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Towards a specic approach to education in dental ethics: a proposal for organising the topics of biomedical ethics for dental education
Sek Gorkey, Tolga Guven, Gurkan Sert
Department of Medical Ethics and History of Medicine, Marmara University Faculty of Medicine, Istanbul, Turkey Correspondence to Dr Tolga Guven, Marmara Universitesi Tip Fakultesi, Haydarpasa Kampusu Deontoloji AD, Tibbiye cad. No.49, 34668 Uskudar Istanbul, Turkey; tolgaguven@hotmail.com Received 29 June 2011 Accepted 7 July 2011 Published Online First 2 September 2011
ABSTRACT Understanding dental ethics as a eld separate from its much better known counterpart, medical ethics, is a relatively new, but necessary approach in bioethics. This need is particularly felt in dental education and establishing a curriculum specically for dental ethics is a challenging task. Although certain topics such as informed consent and patient rights can be considered to be of equal importance in both elds, a number of ethical issues in dental practice are only remotelydif at alldrelevant for medical practice. Therefore, any sound approach to education in dental ethics has to recognise the unique aspects of dental practice in order to meet the needs of dental students and prepare them for the ethical challenges they may face during their professional practice. With this goal in mind, this paper examines the approach of the authors to dental ethics education and proposes a system to organise the topics of biomedical ethics for dental education. While the authors perspective is based on their experience in Turkey, the proposed system of classication is not a rigid one; it is open to interpretation in other contexts with different social, cultural and professional expectations. Therefore, the paper also aims to inspire discussion on the development of an ideal dental ethics curriculum at an international level.
INTRODUCTION
Dental ethics as a specic eld of study is hardly as popular as medical ethics. As noted by Ozar, this discipline can be considered as a young eld, although a heightened awareness of ethical issues has been observed to have changed the approach to dental ethics education from the late 1970s in the USA.1 This situation is probably related to a practical need for managing ethical issues: dentists today are facing challenging ethical problems to an unprecedented degree.2 A similar observation has also been made by other authors, who have indicated that published reports have shown concern about several ethically problematic practices such as .poor quality of care, violations of public trust, agrant advertising..3 While awareness of ethical issues in healthcare may have triggered similar responses in other parts of the world, such developments generally are recent. For instance, in Turkey, such awareness has been observed much more recently, starting in the 1990s, particularly after the enactment of the Regulation on Patient Rights in 1998.4 While compulsory medical
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ethics lectures began as early as the 19th century during the pre-Republic era,5 contemporary concepts such as patient autonomy have begun to be debated only very recently in Turkey. However, a dramatic change in the approach to education in dental ethics in Turkey is yet to be seen. There is no department of dental ethics in any university in the country. At best, this means that lectures on dental ethics are usually provideddif at alldby the members of the faculty of medicine. However, the majority of these lecturers are likely to have a background in medical, rather than dental ethics. While medical and dental practice share common features, certain topics in biomedical ethics are only remotely related to dental practice, whereas some other topics specic to dental practice may have little relevance for medical doctors. Therefore, dental ethics lectures can be a signicant challenge for those who are not familiar with the unique aspects of dental practice. Conversely, if the lecturer does not or cannot adapt the content of the lectures to these aspects, it will not be realistic to expect such general lectures to meet the needs of dentistry students. The department of medical ethics and history of medicine of the Marmara University Faculty of Medicine has been facing this challenge for 16 years.6 During this period, the department has developed a system for creating a curriculum specic to lectures on dental ethics and a short section summarising this approach was recently published in a separate thematic article in the Bulletin of the International Dental Ethics and Law Societyan open-access, non-peer reviewed publication.7 In a nutshell, this system aims to classify the issues in biomedical ethics and put them in an order of signicance relevant for dental practice. This approach has the advantage of allowing the lecturer to arrange a specic curriculum for dental ethics, as well as avoiding an overload of theoretical information. This paper aims to explain our approach in detail and open it to international academic debate, with the hope of making a practical contribution to the eld of dental ethics. It should be noted that the three authors have different backgrounds (dentistry, medicine and law, respectively), each with a postgraduate degree in healthcare ethics. This heterogeneous composition of the team allows the assignment of lectures on curricular topics in accordance with faculty members academic background and expertise. The authors believe this signicantly contributes to the efciency of their approach.
