Laws and Ethics of the profession

By
DR ME OSUH; BDS, FMCDS, MPH

At the end of the lecture, students should be able
to:
Define law and ethics
Understand the history of Ethics
Learn the principles of ethics in dentistry
Know about Medical and Dental Council of
Nigeria
07/01/2016LAWS AND ETHICS OF DENTAL PROFESSION BY DR ME OSUH; BDS, FMCDS, MPH 2

Know the responsibilities of MDCN
Know the Hippocratic oath
Understand Council procedures for conviction
Know what the term fitness to practice means

 A system of rules that guides the conduct of a people
 A set of rules established and enforced by a sovereign
authority such as the local, state, or federal government
as a means to an ordered society.
 Criminal Law pertains when a person commits a
wrongful act against society.
 Civil Law pertains when one person sues another for
satisfaction of a personal wrong done to him or her.

A branch of philosophy that deals with the examination of human
conduct or moral principles (Greek – ethos- custom, Latin –
mos/mores – moral philosophy)
Science of an ideal human character and behaviour in situations
where
- distinctions must be made between right and wrong,
- duty must be followed
- and good interpersonal relations maintained.

Hippocratic oath: One of the oldest binding documents in
history. Still held sacred by physicians: to treat the ill to the
best of one's ability, to preserve a patient's privacy, to teach
the secrets of medicine to the next generation….. summing
up standard of professional ethics. Many versions
Nuremberg code- a set of research ethics principles for
human experimentation set as a result of the Subsequent
Nuremberg Trials at the end of the Second World War

Declaration of Helsinki: regulations issued by the United
States Department of Health and Human Services
governing federally funded human subjects research in
the United States. (Research ethics)
Adopted by World Medical Association(WMA) in 1966

These principles help in choosing the right course of actions
in certain difficult decision making situations
They include:
 Autonomy
 To do no harm (Non maleficence)
 To do good (Beneficence)
 Justice
 Veracity (Truthfulness)
 Professionalism (Confidentiality)

This principle expresses the concept that
professionals have a duty to:
treat the patient according to the patient’s
desires, within the bounds of accepted
treatment, and to protect the patient’s confidentiality.
Under this principle, the dentist’s primary obligations 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 patient’s privacy

This principle expresses the concept that professionals have a
duty to protect the patient from harm.
Under this principle, the dentist’s primary obligations include
 keeping knowledge and skills current,
 knowing one’s own limitations
 when to refer to a specialist or other professional,
 knowing when and under what circumstances
delegation of patient care to auxiliaries is appropriate.

This principle expresses the concept that professionals have a
duty to act for the benefit of others.
Dentist’s primary obligation is service to the patient and the
public-at-large.
Involves competent and timely delivery of dental care within the
bounds of clinical circumstances presented by the patient, with
due consideration being given to the needs, desires and values of
the patient.
Even in contract obligations - patient’s welfare should be placed as
priority/ first.

This principle expresses the concept that professionals have a
duty to be fair in their dealings with patients, colleagues and
society.
The dentist’s primary obligations include dealing with people
justly and delivering dental care without prejudice.
In its broadest sense, expresses the concept that the dental
profession should actively seek allies throughout society on
specific activities that will help improve access to care for all.

This principle expresses the concept that
professionals have a duty to be honest and
trustworthy in their dealings with people.
A dentist’s primary obligations include
 Respecting the position of trust
inherent in the dentist-patient
relationship,
 Communicating truthfully and
without deception,
 Maintaining intellectual integrity.

There should be understanding/ privacy
b/w dentist and patient.
Any information revealed by the
patient to the dentist will not be
divulged without the patient’s consent.
Except the situation where disclosure
is needed to protect others, the
patient itself and community.

ADA: 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.
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.
Professionalism = (Professional + Ethics); more than a degree,
particularly in dentistry 07/01/2016LAWS AND ETHICS OF DENTAL PROFESSION BY DR ME OSUH; BDS, FMCDS, MPH 15

 Altruism is the essence of professionalism. The best interest of the
patients, not self-interest, is the rule.
 Accountability is required at many levels - to individual patients, society
and the profession…
 Excellence entails a conscientious effort to exceed normal expectations
and make a commitment to life-long learning…
 Duty is the free acceptance of a commitment to service.
 Honour and integrity are the consistent regard for the highest
standards of behaviour and refusal to violate ones personal and
professional codes.
 Respect for others (patients and their families, other physicians and
professional colleagues such as nurses, medical students, residents,
subspecialty fellows, and self) is the essence of humanism…"

