U.C.V.
DENTISTRY DEGREE
“COMMUNICATION SKILLS”
ETHICS OF COMMUNICATION,
PROBLEMS AND LEGAL
REQUIREMENTS
SPECIAL INTERVIEWS
ACADEMIC YEAR 2023-2024
ETHICS OF COMMUNICATION,
PROBLEMS AND LEGAL
REQUIREMENTS
LESSON 1:
ETHICS AND ETHICAL PRINCIPLES
ETHICS
Ethics is concerned with moral principles,
values and standards of conduct.
ETHICS
The FIELD OF HEALTH CARE raises numerous ethical concerns related to:
health care delivery,
professional integrity,
data handling
use of human subjects in research
application of new techniques, (gene manipulation).
AFTER COMPLETING THIS PART YOU HAVE TO BE ABLE TO:
1º.- Understand what is meant by Ethics and why is so important.
2º.- Understand the relationship between dentistry and bussiness.
3º.- Understand the difference between profession, professional and professionalism.
4º- Understand the ethics of patient relations, delegation of duties, and financial arrangements.
4º.- Become familiar with elements and principles of ethical decision making.
5º.- Be able to evaluate an ethical dilemma.
6º.- Understand and apply the principals of dental ethics to everyday practice.
8 º.- Understand the ethical issue of compromising quality.
ETHICS
WHAT DO YOU KNOW ABOUT ETHICS IN DESTRISTY?
Ethics in Dentristry
What is it?
ETHICS
ETHICS PRINCIPLES ARE A CENTRAL
ELEMENT IN THE QUALITY OF “DAY TO
DAY” CLINICAL PRACTICE AND OF
ENORMOUS IMPORTANCE TO THE
CARE OF PATIENTS
ETHICS
To achieve proper ethical
conduct in a dental setting,
HEALTH dentists must first begin by
COMMUNICATION treating each patient as an
individual and take true
interest in the patient’s dental
needs and wants.
https://www.youtube.com/watch?v=eVJCa-N1tiE
ETHICS
Health communication relies on strong interpersonal communications in order to
influence health decisions and behaviours.
These connections can positively influence the individual's decision to make
healthy choices.
Patients are more prone to listen when they feel invested emotionally into the
situation. If they feel as if they understand what is being said, they are more
prone to make objective decisions based on the information heard.
ETHICS
Ethics in
1º.- Patients come to the clinic to establish a relationship
dentistry with the dentist in a framework of trust.
2º.- Overseeing all aspects whether at the scientific,
technical, or social relationship or friendship.
ETHICS
3º.- The dental practice can not be conceived as the application of clinical
knowledge based on scientific evidence leaving aside the ethical
Ethics in components that complement the professional training and enable it to
dentistry provide comprehensive care to his patient.
4º- It is necessary to show how important it is for the dentist to know
some aspects that are related to bioethics that will be applied during the
exercise of their profession, and the legal rules.
ETHICS
5º.- Is in the development of professional practice and
patient interaction precisely achieving effective
Ethics in communication will enable you to establish the conditions and
treatment characteristics, the establishment of an early
dentistry
diagnosis and certainly the identification of user needs.
ETHICS
Ethical Dilemma:
Conflict of Interest in the dental setting
https://www.youtube.com/watch?v=WATR7l4l-AM
To mt 6.08
What would you do?
And mt 7.40 to 10
ETHICS
1º.- Ethical Issues Faced By
Dentists
ETHICS
• 1º Quality of Care: Might be deemed inadequate if it
involves:
-- the delivery of substandard care without the patient’s knowledge
-- without consideration of the patient’s wishes
-- without justification by virtue of special circumstances
-- and motivated by financial gain.
ETHICS
• 2º Advertising:
The primary concern is dentists whose marketing and advertising activities
are considerate unprofessional. The ADA (American Dental Association) Code
of Ethics states only that “dentists should not misrepresent their...
competence in any way that would be false or misleading....”
ETHICS
3º Oversupply of Dentists:
Dentists are also concerned that a current oversupply of dentists has
implications for issues of quality of care.
Too many dentists could lead to too few patients and an increase in the
possibility of overtreatment.
ETHICS
4º Patient Autonomy:
TWO VERY IMPORTANT ISSUES:
The need to put the patient’s interest first
Informed Consent : It is a significant ethical challenge to the
dentist because of the large number of different materials and different
techniques available for the same or similar problems. (Under such
circumstances, how much information does the patient need to know to
make an informed decision?)
