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AU 15- Ethics Final > Ethical Decision Making > Flashcards

Flashcards in Ethical Decision Making Deck (52)
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1
Q

Ethical decision making involves both ______ and choosing.

A

judging

2
Q

What are some factors that make adversely affect a dentist’s decision making capacity?

A

emotional state
incompetence
physical and mental disorders
“other conditions”

3
Q

What are the four generally accepted ethical principals?

A
  1. Autonomy
  2. Nonmaleficence
  3. Beneficence
  4. Justice
4
Q

“Respect for autonomy” means that dentists demonstrate a regard for ___________.

A

self-determination

5
Q

What is nonmaleficence?

A

the avoidance of doing harm

6
Q

What is beneficence?

A

the promotion of well-being

7
Q

Justice is _______ in the distribution of goods and the reduction or _______ of harms.

A

fairness

avoidance

8
Q

There are ______ (#) decision elements.

A

6

9
Q

List the 6 decision elements.

A
  1. Assessing the medical and social context
  2. Clarifying the ethical problem
  3. Determining stakeholders
  4. Identifying options and alternatives
  5. Examining the process of decision making
  6. Balancing conflicting principles and obligations
10
Q

The core values (adopted by the American College of Dentists) represent a guide for _________.

A

ethical behavior

11
Q

The core values reflect the _____, _______, and ______ of the College of Dentists.

A

character
charter
mission

12
Q

How many core values are there?

A

nine

13
Q

What are the core values (…yes there are 9 of them)?

A
  1. Autonomy
  2. Beneficence
  3. Compassion
  4. Competence
  5. Integrity
  6. Justice
  7. Professionalism
  8. Tolerance
  9. Veracity
14
Q

Which core value is represented:
“patients have the right to determine what should be done with their own bodies” and “forms the foundation for informed consent and protecting patient confidentiality”

A

Autonomy

15
Q

Which core value is represented:
“the obligation to seek good of others” and “minimize harm” and “referring to those with specialized expertise when the dentist’s own skills are insufficient”

A

beneficence

16
Q

Which core value is represented:
“requires caring and the ability to identify with the patient’s overall well-being” or “acts of kindness and a sympathetic ear”

A

compassion

17
Q

Which core value is represented:
“continual self-assessment about the outcome of patent care and a commitment to lifelong learning” and “the just expectation of the patient”

A

competence

18
Q

Which core value is represented:

“behave with honor and decency” and “affirms core values and recognizes when words or actions are in conflict”

A

integrity

19
Q

Which core value is represented:

“giving to each his or her own due” and “balancing distribution of benefits and burdens in practice”

A

justice

20
Q

Which core value is represented:
“self-governance” and “commitment to promoting oral health initiatives and protecting the public” and “collective best interest of society”

A

professionalism

21
Q

Which core value is represented:
“recognition of differences in a culturally complex community” and “understanding of how differences may affect a patient’s choices and treatment”

A

tolerance

22
Q

Which core value is represented:

“honesty or truth telling” and “is the bedrock of a trusting doctor-patient relationship”

A

veracity

23
Q

What is the ethical dilemma regarding pregnancy?

A

Mary Smith (December issue) is a I5-year-old patient of Dr. Virginia Jones. Having come to the dental clinic for a recall appointment, she reads a sign in the radiology area that female patients are instructed to inform their dentist if they are pregnant. Mary becomes upset, asks Dr. Jones why the sign was there, and confesses that she is pregnant. She asks Dr. Jones not to tell her mother. Dr. Jones feels an obligation to inform Mary’s mother of her condition, as Mary is not legally independent and Dr. Jones is convinced that Mary’s parents would provide care and support.

24
Q

Which code is at stake in this pregnancy dilemma?

A

confidentiality

25
Q

What are the conflicting moral issues in the pregnancy dilemma?

A

conflicting moral issues: respecting the autonomy of a minor while protecting others from harm.

26
Q

What should Dr. Jones do in the situation with her 15 patient?

A

Dr. Jones would be ethically justified in encouraging her to discuss her pregnancy with her mother, but should keep the pregnancy in confidence. However, if Mary required immediate dental treatment, the obligation to protect her confidence would have to be weighed against the risks of harm to others

27
Q

Which ethical dilemma involved dentist-dentist relationships?