J Med Ethics 2012;38:60e63. doi:10.1136/medethics-2011-100067
Group AB
Topics in this column are not entirely specic to medical practice; they are considered to have some relevance for dentistry as well. Therefore, a separate category between groups A and B was created for their classication. The most signicant topic in this section is probably ethics in oncology. While the treatment of cancerous lesions of the oral cavity may not be a part of the routine oral healthcare service of the dental practitioner, the ethical aspects of cancer-related information may nevertheless be important in dental care for a number of reasons. Cancers of other systems may be suspected during or after dental interventions. In addition, dentists may frequently have patients who are receiving treatment for cancers outside the oral cavity. In all these circumstances, the dental practitioner would at least be expected to know the potential ethical issues regarding cancer-related information. Therefore, common ethical problems in oncology (including ethical dilemmas related to truth-telling and the right not to know ) are covered in detail in these lectures. It should be noted that in the near future, at least two of the topics in group A (organ transplantation and genetics) may also need to be classied under group AB, depending on the advances that may be made in the dental sciences.
Group A
The topics in the rst column are highly specic to medical practice and unlikely to be encountered by dentists. We suggest that providing only basic knowledge on these issues to dentistry students is appropriate and detailed lectures may be only marginally useful. Lectures on these topics aim to serve as an introduction to the eld and provide general information about the scope and content of the issues examined in biomedical ethics. It could be argued that these topics could be omitted from a dental ethics course; the so called life and death decisions are usually not a part of dental practice. However, as healthcare professionals, dentists may also serve in different positions within the healthcare system. They may become administrators in a healthcare facility, may serve as members on a hospital ethics committee and/or in other structures involved in shaping healthcare policies. In all these circumstances, a basic understanding of the ethical arguments about the beginning and the end of life, the denition of death and allocation of healthcare resources will be necessary. Furthermore, even if dentists do not assume such responsibilities in the future, they still need to know the functions and compositions of the aforementioned committees, as well as when and how to consult them. Therefore, we think that introducing dentistry students to these concepts is important.
Group C
This group of topics is considered to be entirely specic to dental practice and lectures in this group are provided only in the school of dentistry. The lecture on dental intervention for aesthetic purposes builds on the foundation laid in the introductory lecture (see column BC in table 1 and the paragraph describing the column BC below), but it focuses more on the practical aspects of this concept, such as the ethical concerns
Group B
Topics in this group are considered to be equally important for dental and medical practice. We think that the content of lectures on these topics need not differ in schools of medicine Table 1
A system for classication of issues in biomedical ethics from a dental ethics perspective
Overlapping issues of medical and dental ethics AB Less signicant for dental practice Ethics in oncology B Equally signicant for medical and dental practice Informed consent Ethical issues in biomedical research with human volunteers Research ethics committees Hospital ethics committees Patient rights BC More signicant for dental practice Introduction to the concept of aesthetics Ethical aspects of advertising Ethical issues in HIV infection and AIDS Issues specic to dental ethics C Dental interventions for aesthetic purposes Orthodontics and ethics Ethical and legal aspects of dentistedental technician relationship
Issues specic to medical ethics A Euthanasia Abortion Assisted reproduction Genetic technology Organ transplantation
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Group BC
Topics in column BC are strongly related to dental practice, although they are not specic to dentistry. For instance, aesthetics may also play a role in medical practice (as in the case of plastic surgery), but is less signicant than in dentistry, where aesthetic concerns are a prevalent factor in decision-making.2 However, this introductory lecture does not cover an in-depth discussion of aesthetics. Rather, it aims to provide guidance on how to approach aesthetics and connects ethics and aesthetics by emphasising the value-laden nature of aesthetic judgements. Once the students realise how subjective aesthetic judgements can be, it becomes easier for them to understand why the patients own aesthetic expectations (and not simply the dentists opinion) should be a part of the decision-making.
