Course:DHYG400/Group B

Sorry for the delay, we posted in the block section by mistake

As Registered Dental Hygienists, we are confronted with ethical challenges on a regular basis. It is how we manage or control these challenges and situations that represent not only our own individual moral standing, but that of the voice of the dental hygiene profession. For this assignment we were invited to interview other professionals outside of our realm of dentistry. Subsequently, we have discovered that there are many similarities and differences regarding ethical issues that are also apparent to other professionals in their line of work.

For this assignment, each member of our group interviewed one of the following: a teacher, a chiropractor and a certified kinesiologist.

Ethical Dilemma

As per the CDHO Code of Ethics, which has been adapted from the CDHA Code of Ethics, an ethical dilemma occurs when two or more ethical principles are in conflict. Upon collaborating with our group member, and different professionals that we interviewed, ethical dilemmas occurred despite the line of profession.

Mrs. L, worked as a teacher for 38 years with the Peel District School board, and has now entered into retirement at the age of 65 years of age. She recalls a situation where she was put in a very difficult position and was “torn” with her decision. At the time, when she taught second grade at an elementary school, she suspected a child was being physically abused at home. In the interview she reported that she thought that the child’s mother was great and a very nice person, but always had reservations about the father as Mrs. L could see a change in disposition in the child when the father would arrive to pick the child up from school. Additionally, she discussed how the child would wear long sleeved clothing even on hot summer days and became very distant, introverted and withdrawn from many class activities. Mrs. L felt that she was in a much compromised position as she only suspected physical abuse but did not have verbal acknowledgement or correspondence from the child that these assumptions were in fact occurring at the family home. Mrs. L became very emotional about the dilemma and had often consulted the possibility of this child being removed from the family home, and away from the mother whom she thought was a good person. Mrs. L was bound by the Peel District School Board Code of Ethics to respect the confidentiality of the suspected issue impending. (1) She constructed an issue report to the concern of the School Board and then was referred to the Children’s Aid Society.

Although in many provinces hygienists are self regulated, and some self-initiated, and do not require a DDS to provide a standing order, or to work under their supervision, ethical dilemmas are still prevalent. Take for example, a dental hygienist who recognized that her adult patient is suffering from bulimia. The dental hygienist is to acknowledge the situation and explain to the patient the negative long-term effects to not only her dentition, but the detrimental effects to her general health. The patient is exercising her right to autonomy, while the dental hygienist is practicing her right to beneficence.

Ethical Violations

As per the College of Chiropractors of Ontario’s Code of Ethics, chiropractors “shall attend their patients as often as necessary but shall avoid unnecessary care.” (2) Dr. C is a chiropractor that feels a person becomes a patient when they acknowledge physical symptoms and believe that they need help. In this state, patients “to varying degrees they are anxious, dependent, in pain, disabled, vulnerable and exploitable.” (JCCA) But, often times Dr. C explains in the chiropractic community, patients are mislead to continue treatment that may not be necessary, just to keep a steady flow of patients and thus income. “I rely on patients telling me how they feel, not the other way around.” In this way of creating dependence between chiropractor and patient, and misleading individuals to believe unnecessarily prolonged treatment is required, violates and takes advantage of the trust the patient is putting in the provider to guide them to optimal health.

The CDHA Code of Ethics “is a set of rules or guidelines that address the ethical principles and standards of a profession. The Code provides clear direction in avoiding ethical violations, but cannot provide a clear resolution to ethical dilemmas or ethical distress. Take for example a hygienist that suspects his or her fellow colleague of incompetence. Failure to place the beneficence of the client’s needs first, could result in the patient being harmed. Unemployment and possible disciplinary action by the College is a repercussion of incompetence when a hygienist violates her ethical responsibilities. Ethical Distress The concept of ethical distress is characterized by an individual with the awareness that another is acting unethically but, because of lines of authority, this person is powerless to do anything about it or would consequently suffer serious repercussions by doing so. A great example of ethical distress is when Mr.CK was hired by a rehabilitation clinic to work as a certified kinesiologist. As a recent graduate, Mr.CK was under the impression that he would be working under the guidance and supervision of either a doctor or physiotherapist until he was ready to deal with patients independently. Instead Mr.CK was to be found within an ethical distress. because he lacked the requisite skills and support by the doctor or physiotherapist to perform his job competently; thus he could in fact put the patient and himself at risk. Under the Code of Ethics for Certified Kinesiologists in Ontario, under section “Responsibility to Client”, it states to “recognize their professional limitations and level of competence as well as the special skills of others and, when indicated, recommend to the client that alternative options and services be obtained.” The end result was that Mr.CK did not return to the rehabilitation clinic because he found the business practice to be unethical.