A

Dr. Boley is asked by Ms. Wentworth, an emergency patient, about the quality of care she has been receiving by her regular dentist, Dr. Leeds:
Ms. Wentworth presented to Dr. Boley the sixth unsatisfactory case of Dr. Leeds’ work he had observed during the past two years. How should Dr. Boley respond?

28
Q

What are some options for Dr. Boley?

A
  1. discuss the situation directly with Dr. Leeds, a reasonable action considering that patients sometimes misunderstand our explanations
  2. Report Dr. Leeds to the local peer review committee
  3. file a complaint against Dr. Leeds by contacting the chairman of her local dental society committee on ethics and judicial affairs.
29
Q

Why is Dr. Boley obligated to take some step to address the issue with Dr. Leed instead of doing nothing?

A

our duty first is to the patients’ welfare rather than our colleague’s career

30
Q

What is the ethical dilemma regarding the pulling of a tooth?

A

Your 15-year-old patient Chad and his mother are discussing the treatment plan you have proposed (a plan that includes a thorough preventive program, orthodontic evaluation for Chad’s severe Class II malocclusion, a root canal for #19 and restorative therapy). You explained the importance of maintaining the molar, but Chad’s mother asks him “What do you want, a root canal or would you rather have the tooth pulled?” Chad’s reply is “lets pull it, mom”

31
Q

“When parents or guardians make poor or foolish decisions for their children that are harmful and thwart appropriate function, the dentist is ethically justified in refusing to render treatment” could also be termed _____ _______.

A

justifiable paternalism

32
Q

Which dilemma addresses the issue of payment for services?

A

Mr. Howard Glover is a healthy 30-year-old, who has come to your office as an emergency patient because of a “bad front tooth.” He had regular dental care until he lost his job one year ago and admits to your receptionist that he will be unable to pay for expensive dental treatment.

33
Q

What are the three ethical aspects to Mr. Glover’s case?

A

1) issues of esthetics vs function?
2) what do our professional codes say about our obligation to treat patients?
3) is dentistry a service or a profession?

34
Q

For Mr. Glover, most dentists decided to provide the _________ but have him _________.

A

root canal treatment (save the tooth but no crown)

pay over time (payment plan)

35
Q

Which ethical dilemma addresses a professional judgment of esthetics and truth telling?

A

Mr. Harold Davies is a patient who has come to your office eager to improve his appearance with a new set of complete dentures. He is a healthy. sixty-year-old male. who believes that these dentures will help him feel “younger and more vigorous.” You have completed the maxillo-mandibular relationship records appointment. As you begin tooth and shade selection, Mr. Davies states “just give me the whitest shade you have!”

36
Q

In Mr. Davies’ case there must be considerations of ______ and _______ esthetics. Also the elements of respect for patient ______ and preserving appropriate _______ must be considered in each case.

A

objective vs subjective esthetics

patient autonomy vs appropriate function

37
Q

How should the dentist react to Mr. Davies’ request? Can he/she lie and tell him that the whitest shade is the one they would have chosen himself/herself?

A

No, you cannot lie.
the dentist should attempt to educate the patient about the differences but is justified in deferring the final judgment to the patient.

38
Q

Which ethical dilemma addresses the issue of function, informed consent, and promise-keeping when treatment fails?

A

Ms. Allen: does not have dental insurance, saved for an 18x20 porcelain fixed-partial denture with porcelain occlusion that was cemented three years ago.
While eating a sandwich, she fractured the buccal cusps of both molars leaving some bare metal and some porcelain on the buccal surface. Although she wasn’t in pain, the esthetic deficiency was obvious and she was. angry. She wants to know if you “stand behind your work,” because she cannot pay for another bridge. You explain there are no guarantees for dental care but she still wants to know if you will “stand behind your work.”

39
Q

Treatment ___ ____ and there are __ ________ standards for longevity. Preparing the patient includes ________ ____ ________about these risks.

A

may fail
no absolute
educating the patient

40
Q

What was the response of most dentists to Ms. Allen’s dilemma? (demonstrates the concern for being caring and fair)

A

considering Ms. Allen’s loyalty as a factor: most replaced the prosthesis at a reduced fee or zero fee

41
Q

Which ethical dilemma examines the constituent obligations of the generalist and specialist to the patient and to each other?

