Course:DHYG400/groupA 2011
Ethical Issues in Work and Life
According to the Oxford dictionary, ethics is defined as moral principles. Morality is an individual’s definition of what is ‘good’ or ‘right.’ (1) Most people have a traditional level of moral maturity. (2,3) Once an individual reaches a stage of moral development, they turn to the law or other forms of authority to help them in decision making. (2) However, the law defines the lowest level of acceptable behaviour and ethics is a higher order of conduct. This higher order is raised from social conduct, to that of always promoting good for others. (4) There are a variety of influences in ethical decision making. These include: workplace, profession, religion, legal system, family and community. (2) Because of the many influences, it is understandable that individuals make different decisions.
Every profession has some form of rules for conduct. They may be written or unwritten. Decision-makers in ethical situations are defining their roles by what they think is expected of them, whether the ethical guidelines are written or not. (2) The Code of Ethics for dental hygienists offers written principles and standards for the dental hygiene profession to follow.
A selection of professionals were interviewed, including a high school teacher, licensed practical nurse (LPN), medical researcher, bank manager and a certified general accountant (CGA). Ethical challenges were explored within these professions and offered insight as to how ethical issues are handled within a variety of work environments. The nature of the dental hygiene profession may differ from the professionals that were interviewed. However, examples of their ethical decision-making qualities can be used to help improve dental hygienists’ approach in dealing with ethical problems encountered in oral healthcare.
Ethical Dilemmas
Emma Profession: high school teacher
The environment of a workplace can influence the decisions one makes when encountered by ethical situations. A study done by Devitt and Hise on ethics research, mentions that organizational support influences the level of moral maturity of the decision-maker. (2) Teachers, for example, often work in a positive atmosphere. Many teachers find their profession to be rewarding and satisfying. They are surrounded by motivated, enthusiastic colleagues, who want the best for their students. Should an ethical problem arise, teachers may have little difficulty making decisions, since their focus is on the students. Teachers have the student’s best interest at heart, and therefore the decisions will likely focus on what is best for the student. Although schools are dedicated to the well-being of children, students have minimal say in what happens there. (5) As a result, teachers have an increased obligation to maintain high ethical standards. In oral healthcare, clients expect and trust that they are receiving quality care. The dental hygiene profession is also dedicated to the well-being of their clients, like teachers are to their students. Similar to a student’s voice in school, client’s often have limited say in what happens in a dental office. Also, clients may not be aware of what is an acceptable level of oral health care and for this reason, dental hygienists have an ethical obligation to maintain high standards and always strive to deliver the best care possible.
Unfortunately, ethical situation do arise in school settings. Most schools do not encourage discussion of ethical issues and teachers don’t often have the time. Perhaps there is need for schools to raise awareness of ethical issues, develop ethical codes, and offer assistance for teachers when encountered by ethical dilemmas. (5) Teachers are reminded that ethical behaviour is not just a matter of following the letter of the law or sticking to the obligations of the code. Teachers should also act within the spirit of the law and the code. It is not enough to think that your behaviour is ethical, it must also be seen to be so. The appearance of unethical behaviour can be just as damaging to public confidence in the profession as unethical conduct itself. (6) It’s interesting to note that many schools do not encourage discussion of ethical issues. Like teachers, dental hygienists are educated about ethics in their education programs. Is the practice of dental hygiene also comparable to a high school environment, where ethics is not freely discussed? Dental hygienists are often reminded about the CDHA Code of Ethics and are expected to be guided by, and to be accountable under, the principles and standards emphasized in the Code. (7) However, is it very common for dental hygienists to openly talk about the Code of Ethics in private practice? Dental hygienists may find it challenging to initiate a discussion about ethical problems that arise in a dental practice. Nevertheless, it would be a good idea for dental hygienists to raise concerns about ethical issues that occur, and to collaborate with the dental team to identify methods for resolving these ethical challenges.