ETHICS
5º.- Conflict with patients (and resolution): precipitated
• By dentist By patient
ETHICS
Conflicts precipitated by the dentist.
1º.-Patient who is unable or unwilling to comply with the home care expectations of
the dentist while the dentist wonders whether continuations of the treatment is
justifiable.
2º.- Another example is the management of the questionable child abuse case
where the dentist’s actions could help the patient but damage the parent.
Problems involving the use of potential aversive behavior control techniques in
uncooperative children who require dental treatment.
3º.- How much training is necessary in a new technique such as implant placement
prior to performing it on patient.?
ETHICS
Conflicts precipitated by the patient.
1º.-.The most frequent situation is the patient who requests a procedure that is
contrary to the training and standards of the dentist. ( An example is the request for
complete-mouth extraction by a patient who has an essentially intact dentition than
can be easily salved).
2º.-Another example is the patient who requests sedatives or pain medication when
the dentist is not sure of the necessity.
ETHICS
6º.- Justice: Several concerns :
What are the obligations regarding treatment for patients not-of-record who
are in pain, for patients with AIDS, or for patients whose prior treatment has failed?
Should the dentist discontinue treatment when the patient’s payment
schedule is behind or has stopped altogether?
Should the dentist become involved in treating special patients, including the
handicapped, the aged, and those in nursing homes or other community programs
when that involvement would intrude on a busy and prosperous practice?
Is the dentist obligated to provide any free services? If so, for whom and to
what extent?
ETHICS
7º.- Intraprofessional Relationships:
Examples include the discovery of pathologies overlooked by a colleague when
temporarily covering a colleague’s practice and other situations where communication
with patients without criticizing colleagues is essential.
Referral practices that are based on factors other than the patient’s interest are also
sources of concern.
The most difficult problems are those where colleagues should be confronted when
incompetence should be reported.
ETHICS
8º.- Financial Transactions: (and patients)
Direct transactions such as:
-requests by patients to falsify billing (as in the predating of insurance claims).
-decision on who pays when treatment fails.
-the charging of different fees for the same service under varying
circumstances.
-charging but not providing services.
Insurances: A more troublesome set of issues exists with respect to dental benefit plans.
Dentists perceive these problems as involving issues of
- the waiving of co-payments
- the temptation to tailor the treatment plans of patients to the type of
coverage existing in the insurance plan.
The following scenarios are
examples of situations that
would pose ethical dilemmas:
Scenario 1: You’ve been running behind schedule all day and have not had
time to clean and sterilize instruments from the morning patients. You’ve
discovered that there are no more sterile cord-packing instruments, and
your last patient of the day has waited 10 minutes past her appointment
time for a crown prep procedure.
CHOICES:
• You can quickly process the instruments you need and sterilize them in an
“immediate use” cycle in the autoclave, delaying the procedure at least another 10
minutes, or
• You can thoroughly wipe down the instruments with a one-minute intermediate-
level disinfectant and incorporate them in your tray set-up.
Scenario 2: After the scaling and root planning procedure, the dentist has
legally delegated to you, an expanded functions dental assistant, the tasks
of polishing the clinical crowns of teeth and applying fluoride varnish
before dismissing the patient. During the coronal polish procedure you
detected a large area of calculus extending subgingivally on the
mesiolingual of tooth No. 26.
CHOICES:
You can pick up a scaler and remove the calculus,
You can call the dentist away from another patient to come and remove the
calculus, or
You can disregard the calculus and leave it in place.
When faced with an ethical dilemma, truly the best way to solve it
is to make the choice that would demonstrate your moral duty to
do no harm.
When considering the meaning of ethics, indeed one need only to
refer to the basic tenants we were taught as children, “Always
choose right versus wrong.”
1 º We choose to sterilize the instruments in scenario 1. That is
the right thing to do. Anything less would be below the acceptable
standard of care and a violation of CDC Guidelines.
2º In scenario 2, the proper response is to call the dentist to remove
the calculus. Dental assistants are generally not permitted by law to
remove calculus, especially subgingival calculus. Choosing to remove it
means choosing to break the law. Consequences can occur, leaving the
assistant (and supervising dentist) vulnerable to litigation and even
prosecution. Leaving it in place can also result in harm because
periodontal inflammation would continue in that area and compromise
the patient’s dental health.
1. Exercise in pairs
Look for a situation with an ethical
dental dilemma, suggest several
solutions, and choose the ethically
correct one.