• BENEFITS CONFERED BY PROFESSIONAL STATUS
» Prestige and Respect
» Trust
» Autonomy in Practice
» Physician-Led Regulation
» Financial Rewards
• THREAT TO PROFESSIONALISM
• A questioning society
•A complex health care system
•The commodification of health
•Failure of the professions to meet their obligations

 No matter what your relationship with the doctor, always
address him or her as “doctor”
 Adult patients are always addresses using the more formal,
courteous form of address such as Mr., Mrs., or Ms.
 Always introduce yourself to someone new
PROFESSIONAL CODE OF ETHICS:
Statements encompassing the rules that apply to
persons in professional roles. (professional etiquettes,
universal moral principles)

The Medical and Dental professions in Nigeria are regulated by
the Medical and Dental Practitioners Act Cap 221 (now Cap M8)
Laws of Federation of Nigeria 1990 and sets her up with the
following mandates:
Regulation of training in Medicine, Dentistry and Alternative
Medicine in Nigeria
Regulation of Medical, Dental and Alternative Medicine
practice in Nigeria.
Determination of the knowledge and skills of these
professionals.
Regulation and control of Laboratory Medicine in Nigeria.

Mission Statement: “To regulate the practice of Medicine,
Dentistry and Alternative Medicine in the most efficient
manner that safeguards best healthcare delivery for
Nigerians” underlies these Mandates.
Vision: “To be the foremost Professional Regulatory body
in Nigeria!”

The Act which sets up the MDCN charges the council with the
following responsibilities:
determining the standards of knowledge and skill to be attained by
persons seeking to become members of the medical or dental
profession and reviewing those standards from time to time as
circumstances may permit.
securing in accordance with provisions of this Law the
establishment and maintenance of registers of persons entitled to
practice as members of the medical or dental profession and the
publication from time to time of lists of those persons;

reviewing and preparing from time to time, a
statement as to the code of conduct which the
Council considers desirable for the practice of the
professions in Nigeria; and,
performing the other functions conferred on the
Council by this Law.

At the time of being admitted as a member of the medical
profession:
I solemnly pledge to consecrate my life to the service of
humanity;
I will give to my teachers the respect and gratitude that is
their due;
I will practice my profession with conscience and dignity;

The health of my patient will be my first consideration;
I will respect the secrets that are confided in me, even after
the patient has died;
I will maintain by all the means in my power, the honour and
the noble traditions of the medical profession;
My colleagues will be my sisters and brothers;

I will not permit considerations of age, disease or disability,
creed, ethnic origin, gender, nationality, political affiliation,
race, sexual orientation, social standing or any other factor
to intervene between my duty and my patient;
I will maintain the utmost respect for human life;
I will not use my medical knowledge to violate human rights
and civil liberties, even under threat;
I make these promises solemnly, freely and upon my honour.

I solemnly pledge myself to consecrate my life to the service of humanity;
I will give to my teachers the respect and gratitude which is their due;
I will practice my profession with conscience and dignity;
I will respect the secrets, which are confided in me, even after the patient has
died;
I will maintain by all the means in my power, the honour of the noble traditions
of the medical profession;
My colleagues will be my brothers;
I will not permit considerations of religion, nationality, race, party politics or
social standing to intervene between my duty and my patients;
I will maintain the utmost respect for human life from its beginning even under
threat, and I will not use my medical knowledge contrary to the laws of
humanity;

Def: A document establishing the ethical rules of behaviour of
physicians and dental practitioners, defining the priorities of
their professional work, showing the principles in the relations
with patients, colleagues and the rest of community.
Primarily developed for patient’s benefit.
Represents principles of professional conduct, rules and
responsibilities by which the dentist must aspire to fulfill their
responsibilities.
Vary from country to country or within the same country.

Cherish a proper pride in your
colleagues and treat them as
brothers and sisters.
Should not make disparaging
comments of the procedures or
qualification of colleagues.
Honor mutual arrangements
made regarding remuneration.

On no account do anything harmful to the interest of the
members of fraternity.
Retire in favor of the regular dentist, after the emergency is over.
Institute correct treatment at once with the least comment.
Regard it as a pleasure and privilege to render gratuitous services
to another dentist, his immediate family members.