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REFERENCES
1. 2. 3. 4. 5. Ozar DT. Dentistry. In: Post S, ed. Encyclopedia of Bioethics. 3rd edn. USA: Macmillan Reference, 2004:642e7. Ozar DT, Sokol DJ. Dental Ethics At Chairside. Professional and Practical Applications. 2nd edn. Washington DC: Georgetown University Press, 2002:3, 71, 204e5. Rule JT, Veatch RM. Ethical Questions in Dentistry. Illinois: Quintessence Publishing Co. Inc., 1993:15. Sert G, Guven T, Gorkey S. Turkey. In: Blanpain R, ed. International Encyclopedia of Laws. The Netherlands: Kluwer Law International (Medical Law-Suppl 52), 2007: 84e5, 45e6. Yildirim N, Ulman YI. A Review of Medical History and Ethics Education at the Istanbul University. Bulgarian Historical RevieweRevue Bulgare d Histoire. Research Quarterly, Organ of the Institute of History at the Bulgarian Academy of Sciences. 2005;(3e4):119e26. Gorkey S. Dental Ethics Education in Turkey: Reections from a 16-Year Experience. 8th International Dental Ethics and Law Congress Programme & Abstract Book. International Dental Ethics and Law Society (IDEALS). Helsinki, Finland, 2010:44. Guven T, Gorkey S, Sert G. Dental ethics lectures in Marmara University Faculty of Dentistry. Bulletin of the International Dental Ethics and Law Society 2009;9:6e13. http://www.ideals.ac/members-only/bulletin/ (accessed 5 Jan 2011). Simonsen RJ. Commerce versus care: troubling trends in the ethics of esthetic dentistry. Dent Clin North Am 2007;51:281e7. Kopelman LM. Healthcare and research issues. In: Post S, ed. Encyclopedia of Bioethics. 3rd edn. USA: Macmillan Reference, 2004:389. Weinstein BD. Dental Ethics. USA: Lea & Febiger, 1993:76. Sert G, Gorkey S. The DentistsdDental Technician Relationships: Legal Perspective In Turkey. International Dental Ethics and Law Society (IDEALS) 6th International Congress on Dental Law and Ethics Abstract Book. Italy, 2005:24e5. Gorkey S. Dis x hekimli gi Deontolojisi ve Reklamlard2 (Dental Deontology and Advertisements: Part 2din Turkish). Dergi 1991:16e18. Gorkey S, Kokdemir P. The Ethics of Advertisements and Use of Internet in Dentistry in Turkey. Bulletin of the International Dental Ethics and Law Society 2001;1. http:// www.ideals.ac/members-only/bulletin/Bulletin-1.2/Kokdemir.htm (accessed 10 Jan 2011). Gorkey S. The changing face of Turkeys dental profession. In: Welie JVM, ed. Justice in Oral Health Care. Ethical and Educational Perspectives. Wisconsin, USA: Marquett University Press, 2006:185e93. Guven T, Sert G. Advance directives in Turkeys cultural context: examining the potential benets for the implementation of patient rights. Bioethics 2010;24:127e33. Oguz NY, Miles SH, Buken N, et al. End-of-life care in Turkey. Camb Q Healthc Ethics 2003;12:279e84.
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Towards a specific approach to education in dental ethics: a proposal for organising the topics of biomedical ethics for dental education
Sefik Gorkey, Tolga Guven and Gurkan Sert J Med Ethics 2012 38: 60-63 originally published online September 2, 2011
doi: 10.1136/medethics-2011-100067
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Notes