ETHIC PRINCIPLES
2º.- PRINCIPLES OF ETHICS
APPLICABLE TO COMMUNICATION
ETHIC PRINCIPLES
PRINCIPLES OF ETHICS APPLICABLE TO COMMUNICATION
1º.-Patient autonomy
2º.- Nonmaleficence
3º.- Beneficence
4º.- Justice:
Patients
Colleagues
Society
5º.-Veracity
ETHIC PRINCIPLES
1º.- Patient autonomy:
Is the right of the patient to make his or her own decisions regarding the treatment that
he or she will receive.
It was not long ago that the majority of dental decisions were left in the hands of the
dentist. Now, it is essential that the patient have the final decision in his or her treatment.
The dentist is responsible for providing the patient with all of the available treatment
options, the successes and hardships associated with those treatments, and giving the
patient the ability to make a decision that is informed and best suits his or her needs
Recognizes the dignity and intrinsic worth of individuals and their
right to make personal choices
ETHIC PRINCIPLES
2º.- Nonmaleficence
A)- A dentist must not cause unnecessary harm to a patient (In some courses of treatment some pain may
be necessary to achieve the desired outcome, however the decision regarding the level of pain that is acceptable to
the patient must be determined by the patient).
B).- Once a dentist begins care for a patient he or she is required to see the treatment through to
the end. (If for any reason a dentist feels that he or she cannot complete the procedure, the dentist is obligated to
refer the patient to a specialist or colleague).
C).- It is the obligation of the dentist to inform immediately any patient who may have been
exposed to blood or any other potentially infectious material at the dental office. (It is the
responsibility of the dentist to immediately refer the patient to a qualified healthcare provider to obtain post-
exposure services and follow-up).
A Physician´s should always act in “Good Faith” and not cause pain to his patient
ETHIC PRINCIPLES
3º.-Beneficence
Promoting or doing good: It is essential that the dentist provides competent
and timely dental care with the needs, desires, and values of the patient
given due consideration.
Areas: (addresses the dentist’s responsibility to put the patient’s welfare first):
* community service (offering free or discounted dental care to the
needy).
* reporting investigative findings that promote or safeguard the
health of the general public.
* reporting symptoms consistent with domestic violence and child
abuse the proper authorities.
Acts in the best interests of patients and society even when there is
conflict with the dentist's personal selfinterest.
ETHIC PRINCIPLES
4º.-Justice
Dentists have the responsibility to be fair in their dealings with
patients, colleagues, and society.
Practicing justice includes:
*Serving patients without discrimination against race,
creed, color, sex or national origin.
* If a dentist is called upon for professional and expert
testimony, it is essential that the dentist provide professional
testimony without the interference of personal opinion.
*Also the responsibility of a consulting dentist to provide
care without undermining the treatment given by a previous treating
dentist.
Treats all individuals and groups in a fair and equitable manner and
promotes justice in society
ETHIC PRINCIPLES
5º.-Veracity
Revolves around being truthful and respecting the position of trust that is essential in the dentist-
patient relationship.
Truthful communication without deception and maintaining intellectual integrity.
For example, it is unethical for a dentist:
* to mark-up charges for procedures done to patients who may carry a particular insurance,
* or to recommend treatment that is unnecessary. Such treatment also includes the referral of
patients to unnecessary specialists, or the recommendation of products to gain profit of any kind.
* it is unacceptable for a dentist to advertise or communicate in such a way as to solicit a patient
based on partial truths.
Values truthfulness as the basis for trust in personal and professional
relationship
ETHICS
Ethical Dilemma:
Autonomy vs. Non-Maleficence
https://www.youtube.com/watch?v=cnl40RTbw_U
ETHIC PRINCIPLES
Recognizes the dignity and intrinsic worth of individuals and their right to make
personal choices
A Physician´s should always act in “Good Faith” and not cause pain to his patient
Acts in the best interests of patients and society even when there is conflict with
the dentist's personal selfinterest.
Treats all individuals and groups in a fair and equitable manner and promotes
justice in society
Values truthfulness as the basis for trust in personal and professional relationship
ETHIC PRINCIPLES
https://www.youtube.com/watch?v=0VCcymTKG6U
ETHIC PRINCIPLES
https://www.gdc-uk.org
ETHIC PRINCIPLES
2. Exercise, In pairs
Choose a standard number ?,
describe a real dental practice
situation, and act it out!
Upload on the platform (written)
SHARED DECISION MAKING
3º.- ETHICAL DECISION MAKING
SHARED DECISION MAKING
Why Shared Decision Making?
Ethical Decision
It is ethically the right thing to do.
Making
Shared Decision It is “perfected” informed consent and
Making addresses issues with the current informed
consent process.