Students may disclose personal information to their teachers. For example, a student may tell a teacher that they are being physically abused at home. Teachers are required by law to report to Children’s Aid Society (CAS), if a student is being hurt. But in such a situation, the teacher is not simply dealing with legal obligations. Of course, the teacher wants to ensure that the student is safe and protected from harm. However, the teacher will likely recognize that what she decides to do in addressing this particular issue is not a choice between right and wrong, but a choice between two rights. (5) The two rights, in relation to the Code of Ethics that dental hygienists follow, would be the ethical principles involved. Dental hygienists often encounter ethical dilemmas in practice and base their decision-making on the ethical principles involved. The teacher is aware that she needs to advise the appropriate individuals (i.e. guidance counsellor and possibly Children's Aid Society) to ensure the student is safe. Here, the teacher is showing beneficence, because she is caring and acting to promote the good of another. (7) At the same time, the teacher respects the student’s privacy and is responsible for keeping their information confidential. Would the student be appreciative to having her personal information disclosed to others? If the teacher discloses the student’s personal issues, will the student trust the teacher in the future? The teacher is unsure if revealing the sensitive information would make matters worse. Dental hygienists are also required to respect an individual’s privacy and keep information confidential. Privacy pertains to the individual’s right to decide the conditions under which others will be permitted access to his or her personal life or information. Confidentiality is the duty to keep secret any information obtained in a professional relationship. (7) An ethical dilemma puts one in a difficult position when having to decide on a course of action. When a professional has another person’s best interest at heart, they want to do what is best for that individual. In the situation described above, the teacher will most likely reveal the student’s confidential information, in order to make sure that the student is removed from a potentially harmful environment. Therefore, the principle of beneficence will overpower the principle of privacy and confidentiality.
For dental hygienists, breaking the principle of confidentiality is accepted in certain circumstances. During dental hygiene care, client's sometimes disclose personal information. A client may reveal their thoughts about being depressed and planning on harming themselves. Similar to the situation with the teacher, the dental hygienist needs to decide whether they should keep this information confidential or decide to tell someone. The client is at risk of being harmed. Caring about the good of another will likely lead the dental hygienist to report the client's thoughts and intentions to a responsible individual who can address the concerns. This is an example where dental hygienists can disclose a client's private and confidential information. (7)
Gaudine andThorne reflect on how emotions affect ethical decision-making in organizations. Ethical sensitivity triggers the ethical decision-making process by identifying an ethical dilemma. Ethical sensitivity is the awareness that the resolution of a particular dilemma may affect the welfare of others. (1) Emotion is usually not considered an important aspect of the ethical decision process because it may interfere with a proper ethical decision process. (1) When teachers learn private information about their students, they feel compassion for them and don’t want to see them getting hurt. Ethical decisions may be affected by emotions. (1) In a profession where one cares about others, it is difficult to ignore emotions when faced with an ethical challenge. Emotions can arise when dental hygienist encounter ethical situations. Dentists may place pressure on a dental hygienist to act unethically. Dental hygienists may get emotionally involved because they want to provide quality care and the client’s trust the care that they receive. According to Gaudine and Thorne, emotions should not be ignored but rather taken into consideration in the ethical decision making process. Attention to one’s emotions may result in better ethical decisions. Sometimes exploring one’s emotional responses may trigger the recognition of an ethical dilemma in the workplace.(1)
References:
1. Gaudine A, Thorne L. Emotions and ethical decision-making in organizations. Journal of Business Ethics 2001;31: 175-187.
2. Devitt R, Van Hise J. Influences in ethical dilemmas of increasing intensity. Journal of Business Ethics 2002;40: 261-274.
3. Schminke M, Ambrose M, Miles J. The impact of gender and setting on perceptions of others’ ethics. Sex Roles 2003 Apr;48(7/8): 361-375.