The best recommendation for a dentist should be his/her
personal reputation, professional ability and fidelity.
The welfare of the patient should be the top priority.
Be courteous, sympathetic, friendly and always be ready to the
call of patients.
Observe punctuality in fulfilling appointments.

Race, Religion, Nationality or Relation should not
interfere in providing the best available services.
Provide high quality of care to the patient.
Keep knowledge current and strive for better
treatment of patient.
Maintain accurate dental and medical records of
patients
Keep all personal information regarding a patient
confidentiality.

To participate in community affairs
Educate the public in promotion of health
To be trustworthy and honest
To provide for his needs/welfare
To honor his parents

 To respect the property of others
 To follow community laws
 To use the social services provided
 To take a leadership role in community and
 Elevate the esteem of profession

Grounds for Suspension or Revocation
• Conviction of a crime
• Unprofessional conduct
• Personal or Professional incapacity

Some of the procedure constituting litigation and possible conviction
can be obtained from
Attitude towards members of the disciplinary organs of the
profession
Professional negligence
Rules guiding physicians in biomedical research involving
human subjects

Association with chemists, opticians, optometrists, dental
technologists, other para-professionals and insurance agents
Improper relationship with colleagues or patients
Self-advertisement and related offences: relationship with
the media
Issues on private medical or dental practice; ……..

Practice by unregistered persons employed by the
dentists.
Represent itself in a manner that is false or
misleading and representing their fees in deceptive
manner.
Issuing any certificate signed by the dentist which is
untrue, misleading or improper.
Use of bogus diplomas, allowing or accepting
commissions. 07/01/2016LAWS AND ETHICS OF DENTAL PROFESSION BY DR ME OSUH; BDS, FMCDS, MPH 40

Non referral, in case treatment beyond the dentist
skill.
Performing unnecessary services for purpose of
monetary gain.
Emerging consultation during temporary absence of
patient’s dentist, and patient is not sent back.
Dentist advertising whether directly or indirectly, for
purpose of obtaining patients.

Not defined nor limited but includes
 GA and sedation administration by untrained persons
Sterilization ; A dentist’s duty to take appropriate precaution
to protect staff and patient
Abuse of professional relationship: immorality
Improper statements or certificates, misleading
pronouncements
Drinks and drugs
Advertising
Leaving a practice
Canvassing…

After investigation and trial of a registered practitioner,
if pronounced GUILTY, the MDCN Registrar shall take
the following steps:
(A) The sentence pronounced shall be published in the
Gazette of the Federal Republic of Nigeria and also as a
paid advertisement in each of four national newspapers.

Notification of the publication shall be duly
deposited with the
 permanent secretaries of the Federal
 and all the State Ministries of Health,
 and the National President of the Nigerian
Medical Association (if a medical practitioner) or
the Nigerian Dental Association (if a dental
surgeon).

(B) Where the name of registered practitioner is
suspended from the Register for a period of
time the Registrar will in addition to (a) above
direct the practitioner to complete on a monthly
basis, an approved pro forma to the effect that he
maintains compliance with the sentence till
suspension period expires

Practitioners like any member of the society are prone
to various ailments and detestable habits.
To some extent these ailments and habits do not only
impair the productivity, judgement and alertness of
practitioners but can render them unreliable.

The Council views the following as conditions which could
render a practitioner unsafe and constitute obstacles of
fitness to practice medicine or dentistry:
i. A practitioner suffering from senile dementia.
ii. A practitioner suffering from physical or mental
conditions which can imperil his patients,
embarrass his professional colleagues and indeed
jeopardize his own career and professional position.

iii. A practitioner who has become addicted to drugs
and might or indeed does commit offences
against the Dangerous Drugs Act and Regulation.
iv. A practitioner addicted to alcohol who might or
is not in the right frame of mind to treat patients.

1. List the principles of ethics ?
2. Discuss any 4 of these ?
3. Define the term dental professionalism ?
4. What are the duties of a dentist towards his patients,
colleagues and community ?
5. What are the grounds for suspension or revocation of a
dentist’s licence ?
6. What situations would render a dentist unfit to practice
in Nigeria ?

Thank you

CodeOnMedicalEthics in Nigeria pdf
Google
Wikipedia
Textbook of Community Dentistry with multiple choice
questions (JAYPEE)
Textbook of preventive and community Dentistry
(ELSEVIER)
Essentials of Preventive and Community Dentistry by Soben
Peter

Laws and Ethics of the profession

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