It helps bridge health disparities.
It can impact the quality, cost, and safety of
health care delivery.
SHARED DECISION MAKING
Collaborative process that allows patients and
their providers to make health care decisions
together.
It takes into account the best clinical evidence
available, as well as the patient’s values and
So what is shared preferences.
decision making?
(SDM) Shared decision making is not a goal. The goal is
better health decisions to achieve outcomes that
matter most to the patient. And shared decision
making is a way to reach that goal.
A proven process to incorporate the patient’s voice
in health care decisions, shared decision making is
the pinnacle of patient-centered care.
SHARED DECISION MAKING
* Brings at least two experts to the table, the patient and
the provider, although family members and other members
of the care team may be involved.
How does it * Is appropriate for any health decision where there is more
than one medically reasonable option.
work?
* Benefits all patients, regardless of age or education.
* Decision aids can be used to facilitate a shared-decision-
making conversation between the patient and provider.
These tools can help patients understand the clinical
evidence and help them identify their preferences. Decision
aids do not advise people or advocate for one option over
another. Instead, they prepare patients to make informed,
values-based decisions with their provider.
FOUR STEPS TO
MAKING ETHICAL
1º.-Identifying the alternatives, involves determining the most appropriate DECISIONS RELATING
course of action, identifying resulting circumstances of the procedure, and TO DENTAL
relaying the most important features of each treatment to the patient. SITUATIONS.
2º.- Determining what is professionally at stake, relates to the
professional opinion of the dentist. The dentist must specifically
consider the normative action taken in similar treatment situations and
apply those considerations to the decision making process.
3º-Determining what else is ethically at stake, takes a more broad view of
what is ethically at stake for the patient in each treatment alternative.
4º-Determining what ought to be done, or ranking the alternatives, the
decision is made applying various values, virtues, rules, rights, and
professional norms. No matter what the outcome, the principles of ethics
come into play during every decision made regarding dental treatment.
Each step is deeply
rooted in ethical
guidelines set forth
by the ADA.
One of the most effective methods for decision
making in the dental treatment process is the
ACD Test
ETHIC PRINCIPLES
FROM THE MOMENT A DENTIST ACCEPTS A PATIENT, BOTH THE DENTIST AND THE PATIENT
ACCEPT CERTAIN OBLIGATIONS PERTAINING TO THE PATIENT-DENTIST RELATIONSHIP.
THESE RESPONSIBILITIES INCLUDE:
DISCLOSING RELEVANT INFORMATION REGARDING THE PATIENT’S CARE,
MUTUAL RESPECT,
BEING TRUTHFUL AND TRUSTWORTHY,
AND CONSIDERING THE PATIENT’S VALUES AND PERSONAL PREFERENCES.
THE CIRCUMSTANCES UNDER WHICH A DENTIST MAY MAKE “ETHICAL DECISIONS” IS NEARLY
UNLIMITED.
• https://www.youtube.com/watch?v=EnHwhj9
YhZ8
ETHIC PRINCIPLES
WHETHER THE DECISION IS REGARDING MANIPULATION OF DATA ON AN INSURANCE FORM TO
SECURE BETTER TREATMENT FOR A PATIENT, WARNING A PATIENT OF POTENTIALLY UNHEALTHY
HABITS, OR DETERMINING THAT ANOTHER DENTIST’S WORK MAY BE INFERIOR, IT CAN
SOMETIMES BE DIFFICULT FOR A DENTIST TO MAKE PROFESSIONAL AND ETHICAL JUDGMENTS
.
OFTEN THE DECISION MAKING PROCESS CAN BE AS SIMPLE AS APPLYING THE “GOLDEN RULE,”
HOWEVER UNDER CERTAIN CIRCUMSTANCES THE PROCESS CAN BE FAR MORE COMPLEX.
BECAUSE OF THIS, THERE ARE SEVERAL MODELS THAT EXIST TO ASSIST THOSE IN THE
PROFESSION WITH THE TOOLS NECESSARY TO MAKE ETHICAL DECISIONS.
4º.-PROFESSIONALISM
PROFESIONALISM
What do people expect from a
professional?
PROFESSIONALISM
BEHAVIOR EXPECTED OF ONE IN A LEARNED PROFESSION
POSSITIVE HABITS OF CONDUCT, JUDGMENT, AND PERCEPTION OF
THE PART OF BOTH INDIVIDUAL PROFESSIONALS AND
PROFESSIONAL ORGANIZATIONS
Professionalism
QUALITY OF CONDUCT AND CHARACTER THAT ACCOMPANIES THE
USE OF SUPERIOR KNOWLEDGE, SKILL, AND JUDGEMENT, TO THE
BENEFIT OF ANOTHER, PRIOR TO ANY CONSIDERATION OF SELF-
INTEREST
PROFESIONALISM
What is a “professional”?
