The Legal and Ethical Dilemma in Dental Health

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Table of Contents

Introduction
Legal Aspects
Ethical Aspects
Conclusion
Reference List

Introduction

The legal and ethical dilemma that I have been faced with in practice concerns the scenario when a practicing dentist, examining a new patient, discovers the fact of poor dental work. The question is whether the doctor should inform the patient and contact the previous doctor to discuss the case, or they should immediately contact the dental association and the authorities to appeal against the unqualified actions of a colleague. This dilemma is difficult to solve due to the intersection of the value of the patient and the value of the dentist, which are associated with the internal characteristics of their activities, in particular, with relationships with colleagues.

Legal Aspects

In legal practice, there is a concept of negligence, which implies an unfair or negligent attitude of an official to their work, as a result of which another person or his property is harmed. The reasons for negligence may be insufficient competence of a specialist, incorrect assessment of the seriousness of the situation or ordinary laziness. Medical negligence is especially dangerous, because it can lead to significant harm to human health or death. Although there is no separate article due to the negligence of medical workers, in accordance with the labor code, a medical specialis, like any other employee, must conscientiously perform his work duties (Nazir and al., 2018). Unfair execution of professional instructions and other regulations may become a reason for initiating a criminal case.

The objective side of the crime in the case of silencing the incompetence of a colleague in dentistry is expressed in the failure to fulfill the duties of the statement to the appropriate authorities. An obligatory sign of the objective side in this case should be adverse consequences, expressed in violation of the rights and legitimate interests of the patient. However, in order to qualify the incompetence of doctors, a direct causal relationship must be established between the actions of the dentist and the consequences that have occurred (Neville, 2020). In practice, it is not easy to prove it, since the line between negligent attitude and justified medical risk is very difficult to establish (Chopra and Sahoo, 2020). Therefore, it is quite difficult to prove the guilt of an incompetent dentist, but at the same time a doctor can easily acquire a reputation as a slanderer among colleagues and ruin their reputation.

One of the legal cases that has a bearing upon the situation is the case of an elderly man from Boston in 2018 (Alsadiya and al., 2018). On the recommendation of an orthodontist, the patient decided to install a bracket system. The doctor examined his oral cavity and informed the patient that the installation would require the removal of four teeth. However, the orthodontist mistakenly removed the adjacent teeth. Some time later, the man turned to a private clinic, where the doctor informed the patient about the incompetence of a colleague. The specialist, after studying the case materials, reported that in this situation there were no indications for the removal of the fourth tooth. Therefore, a doctor who pulled out a healthy tooth was brought to responsibility and compensation.

The next example of legal case that has a bearing upon the situation is a criminal case in Los Angeles in 2018, when the provision of services of inadequate quality entailed causing serious harm to health (AIshammery, 2019). The patient had serious complications from the toxic effects of the drug that the doctor used to treat pulpitis. At the same time, the defendants in the case were four dentists, to whom the woman turned for the treatment of this problem. If the doctors who discovered the incompetence of colleagues and promptly reported the poor-quality provision of medical services by colleagues, they themselves would have managed to avoid responsibility.

Ethical Aspects

Key ethical theories in medicine require both respect and support towards colleagues and protection of the patient. Medical ethics requires doctors to be polite to colleagues at work. Criticism should be justified, correct and on the merits of the case, not passing on the personal qualities of a colleague. Medical etiquette requires great correctness in the relations between all members of the team, so direct accusations are condemned by the medical community (Bhadauria and al., 2018). Doctors should treat colleagues with special respect. The most important requirement of medical ethics – respect for colleagues and the patient – must be strictly observed (Kemparaj and al., 2018). Often reports on medical errors of colleagues can be incorrectly interpreted in the circle of dentists as manifestations of snobbery, unacceptable in the team.

If the facts prove a medical error, the dentist should think first of all how to help the patient, and not blame their predecessor for everything. Among such errors may be incorrectly interpreted examination results, an incorrect diagnosis or incorrect treatment (Holden, 2018). However, corporate solidarity does not mean that mistakes should be ingnored (Maiti and Umashankar, 2021). The doctor’s code of ethics states that first of all, it is necessary to discuss the situation with a colleague – in person and in private (Favaretto and al., 2020). In difficult cases, when it is impossible to immediately unambiguously establish whether a mistake has been made and how to proceed, a more experienced colleague or a consultation of several doctors can be contacted.

At the same time, the key medical ethics theory – deontology – has a set of ethical standards when performing their professional duties by medical professionals where the problem of relationship with patients is of paramount importance (Jeong and al., 2019). The main duty of a doctor is to improve the health of a sick person (Nascimento and al., 2022). According to this theory, the tactics of a doctor in relation to a patient, as a rule, are strictly individualized and should be built depending on the severity of the patient’s condition, taking into account their character, culture and education (Padalka and al., 2019). However, in all cases, the doctor is obliged to inform the patient about the seriousness of the patient’s situation and the development of possible complications. The doctor should also note the result of the intervention of colleagues, if it affected the course of the disease.