Comparatively to our profession in dental hygiene, we feel that it is possible that most registered dental hygienists have, in one way or another, experienced episodes of ethical distress; perhaps when working for a dentist. Many dentists have their own systems for their practices which may not coincide with the practices of dental hygienists. It is to be understood that what a dentist may believe is required for an individual’s plan of health, may not correspond with the hygienist’s treatment plan. For example, for some dental practices there exists a belief in shortening the length to thirty or forty-five minute appointments in order to accommodate for more people to be treated within a working day. This goes against the consensus of our way of thinking, where we appreciate more time of about an hour or more for additional discussions about treatment plans to truly convey and manage all of the established data for collaboration. By condensing an appointment, we believe that this individual will not experience quality dental care and for most cases it is not possible to finish to completion about debridement and evaluation. However, when working for a dentist we are bound by these systems created. By addressing this issue of lengthening the appointments for the individual’s benefit, we may risk our line of work under a dentist’s authority. It is this predicament that is difficult to deal with and often causes distress when working throughout the day. It important for dental hygienists to convey thought and theory processes for the rationale to implement change and awareness of the benefits to lengthen the appointments based on individualized care.

This discussion of the power of superiority regarding ethics is further demonstrated by Tevino in 1986: Some models of ethical decision-making suggest that the perceptions individuals hold about others’ ethics are critical in shaping their own beliefs and behaviour. For example, the behaviour of superiors is among the strongest influences on an individual’s ethics. (3) This further confirms the relevance of ethical distress as managed and controlled by superior positions.

Ethical Resolution Ethical behaviour is a prerequisite for a society to function in an orderly way. Ethics is the glue that binds the society together. (4) As a group we all reside and work in Ontario. We regularly and most often unconsciously consult the Ethical Decision-Making Model from the CDHO, previously constructed and implemented by the CDHA.(5) The eight steps within the model are essential for assessing and managing issues of ethical dilemmas, ethical violations and ethical distress. From these issues, it is necessary from the Ethical Decision-Making Model to identify and clarify the problem, gather data in between, identify and assess the options, assess and implement the course of action and evaluate the outcomes. From start to finish these steps are conducive to encouraging appropriate methods in establishing commendable outcomes. As dental hygienists of Ontario we appreciate this model and frequently refer to its constituents throughout any ethical matters we may encounter. We value this model and employ its methods to institute sound outcomes throughout all of our ethical endeavours within the dental practice. From this assignment, we have communicated with other professions such as teachers, chiropractors and kinesiologists who are familiar with their own methods from their own code of ethics to ascertain similar and effective outcomes in their profession. We value our new found knowledge of these professions to have achieved a better perception of how relevant ethical issues are to their professions.

References

1. http://www.peel.edu.on.ca/departments/diroff/policies/policy_61.htm 2. http://www.cco.on.ca/english/Members-of-CCO/Policies-and-Guidelines/Guidelines/ethics/ 3. Schminke M, Ambrose, M. Miles JA. The Impact of Gender and Setting on Perceptions of Others' Ethics. Sex Roles, Apr2003; 48 (7/8):361-375 4. Rodgers W, Gago S. Cultural and Ethical Effects on Managerial Decisions: Examined in a Throughput Model. J of Business Ethics Jun2001 Part 2; 3(4):355-367.