1º.- A professional has respect for human beings.
2º.- A professional is competent.
3º.- A professional has integrity.
4º.-A professional's primary concern is service, not prestige or
profit.
PROFESIONALISM
DENTISTRY
According to the ADA, (American Dental Association) DENTISTRY IS
DEFINED as the evaluation, diagnosis, prevention, and/or
treatment (nonsurgical, surgical, or related procedures) of diseases,
disorders, and/or conditions of the oral cavity, maxillofacial area,
and/or the adjacent and associated structures and their impact on
the human body; provided by a dentist, within the scope of his/her
education, training, and experience, in accordance with the ethics
of the profession and applicable law.
DENTISTRY
Expands on the basic principles of ethics to include the
conduct, aims, and qualities that characterize a
professional or a profession. It communicates behavior
expectations as they relate to a given profession.
Necessity of dental professionals and professional
organizations to give priority to the well-being of the
patients they serve.
The commitment to promoting oral health initiatives
and protecting the public requires that the profession
work together for the collective best interest of society
DENTISTRY
Do Dentist really have obligations to patients?
By agreeing to take part in the dentist-patient relationship, both
patients and dentists accept certain obligations. The dentist is
obligated to:
respect patient privacy,
maintain patient confidences, keep promises, be truthful,
and consider patient values and personal preferences in treatment
decisions.
DENTISTRY
CATEGORIES OF PROFESSIONAL OBLIGATIONS:
1. Chief Client
The chief client is the person or set of persons whose wellbeing
the profession and its members are chiefly committed to serving.
2. Ideal Relationship Between Dentist and Patient
An ideal relationship is based on mutual respect and recognizes that the
dentist and patient both bring important values to the professional setting.
DENTISTRY
3. Central Values
The focus of each profession's expertise is a certain set of values, and each
profession is obligated to work to secure these values for its clients.
4. Competence
Every professional is obligated to acquire and maintain the expertise
necessary to undertake professional tasks.
5. Relative Priority of the Patient's Wellbeing
While the wellbeing of the patient is to be given considerable priority, it is
not to be given absolute priority
6. Ideal Relationships Between Coprofessionals
There does not seem to be any one account of ideal relationships between
dentists and their coprofessionals because so many different categories
must be considered, but there are professional obligations to co-
professionals;
7. Relationship Between Dentistry and the Larger Community
The activities of every profession also involve relationships between the
profession as a group or its members and the larger community and non
professional groups and others within it;
8. Integrity and Education
These are subtle components of conduct by which a person communicates
to others what he or she stands for, not only in the acts the person
chooses, but also both in how those acts
are chosen and in how the person presents to others in carrying them out.
https://www.gdc-uk.org/standards-guidance/standards-and-guidance/promoting-professionalism
https://www.gdc-uk.org/about-us/what-we-do/research/our-research-library/detail/report/professionalism-a-mixed-methods-
research-study
Given the amount of training required to
become a professional in dentistry, one would
presume that once the degree is obtained, a
professional is born.
However, professionalism is more than a
degree, particularly in dentistry.
It is here that the professional and ethics
coincide and therefore go hand in hand.
3. Practice. Groups
1º.- POWERPOINT EXPLAING GUIDANCE ASSIGNED
2º.- REAL SITUATIONS (YOU, FAMILY, FRIENDS…) IN DENTISTRY/MEDICAL PRACTICE
THAT HAVE TO BE WITH THAT GUINDANCE.
https://www.gdc-uk.org/docs/default-source/guidance-documents/guidance-
on-advertising.pdf?sfvrsn=a5540520_2
https://www.gdc-uk.org/docs/default-source/guidance-documents/guidance-on-
child-protection-and-vulnerable-adults.pdf?sfvrsn=eebbd01b_2
https://www.gdc-uk.org/docs/default-source/guidance-
documents/guidance-on-indemnity.pdf?sfvrsn=bf73d73d_2
https://www.gdc-uk.org/docs/default-source/guidance-documents/guidance-
on-using-social-media.pdf?sfvrsn=de158345_2
https://www.gdc-uk.org/docs/default-source/guidance-documents/guidance-on-
reporting-criminal-convictions.pdf?sfvrsn=cc567ff_2