On the one hand, discussing medical errors with patients and relatives can lead to refusal to see a doctor next time and loss of trust. However, an honest and impartial discussion of the error at a medical conference contributes to the professional growth of the department staff (Campin, 2022). It is necessary to remember about the corporate ethics of medical workers, that a single team of doctors of all specialties works at the hospital and the good name of the medical institution consists of the good names of all its employees (Loganathan and al., 2020). However, first of all the doctor should take care of the patient’s safety and focus on what will bring them the greatest benefit.

Conclusion

The main legal and ethical issues arising from the scenario are quite contradictory. On the one hand, it is very difficult to prove the responsibility of a colleague if there is no fatal outcome or a serious condition of the patient immediately after medical intervention. However, in case of negative long-term consequences, it is possible to accuse the dentist, who ignored the fact of his colleague’s mistake, of inaction and negligence. The ethical side of the issue is even more confusing. For one thing, the dentist needs to maintain a respectful relationship with a colleague. In the medical society, the influence on other people’s mistakes is condemned; this can ruin the reputation of a doctor, causing strained relations with colleagues, who will be considered a snob. However, in the doctor’s code of ethics, the patient’s health is considered above all, therefore, the association of doctors and legal authorities should be notified if this rule is violated.

When in this scenario there was a need to decide whether to report the error to another dentist and to whom, I chose to talk to a colleague one-on-one. I think that whether the actual outcome was the most satisfactory one and the situation could not have been handled more effectively. After talking with a colleague, I was convinced that they made a mistake due to fatigue, not incompetence, noticed it and will be more attentive. At the same time, I did not needlessly frighten the patient and turn them against the doctor. I also maintained a warm relationship with a colleague and did not ruin either their or my reputation. However, each case is different, and if the client had suffered significant damage, I would have had to report it.

Reference List

AIshammery, S. A. (2019) ‘Professional ethical consideration in esthetic dental practice: A survey among dentists in Riyadh, Kingdom of Saudi Arabia’, Professional Ethical Consideration in Esthetic Dental Practice, 13(1), pp. 10–13.

Alsadiya, H., Rai, R. and Eswaran, B. (2018) ‘An ethical awareness among dental interns in dental practice’, Journal of Education and Ethics in Dentistry, 8(1), pp. 32–40.

Bhadauria, U. S., Dasar, P. L., Sandesh, N., Mishra, P. and Godha, S. (2018) ‘Medico-legal aspect of dental practice’, Clujul Medical, 91(3), pp. 255–258.

Campin, A. (2022) ‘Dental support organizations and the corpora corporate practice of dentistry: Will streamlining create legal violations?’, DePaul Journal of Health Care Law, 23(2), pp. 1–19.

Chopra, S. S. and Sahoo, N. K. (2020) ‘Protocol for tele dentistry during COVID-19 in Armed Forces dental establishments’, Medical Journal Armed Forces India, 76(3), pp. 356–359.

Favaretto, M., Shaw, D., Clercq, E. D., Joda, T. and Elger, B. S. (2020) ‘Big data and digitalization in dentistry: A systematic review of the ethical issues’, International Journal of Environmental Research and Public Health, 17(2945), pp. 1–15.

Holden, A. C. (2018) ‘Consumer-driven and commercialised practice in dentistry: An ethical and professional problem?’, Medicine, Health Care and Philosophy, 21(12), pp. 583–589.

Jeong, J. H., Mun, S. J., Bae, S. S., Kim, S. K. and Noh, H. J. (2019) ‘A study on the dental hygienists’ legal scope of clinical practice’, Journal of Korean Society of Dental Hygiene, 19(2), pp. 207–219.

Kemparaj, V. M., Panchmal, G. S. and Kadalur, U. G. (2018) ‘The top 10 ethical challenges in dental practice in Indian scenario: Dentist perspective’, Contemporary Clinical Dentistry, 9(1), pp. 97–104.

Loganathan, M., Harikrishnan, P., Shiva, K. G., Rajendran, V. P., Sithik, N. B. and Sengottuvelu, M. (2020) ‘Dental record maintenance and its applicability in medico-legal scenario: A survey among practicing dentists’, University Journal of Surgery and Surgical Specialities, 6(6), pp. 1–4.

Maiti, R. and Umashankar, G. K. (2021) ‘Legal implications of dental practice in India: A critical review of court cases in India’, Legal Implications of Dental Practice, 15(3), pp. 152–155.

Nascimento, C. T., Oliveira, M. N., Vidigal, M. T., Inocêncio, G. S., Vieira, W. A., Franco, A., Ferreira, M. C. and Paranhos, L. R. (2022) ‘Domestic violence against women detected and managed in dental practice: A systematic review’, Journal of Family Violence, 62(5), pp. 345–350.

Nazir, M. A., Izhar, F., Tariq, K., Anjum, K. M., Sohail, Z. B. and Almas, K. (2018) ‘A cross-sectional study of dentists about the need for a practice management course in undergraduate dental program’, European Journal of Dentistry, 12(4), pp. 508–515.

Neville, Z. (2020) ‘Dentistry, e-health and digitalisation: A critical narrative review of the dental literature on digital technologies with insights from health and technology studies’, Community Dental Health, 37(1), pp. 51–58.

Padalka, A. I., Kostenko, V. G. and Sheshukova, O. V. (2019) ‘Specifics of applying ethical principles in pediatric dental practice’, Problems of Modern Medicine, 18(2), pp. 250–253.

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