4. Neish N, MacDonald L. CDHA Code of Ethics workshop: application to day-to-day work. Probe 2003 Jan/Feb:37(1): 27-33.
5. Lashway L. Ethical leadership. Eric Digest. 1996 June:107.
6. Australian Capital Territory. Teachers code of professional practice. Dept of Education and training. Canberra, 2006.
7. Canadian Dental Hygienists Association. Code of Ethics. CDHA, Mar 2002.
Cheta
Profession: Bank Manager
Ethical decision-making is critical for professional work in all fields, but it has been given particular attention in the sciences and academia.(4) Bank Manager at TD Financial Institution was faced with ethical dilemma with colleague/ friend's professional and personal life. Bank manager being responsible to make the management authority to be aware of some personal circumstances that her friend/ colleague facing in his personal like possibly may affect his professional performance and after all might lead to major problem for corporation. TD financial institution code of conduct and ethics stats that it is most important to maintain privacy and confidentiality for your customers and employees. (1) It is not appropriate professional behaviour to speak about your colleague with other peers. At the same time TD Financial institution code of conduct and ethics stats the accountability and responsibility towards you company and work. (1) It is important to make the work environment violation and safe. It is also important make the management aware of any ongoing possible negligence or violation in work environment which can possible affect the company in negative aspect. The bank manager was face with three ethical principles of privacy/ confidentiality, professionalism, and accountability/responsibility towards her company. Bank Manager was faced with ethical principle of privacy as it was confidential and personal information that her colleague/ friend shared with her. On the other hand she was faced with professionalism as it is no appropriate behaviour to talk about her colleague to her management. Professionalism often can be defined as aspiring toward altruism, accountability, excellence, integrity, and respect for others. (3)These affective and tangible components of professionalism can at times be competitive with the financial and productivity demands encountered in practice.(3) However, she was accountable towards company and was responsible to make the management aware of any possible circumstances that may affect company in negative way. This could be compared to RDH code of ethics principles of accountability, confidentiality, and professionalism.(2) Ethics, values, and professionalism are best measured in contexts comparable to practice; therefore, authentic evaluation is desirable for assessing these areas of competence. (3) To make a right ethical decision is very important to obtain meaningful and positive outcome of dilemma.
References:
1.TD Financial Institution Code of Conducts and Ethics. 2.CDHA. Code of Ethics. (Online) 2011 (cited 2011 Oct. 16); Available at http://www.cdha.ca/pdfs/Profession/Resources/CDHA_Code_of_Ethics_public.pdf 3.Effectiveness of Faculty Training to Enhance Clinical Evaluation of Student Competence in Ethical Reasoning and Professionalism Carole Christie, M.Coun.; Denise Bowen, R.D.H., M.S.; Carlene Paarmann, M.Ed. 4.Strategies in Forecasting Outcomes in Ethical Decision-making: Identifying and Analyzing the Causes of the Problem Cheryl K. Beeler, Alison L. Antes, Xiaoqian Wang, Jared J. Caughron, Chase E. Thiel, and Michael D. Mumford The University of Oklahoma
Ethical Violations
Rachelle
Profession: CGA accountant
Within the world of accounting high levels of ethics is required. (1) Clients strongly rely on their accountants in handling their personal and/or business’s investments based on their yearly statement. (1,2) “Accounting plays a key role in the social and economic progress of a nation.” (2, p.300) Accountants are often faced with ethical issue, which lead them to make unethical decisions. (3) Money, power, knowledge, popularity and integrity are some of the reasons that will encourage accountants to work unethically. (2) Demanding clients are usually the ones who will lead their accountants in altering their tax reports, creative accounting, changing the fees that will lead to misleading financial statements and bribery. (1,3)
CGA’s are entitled to follow their Code of Ethical Rules and Rules of Conduct, which is specific to all CGA’s throughout Canada. (4) Depending on where the accountant is employed, the company may have their own Code of Ethics, making a second code to fallow. As Flory discusses in his article, ethics codes will allow an accountant to establish the public’s confidence and strengthen its competitive position. (3) The accountant’s moral and ethical background will play an important role if he fallows or not the code of ethics. (2) Other authors argue that the firm’s corporate culture and the values they project will negatively influence the accountants to make an ethical decision. (1) Flory also mentions that the accountants business Code of ethics may be more powerful in encouraging ethical business behavior than the Code of Ethics created by their association. (3) The consequences of unethical work can lead to fraud, accounting scandals, closure of company and firms, bankruptcy resulting in thousands of job losses. (1)
The CGA’s Code of Ethical Rules and Rules of Conduct implies that 2 elements of character are crucial to members of the CGA self-regulated profession. (4) In every circumstance, there actions must show integrity and trustworthiness. (4) They also encourage every CGA to apply the independence standard, which requires the CGA to be independent of mind and of appearance in all of their work. Priority in decision making is a lot of the CGA’s own judgment, which make their Code of Ethics more specific about the responsibilities of their profession and their duties.
