ETHICS IN DENTISTRY

1. Dr.shari.S.R
FIRST YR MDS
GDC ,TVM

3. The word ethics is derived from
Greek word “ethos” meaning
custom or character

4. DEFINITION
• Ethics is the philosophy of human conduct, a way of stating and evaluating principles
by which problems of behaviour can be solved.
• Ethics is concerned with standards judging whether actions are right or wrong.

5. DENTAL ETHICS
Dental ethics simply means moral duties and obligations of the dentists towards the
patients ,professional colleagues and to the society.
• It considers how we should act best in the light of our duties and obligations as moral
agents.

7. HISTORY
Hippocratic oath is the first ethical standards given by Hippocrates, the father
of medicine, in the 4th century BC
“prescribe regimens for the good of my patients
according to my ability and my judgment and
never do harm to anyone”

8. THE INDIAN SCENARIO
• Ethical rules for dentist were initially formed by the DCI, and the Dentist
act was amended via section 17A
• The code of ethics was framed by dental council in 1975 and later notified
by the government of india as dentist regulations 1976(Code of Ethics).
• It is in force from august 1976

9. Micro -ethical principles
They focus primarily on rights and duties and donot see indviduals as a part of a wider
social order
Macro ethical principles
These are set of principles designed to protect the human dignity ,integrity,,self
determination,confidentiality,rights and health ,of populations and the people
comprising them.

10. ETHICAL PRINCIPLES
1. To do no harm [ Non-maleficence ]
2. To do good [ Beneficence ]
3.Respect the person
4.Justice
5.Veracity or Truthfulness
6.Confidentiality

12. TO DO NO HARM (Non-maleficence)
• Considered to be the foundation of social morality.
• Actions of the healthcare provider should not harm the patients in anyway
• Iatrogenic diseases-doctor induced illness.
• Use of unsterilized instruments
• Iatrogenic diseases (underfilling, overfilling etc)
• Doing procedures beyond his competency

13. TO DO GOOD ( Beneficence )
• A practitioner should act in the best interest of the patient.
• Attempts to maximise the benefits and minimize harm.
• Before doing any action, decide whether it would help the patient to recover
or to perform his functions better
• Plan for a treatment or investigation only if necessary

14. RESPECT THE PERSON
Autonomy Informed consent

15. AUTONOMY
• It is the principle that dictates that health care professionals respects patients right to make
decisions concerning the treatment plan.
• Dentists usually try to direct the patient towards a particular mode of treatment by stressing
only over the advantages rather than mentioning disadvantages.
• Respect patients right to make decisions
• Don’t force decisions on patients
• Paternalism

16. INFORMED CONSENT
Two step process
• Firstly information is presented to the patient by doctor
• Secondly the patient satisfies himself or herself that she understands and based upon
this understanding either agrees or refuses to undergo the treatment.
• Description of,
a. procedures to be carried out
b. foreseeable risks or discomforts to the subject
c. reasonably expected benefits from the treatment
• A statement that the patient has understood the procedure and is willing to undergo the
treatment.
• The signature of the patient and of a witness.

17. JUSTICE
• Provide equal treatment to all without any prejudice
• Violation of justice
• Discrimination between patients based on caste, creed, socioeconomic status, health
condition
• Principle of justice is to protect the weak and to ensure equality in rights and
benefits, for both groups and individuals

18. TRUTHFULNESS
• The patient - doctor relationship is based on trust.
• Lying shows disrespect to the patient and threatens relationship.
• Patient expects the dentist/doctor to give true information about treatment and
prognosis
• Don’t:
• Hide treatment failures
• Give false information

19. CONFIDENTIALITY
• Health is a sensitive issue
• The patient has right to expect that all communications and records pertaining to their
care will be treated as confidential.
• Disclose only if it is beneficial for the patient (with consent)
• Avoid
- Gossiping about the patient

20. EHICAL RULES FOR DENTISTS
[given by DCI]
• Duties of dentist towards patients
• Duties of dentists towards one another
• Duties of dentists towards the public

21. DUTIES OF DENTIST TOWARDS PATIENTS
• Dentists should be courteous, sympathetic, friendly and helpful.
• Observe punctuality in fulfilling his appointments.
• Should not permit considerations of religion, nationality, race, party politics or social
standing to intervene between his duties and treatment

22. Duties of dentists towards one another
• Every dentist should cherish a proper pride in his / her colleagues and should not
disparage them with words or act.
• If a dentist is consulted by a patient of another dentist and the former finds that the
patient is suffering from previous faulty restoration , its the duty of the dentist to correct
the treatment at once with few comments as possible so as to avoid reflection on his
predecessor.