A

Mr. Crane (patient) asked the periodontist, “Are these crowns causing a problem for my gums?” Since the crowns were provided by the referring dentist, how should the specialist respond to the patient? The periodontist is a new practitioner in an established specialty practice, and revealing unfavorable information to the patient may be poorly received by both Mr. Crane and the referring dentist. Specialists as well as generalists prosper by building and nurturing their referral network, although in this case, communication is scant. The crowns are in deed causing issues: Should Dr. Wilkins answer Mr. Crane’s question?

42
Q

Which case describes a non-compliant patient with unreasonable demands?

A

Mr. Green has generalized chronic periodontitis with 4-6mm pockets with bleeding in all four quadrants and needs bridge work done. He has a poor attitude and spouts out that he’d rather sign a waiver to skip the “gum work” and get on with the bridges.

43
Q

What should be done in Mr. Green’s case?

A

The dentist is ethically justified in this case to:

  • inform Dr. Green of his disruptive behavior
  • attempt to educate him regarding his oral health
  • plan for periodontal therapy prior to fired partial dentures

if he continues to be obnoxious/noncompliant: the dentist is justified to dismiss Dr. Green after taking steps to assure that he is not abandoned.

44
Q

Which dilemma addresses problematic patient requests and dental claims?

A

Upon receiving a reply and a “rejection of the treatment plan” with an explanation that a removable partial denture would be allowable but not the fixed partial denture the patient wanted. The patient asks you to submit it as a removable partial denture, and she will pay the balance. You explain to her that this is illegal, but she again insists that you follow her decision

*(this is not really an ETHICAL dilemma….it is illegal)

45
Q

Dentists must routinely manage the complex areas of informed consent and third-party payers in practice. Dentists also have an obligation to maintain implicit promises, such as being ________, in the process.

A

truthful

46
Q

Which ethical dilemma discusses a dentist’s legal and ethical obligation to discuss proposed treatment, reasonable alternatives and risks/benefits of treatment?

A

Carole comes in for a Class V resin: you isolate, prepare, etch, place, and polish the restoration. She is pleased with the appearance of the restoration and with the appointment. That evening she calls you and she is in acute pain that started three hours after the appointment and has been “throbbing” for the last two hours. The next day she returns and you discover unexpected pulpitis that requires root canal therapy. She is angry that she was not warned of this risk and feels that she should not have to pay for the root canal.

47
Q

Is Carole’s dentist ethically obliged to perform the root canal therapy at no fee?

A

If Carole’s dentist was practicing competently using the dental composite technique, and if the lesion offered no observable complications (i.e.. pulp tests and RDT), the dentist is NOT ethically obligated to perform, or refer, root canal treatment at no fee.

48
Q

Which ethical dilemma involves coordinating dental treatment with other healthcare professionals regarding overall health of the patient?

A

Mr. Finley presents with many decayed teeth and 4 that need extracted after having radiation treatment on his neck and mandible. He is worried because he was told that because of his radiation treatment, he was at high risk for osteoradionecrosis from dental infection or extractions. He does not have dental insurance and admits that he has limited funds. He pleads with you — “Please help me. You are my only hope for treatment!”

49
Q

What is the primary goal for Mr. Finley?

A

prevent further harm

50
Q

What are the steps taken to prevent further harm to Mr. Finley?

A
  1. initiate a comprehensive review of his case WITH the radiation oncologist
  2. establish a comprehensive dental treatment plan
51
Q

Which dilemma is a reminder that competent, compassionate dentists may disagree on treatment of painful situations?

A

Carol is a patient who trust you implicitly. She was unable to reach you last weekend for an emergency and was seen by the dentist of a friend. The dentist diagnosed that she had fractured teeth and recommended the extraction of the upper right first and second molars. She refused this treatment and the dentist prescribed an analgesic and returned her to your office.
Carol is now insisting, “We need to do something, please extract the teeth, I trust you and I don’t want anyone else to extract them.” You explain that you do not agree with the treatment but she continues to insist “We need to do something!”

52
Q

When definitive diagnosis is not possible, dentists still agree that something must be done about what?

A

relieving pain