ethereal that a dentist, himself impeccably ethical, was heard to remark. "Ethics is simply imbibed in your mother's milk." Could that be true or is there merit in the teaching of Ethics at our Dental Schools?

Medical and Dental ethics have embraced many of the concepts originally formulated by Immanuel Kant, the German philosopher who lived from 1724 to 1804. Kant held that it is a recognition of duty which enables people to have the will to act in a morally correct manner. It is the motive for the action, not the consequences of the action, which determines whether the action is right or wrong. Hence it may be argued that good consequences may flow coincidentally from an action actually intended to cause hurt. Equally, bad results may be incurred by an otherwise well intended action. Kant then suggests that it is a good will that is the fundamental good.. and that is in fact only good when an action is chosen because it is accepted as a duty. Such respect for duty surely provides a foundation for all ethics and indeed there is a term recognising this interpretation of Ethics, Deontological Ethics. Kant did not suggest the term himself for it was first used in 1930 by CD Broad in his book Five types of Ethical Theory. "Deon" comes from the Greek word δέον meaning obligation or duty. The meaning of the term has been best retained in French, code de déontologie. ethical code, especially applied to professional ethics.

The application is readily discernible, professionals have a duty to behave morally toward their patients. Kant suggested that the ability to reason Is the basis of morality and therefore himself reasoned that all persons, being rational beings, have the right to common dignity and respect. These are fundamental tenets in our modern Ethical Code. Kant expressed the philosophy in more abstruse terms: "Act only according to that maxim by which you can at the same time will that it should become a universal law." For example, a lecturer who used students in a research project without their knowledge must then be prepared to allow ALL researchers the same latitude, an obviously undesirable situation.

Kant went further in his exploration of philosophical questions, and considered the concept of autonomy. In fact many believe that the basis of Kant's theories on morality is the idea of autonomy. The dictionary definition of autonomy may be "independent, self governing", but Kant understood that this is not freedom per se, that is, being restrained by no laws, but rather a freedom bounded by laws that are largely of one's own making. So the autonomy originates in the freedom to make those laws and actions express the will of the individual, not the will of someone else.

In Dentistry one of our essential requirements is to ensure that the patient is informed and that Consent to Treatment is based on proper disclosure. But if we apply that unreservedly, we are delegating to the patient the treatment decision. It is a situation of reductio ad absurdum, how can a professional allow the management of the case be determined by an untrained patient?

Also recognised is the dilemma of when is it permissible to steal, perhaps when the alternative is starvation? Under what circumstances may it be considered right to kill? When you are defending yourself from attack? Kant's Categorical Imperative had three major formulations, which may conveniently be summarised in a most simplistic interpretation: Do unto others as you would wish them to do unto you.

Kant insisted on the requirement that to be morally good, the laws of behaviour had to be applicable universally. To act in a morally right manner, actions must be determined on the basis of duty. Does that help in our applying autonomy in treatment decisions? Certainly, because although patient and dentist may be coming from different directions, it will be duty that will decide, for the patient, a duty to seek the best possible treatment under the circumstances; for the dentist, as set out by the American Dental Association, his or her moral obligations and duties must include involving patients in treatment decisions in a meaningful way, with due consideration being given to the patient's needs, desires and abilities and safeguarding the privacy of the patient. (Of course the dentist retains the autonomy to ensure that he or she will continue to make a living!)

Ethics will always raise questions, ethics may on occasion be controversial, but there are clear principles underlying the ethos. While not all agree with his concepts, nevertheless Kant went a long way to guide the principles of professional ethics. For all these reasons Dental Ethics must retain an important role in Dental Curricula. Bebeau and Thoma undertook an exploration on how a course in Ethics affected the moral reasoning of a sample (n=720) of dental students. The conclusion was that not only did the students benefit from the course but also valued it.

Mother's milk it may be.. it is certainly food for thought!

 

 

Correspondence:
WG Evans
Managing editor
E-mail:bill.evans@wits.ac.za