When considering similarities to the CDHA’s Code of Ethics and the CGA’s Code of Ethical Rules and Rules of Conduct, both profession practices within similar principle. In both professions, confidentiality is very crucial. Whether handling the client’s personal, health and wealth information, it must remain confidential and shall not be disclosed. (4,5) In both professions, exemptions do apply. If personal information is required by the law, then the information would need to be disclosed. (4,5) Confidentiality is often not respected in both professions, that leads to unethical principles. Clients’ personal information is often unethically disclosed for the professional’s personal and professional gain. (3)
CGA’s Code of Ethical Rules and Rules of Conduct could be interpreted like a book of common laws. Even though the accountant is a self-regulated profession, a large section of their Code of Ethics is attributed to several Rules of Conduct that implicates various areas of the accountants life. (3,4) Unfair Methods of Competition from the Name of Firm to the Legal Change of Member’s Name needs to be fallowed as per the Code of Ethics. (4)
References
1. Accounting Ethics. Wikipedia. [Online]. [cited 2011 Oct. 20]; Available at: http://en.wikipedia.org/wiki/Accounting_ethics 2. Keller CA, Smith KT and Smith LM. Do gender, educational level, religiosity, and work experience affect the ethical decision-making of U.S. accountants. Critical Perspectives on Accounting. 2007.18;299-314 3. Flory SM, Phillips TJ, Reindenbach E, Robin D. A Multidimensional Analysis of Selected Ethical Issues in Accounting. The Accounting Review. 1992 April. 67(2); 284-302. 4. CGA- Canada. Code of Ethical Rules and Rules of Conduct. [Online] 2011 [cited 2011 Oct. 20]; Available at: http://www.cga-canada.org/en-ca/StandardsLib/ca_ceproc.pdf 5. CDHA. Code of Ethics. [Online] 2011 [cited 2011 Oct. 20]; Available at http://www.cdha.ca/pdfs/Profession/Resources/CDHA_Code_of_Ethics_public.pdf
Ethical Distress
Allison Profession: LPN
Licenced Practical Nurses (LPN) abide by a code of ethics which is similar in many ways to the dental hygiene code of ethics.(1,2) Similar themes within both professional Code of Ethics documents include: ensuring safe and competent care, putting client’s needs and safety in the forefront, privacy and confidentially, maintaining continuing education, and practicing within one’s professional scope of practice.(1,2)
An ethical dilemma which both LPN’s and registered dental hygienists (RDH) could encounter would be if a superior or employer asks them to perform a task which is beyond their scope of practice.(1,2) According to the code of ethics documents, both the LPN and RDH must always practice within their scope to protect the safety of the client regardless of the requests of employers or superiors.(1,2) This can cause ethical distress if they feel like their job is in jeopardy due to not following the employer’s/superior’s instructions, despite the maleficence that the ethical violation may cause to the client.(1) To determine the best possible ethical solution to such dilemmas one must evaluate the situation and forecast possible outcomes with reference to their professional code of ethics.(3) Solutions for dealing with this type of ethical dilemma could include: discussions with the employer or superior with reference to professional scope of practice documents or one could also request additional training or certifications which would increase one’s scope of practice.(3) Hopefully the consequences of these solutions would be for the employer to respect the LPN and RDH more since they are demonstrating their commitment to the ethical principles of beneficence and nonmaleficence.(1,2) Another similarity between the ethical practices of RDH’s and LPN’s is the requirement for reporting should a co-worker violate the code of ethics. Reporting unethical behaviour, while necessary to protect the best interest of the clients, can be challenging especially if the offender is someone with whom the LPN or RDH works closely with.(4) It is suggested by Booth that a supportive work environment with understanding managers will assist staff in reporting any unethical behaviour by their co-workers(4).
