Tuesday, June 3, 2014

Ethical dilemmas in clinic

As we begin clinic (next week for me!), we will face ethical dilemmas. We’ll have to make choices unmonitored by other people and choose the ethical option in each case. There is no right or wrong answer bubbled into a Scantron to be graded by a professor. It could be something as small as dropping a dental mirror and making sure to wipe it down before using it- although nobody sees it. Other situations will be more complex.

2014-05-20 08.24.58Laura sent me this picture of an owl sitting on a Saguaro, looking so darn regal.

In class, we discussed a couple of scenarios that students may be dealing/have dealt with in clinic. My friends and I often have similar discussions. Because people have different values and life experiences, these discussions get very heated. Here's some from our class I found interesting:

- A patient requests re-assignment to another dental student after the first visit. When asked why, the patient responds, "I just don't want that type of dental student providing my care." (race, ethnicity, gender, sexuality…)

- A patient complains of pain and requests prescription for opiates. When you explain the prescription and referral process, the patient threatens that he will make trouble for you unless you get him the prescription now.

One of my favorite things in JADA (The Journal of American Dental Association) is the Ethical Moment section. For each clinical scenario, we are encouraged to think about the five principles governing all our ethical decisions:

Patient autonomy

Someone answers the dilemma and the following week, readers (often dentists) write in with their own responses and their own experience in similar situations. It is the conflict of these principles that makes decision difficult- complex cases twist and distort the principles in a complicated knot. Is it more important to respect patient autonomy? But what about non-maleficence? (About flippers, for example)


I know I have a challenge ahead. These conversations can be hard because OF COURSE I’m a moral person with an ethical backbone. But the difficulty stems from the fact that the wrong choice may be so darn tempting. Extra points without the extra work. More money for procedure B and the patient does want it! So much to do, so little time, so on.

But I also know each making of these ethical decisions (within the realm of our limited present knowledge) gives us the chance to practice these principles. It’s not enough to say “I’m an ethical dentist.” I want to practice ethical dentistry.

What ethical dilemma have you faced this week?
What’s your most common excuse?
(for me it has to be time- like: “do I really have to drop off the gym towel there?”)


  1. It’s not enough to say “I’m an ethical dentist.” I want to practice ethical dentistry. dental cleaning

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