23. Duties of dentists towards the public
• Dentist should take leadership roles in the communities on matters
related to dental health.

25. UNETHICAL PRACTICES
• Practicing by unregistered persons employed by the dentist.
• Signing a certificate issued for untrue, misleading and improper reasons.
• Direct or indirect advertising.
• Use of bogus diplomas.
• Undercharging for solicit patients.

27. NEED FOR RESEARCH ETHICS
“Many prominent medical researchers in
the 19th and 20th centuries conducted
experiments on patients without their
consent and with little if any concern for
the patients well-being”

33. NAZI EXPERIMENTS
• Testing with infectious diseases
• Killing
• High altitude experiments
• Experimental surgery
• Traumatic experimentation
• Pharmacological

34. NUREMBERG TRIAL
“ 9 Of the 26 doctors were sentenced to death “
“The basis of the judgment is known
as the Nuremberg Code, which has
served as one of the foundational
documents of modern research
ethics. “

35. NUREMBERG CODE
• Totally voluntary informed consent
• Based on prior animal experiments
• Justification of benefit to individuals and society
• No expectation of death/injury from an
experiment
• Proper preparations should be made to
protect the experimental subject against
even remote possibilities of injury,disability
or death.

36. NUREMBERG CODE
• The experiment should be conducted only by
scientifically qualified persons
• Participants can withdraw from the study at any time
• Termination of the study if adverse effects emerge
• The experiment should be conducted as to avoid all
unnecessary physical or mental suffering and injury.
• The degree of risk to be taken should never exceed
that determined by humanitarian importance of the
problem to be solved by the experiment.

37. TUSKEGEE TRIALS
• 1932 forty year old study launched by Public
Health Service Alabama.
• 399 African Americans were selected and
infected with syphilis.
• All the men selected were poor, uneducated and
were desperate to receive Hot meals provided by
the commission.
• Ironically they were also offered Burial insurance.

39. THE DECLARATION OF HELSINKI
(1964)
• Declaration of Helsinki is a set of ethical principles regarding human
experimentation developed for the medical community by the World
Medical Association (WMA).
• It is widely regarded as the cornerstone document on human
research ethics

40. • Right to make informed decisions regarding participation in research
• Research should be based on a thorough knowledge of the scientific
background
• Careful assessment of risks and benefits
• Conducted by suitably trained investigators using approved protocols,
• Subject to independent ethical review
• Information regarding the study should be publicly available
• Experimental investigations should always be compared against the best
methods, but under certain circumstances a placebo or no treatment group
may be utilised

41. THE DECLARATION
OF
GENEVA(Physician’s
pledge)

42. • It was adopted by General assembly of the world medical association at Geneva in 1948,amended in
1968,1983,1994,2005,2006 and in 2017.
• The oath seems to be a response to the atrocities commited by doctors in Nazi, Germany.
• This oath requires the physician to not use his medical knowledge contrary to the laws of humanity.
• AS A MEMBER OF THE MEDICAL PROFESSION:
• I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;
• THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;
• I WILL RESPECT the autonomy and dignity of my patient;
• I WILL MAINTAIN the utmost respect for human life;
• 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;

43. I WILL RESPECT the secrets that are confided in me, even after the patient has died;
I WILL PRACTICE my profession with conscience and dignity and in accordance with good medical practice;
I WILL FOSTER the honour and noble traditions of the medical profession;
I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;
I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;
I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;
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.

44. CONCLUSION
• Healthcare is not a business.
• Hence, adherence to a code of ethics is important for the continued
trust of the society in dentistry.
• Ethics is not a rule or cannot be forced on anyone………………………………
..…………………………………………………………....It has to be self cultivated.

45. REFERENCES
• Essentials of preventive and community dentistry 4 th edition –soben peter
• Hirsch gert,Ethics in dental practice,JADA,Vol 113,October 1986,
• Bailey .B.L. Informed consent in dentistry.JADA 110(5):709-713,1985
• Nash ,D.Ethics in dentistry.JADA 109(4):597-603,1984
• Google ,WMA-Declaration of Helsinki -2008 version.