Ethical issues for LPN’s working in a long term care facility are unique when compared to hospital settings, or RDH’s in clinical practice, since the focus is on chronic continued care which often involves end of life considerations. (5) An LPN’s focus often becomes more about compassion which extends beyond the treatment of one particular client to their families and loved ones during times of grief. (5) The client’s beneficence remains the focus of care, but more considerations with regards to the family’s wishes should be respected. (5)
Birchley suggests that healthcare professionals need to develop a sense of conscience, which should be a focus in their educational training and this will assist in their ability to make morally right decisions in challenging situations.(6) With regards to client confidentiality, an LPN working in a long-term care facility has the added dimension of accommodating those clients with reduced mental capacity quite often.(2) Where generally an RDH working in private practice only has to involve the client themselves in the decision making process, an LPN in long term care may have to involve and consult the next of kin and other family members or power of attorney in the decision making process.(5) Ethical dilemmas could arise for the LPN if all of those involved do not agree with the path of treatment, the care provided, who should be involved in the decision making process or many other aspects of care.
1. CDHA. Code of Ethics. (Online) 2011 (cited 2011 Oct. 16); Available at http://www.cdha.ca/pdfs/Profession/Resources/CDHA_Code_of_Ethics_public.pdf
2. Code of Ethics for LPN’s: Companion Guide. (Online) 2011 (cited 2011 Oct. 16); Available at http://www.clpnbc.org/content_images/documents/CodeofEthics%20Companion%20Guide.pdf
3.Beeler C K, Antes A L, Wang X, Caughron J J, Thiel C E, Mumford M D. Strategies in Forecasting Outcomes in Ethical Decision-making: Identifying and Analyzing the Causes of the Problem. Ethics Behav. 2010 March 19; 20(2): 110–127.
4. Booth B, Carruth A. Violations of the Nurse Practice Act: Implications for Nurse Managers. Nursing Management. 1998 Oct; 29(10),35-39.
5. Van der Dam S, Abma T, Kardol M, Widdershoven G. ‘‘Here’s My Dilemma’’. Moral Case Deliberation as a Platform for Discussing Everyday Ethics in Elderly Care. Health Care Anal.[e-pub ahead of print] 2011 Aug 2.
6. Birchley, G. A clear case for conscience in healthcare practice. Journal of Medical Ethics. [e-pub ahead of print] 2011 June 27.
Bibliography
Fang ML. Evaluating ethical decision-making of individual employees in organizations—an integrative framework. Journal of American Academy of Business 2006;8(2):105-112.
Jonasson L, Liss P, Westerling, B, Bertero C. Corroborating indicates nurses’ ethical values in a geriatric ward. Int J Qualitative Stud Health Well-being. 2011 Sept 14;6:7291-7301.
Neish N, MacDonald L. CDHA Code of Ethics Workshop: Application to Day-to-Day Work. Probe 2003; 37(1):27-33.
Overcoming Ethical Situations in Dental Hygiene Practice
Should Marlene's section be included in here? Marlene: Profession:
Ethical standards in the medical research field are similar to the ethical standards in the dental hygiene profession. The principles of autonomy, beneficence, non-maleficence, informed consent, and confidentiality are the cornerstone of each profession. (1, 2) Experimental studies must be designed in a way to ensure that all these principles are maintained. The dental hygiene process of care must also be developed to ensure that these principles are maintained. With each profession, the patient or subject must always have the right to participate and remove themselves from the study or treatment at any time without reprisal. (3) Treatment must be voluntary and the decision be made with all the available knowledge and research being disclosed to the patient or participant. Documented consent is necessary to ensure that the subject or patient has all the information he or she needs to make an informed decision. (3) The health and safety of the participant must be the first priority of the research design. Every experiment must be preceded by careful assessment of predictable risks and burdens in comparison with foreseeable benefits to the subject or to others and be terminated if risks outweigh the benefits. (4) Although every profession will be faced with ethical dilemmas, the medical research field has a very low rate of deviant behaviour. (5) This is most likely linked to the introduction of ethical committees that must approve an experimental design before it begins. This committee is made of up members of the public and medical field whom have nothing to gain from the success or failure of the study. This differs from the dental hygiene profession because individual members are obligated to report unethical behaviours to their college. The reporting of unethical behaviours is subject to directly witnessing or having firsthand knowledge of unethical behaviours and be willing to report a co-worker or colleague. This system puts dental hygienists in a tough position because of the personal and often intimate relationship that dental hygienists have with one another. With no “watchdog” within private clinical practices, unethical behaviours may go unreported, possibly putting the patient and public at risk. Darby and Walsh suggested implementing a dental ethics committee (DEC) within the private practice setting to ensure that ethical principles and codes for resolving ethical dilemma are used. (6) The purpose of a DEC is to identify ethical dilemmas, use a decision-making model to work through problem or conflict, address concerns, identify alternatives and use a team approach to solve the dilemma. The DEC should develop guidelines outlining its purposes, functions and membership. These guidelines can be incorporated into regular staff meetings and can assist raising issues of concern to all staff members, educates staff about ethical issues and encourages ethics-based office philosophy. (6) Another reason that the medical research profession reports a low rate of unethical behaviour could possibly result from a researcher being black-listed if they are found guilty of unethical behaviours. (5) The consequences for unethical behaviour are very high and careers can be destroyed by misconduct. In this field, individual success is not determined by how many studies are conducted but according to formal criteria such as the number of publications, benefits received based on the outcomes of research and enhanced status within the research community. (5) Although these criteria may seem like an incentive to participate in unethical behaviours, the transparency required in experimental designs and the presence of an ethical review committee is enough of a deterrent to maintain ethical standards. Dental hygiene can use the examples from the medical research field to overcome ethical situations in private practice. Darby and Walsh suggest an ethical decision-making framework model to facilitate ethical decision making. This model includes defining the problem or conflict, identifying what the ethical issues are, gathering relevant information about the problem or conflict, identifying alternate courses of action, establishing an ethical position and the selecting, justifying and defending the course of action. (6) Once an ethical situation has been defined and all the information gathered about the situation, the dental hygienist can critically look at all the potential courses of action and potential outcomes to the situation. A dental hygienist has an obligation to the client (legal and ethical), obligation to the other people involved in the situation (colleagues, family members, public), an obligation to their own personal beliefs and values, alternatives to protecting the client’s best interest and a professional obligation to do the least harm to the client while at the same time working within the professional constraints of the dental hygiene profession. (6)
References
1. CDHA. Code of Ethics. (Online) 2011 (cited 2011 Oct. 19); Available at http://www.cdha.ca/pdfs/Profession/Resources/CDHA_Code_of_Ethics_public.pdf 2. Wikipedia. Medical ethics. (online) 2001 (cited 2011 Oct 19); Available at: http://en.wikipedia.org/wiki/Medical_ethics 3. National institute of Health. Ethical Principles for medical research involving human subjects. (Online) 2004 (cited 2011 Oct 19); Available at: http://ohsr.od.nih.gov/guidelines/helsinki.html 4. Medical Research Council. Ethics and research guidance. (online) 2011 (cited 2011 Oct 19); Available at: http://www.mrc.ac.uk/Ourresearch/Ethicsresearchguidance/index.htm 5. Komesaroff, P.A. Misconduct in medical research: ethics and democracy. International Medicine Journal. 2003; 33: 137-139. 6. Darby, M. and Walsh, M. Dental Hygiene Theory and practice. 2nd Edition. Philidelphia, PA. Elsevier; 2003.