ethical dilemmaas

Question 1

what are the four ethical pillars

Answer 1

• autonomy
• beneficence
• non-maleficence
• justice

Question 2

what is autonomy

Answer 2

this is the individuals dignity and the respect of the individuals ability to make decisions for their own health. right to treatment, choice of treatment and treatment refusal. relates to importance of informed consent

Question 3

what is beneficence

Answer 3

the dentist should be acting in the best interest, doing the greatest good, balancing risks and benefits

Question 4

what is non maleficence

Answer 4

avoid causing harm and strive to protect the patient from harm

Question 5

what is justice

Answer 5

fairness, equitable use of resources and equal access to care. individals should be similarly treated. there should be an awareness that an individuals treatment may effect the well being of someone else as a consequence of scarce resources.

Question 6

what is NICE

Answer 6

the national institute of clinical excellence, which makes choices of how the budget is spent. links to justice and how the treatment of one person could lead to the NHS having less money to spend on others.

Question 7

what does the general dental council outline as the principles and responsibilities in the practice of dentistry

Answer 7

• putting the patients interests first and acting to protect them
• protecting the confidentiality of patients information
• respecting patients dignity and choices
• cooperating with other members of the dental team and other healthcare colleageues in the interest of patients
• maintaining professional knowledge and competence
• being trustworthy

Question 8

you are approached by the police for information regarding one of your patients - what do you

Answer 8

if they confirm it is to prevent or detect serious or harmful crime, give it to them. police are not automatically entitled to access patient’s personal data unless there is a court order. it must be documented in the patient’s notes, and only the minimum data is revealed. if in doubt, i would ask the other members of the team about their thoughts on the matter.

Question 9

what is gillick competence?

Answer 9

this is when a patient has shown they understand the treatment and what it means. only if a patient demonstrates gillick competence can they give consent for a treatment. those over the age of 16 in the UK are assumed to have gillick competence.

Question 10

the mother of a 17 year old patient calls the practice and asks if her son has been attending appointments with you. he only ever comes alone. what do you do?

Answer 10

he is 17, and so can be assumed to be gillick competent and be able to consent to his treatments on his own without his parents involvement or knowledge.
information regarding his attendance is a confidential matter and can only be disclosed to the mother if the son has consented to the sharing of that information.

Question 11

insert a case of a patient who is enquiring about assisted suicide what are your thoughts on this case?

Answer 11

according to the suicide act 1961, assisted suicide is illegal.
arguments against it include the financial pressures that may lead to doctors using assisted suicide almost as an easy way out because it frees up beds and other resources. some patients may make the decision irrationally due to distress or pressure from relatives, and they may not have the capacity to make the decision themselves. arguments for assisted suicide include that the patients autonomy needs to be respected. if the patient has the mental capacity to make that decision it should be respected. in some cases it could be argued that it is more humane to end patients suffering with assisted suicide if their quality of life is poor and filled with pain.
in conclusion, this is a very controversial issue and if it was to be legalised, it would need to be tightly regulated. doctors have the responsibilty to maintain beneficence and non maleficence toward patients, which clash quite a lot with an issue such as this. it could allow people to die without pain and suffering, but ultimately there is no way to give an answer that everyone would agree with. if it were to be legalised, like i said, regulations would have to be tight.

Question 12

a 13 year old patients father calls following his childs appointment he wasnt present at. he wants to know what happened at the appointment. what do you do?

Answer 12

advise him to come to clinic if he wishes to know because you cannot disclose such information over the phone. it may be the case that the father does not have parental responsibility, if him and the mother are not married, in which case i would not disclose information to him.

Question 13

should HIV positive dentists be allowed to practice?

Answer 13

patient safety in dental settings has been enhanced over past decades, by universal precautions and legal obligations to comply with rigorous infection control procedures.
HIV positive healthcare workers who return to clinical duties should be required to demonstrate they are on combined anti-retorviral treatment and must have achieved undetectable levels of the virus.

Question 14

what are your views on refusing obese patients/ smokers treatment

Answer 14

is it wrong to deny treatment based on a lifestyle factor? the decision should be taken individually depending on the treatment. there are a variety of different social determinants that could lead to someone smoking or being obese, so holding the patient responsible and denying them care for something that isnt necessarily their fault is morally wrong. it may hinder the success of the treatment, in which case it should be discussed with the patient as part of the aftercare of the surgery. if they were to receive a lung transplant for instance, they should be informed of the dangers that smoking can have on the success of the operation and direct them toward support to help them quit smoking.

Question 15

should being HIV positive be something that should be disclosed to patients

Answer 15

the disclosure of this information can leave the dentist open to discrimination.
in cases where the risk of viral transmission is deemed negligble and which procedures can be performed safely, informing patients is unnecessary and could cause more harm than good due to dental anxiety and stigmatisation

Question 16

sarah, a 16 year old student, has come into the practice. you are her dentist, and she has asked you for a friend request on facebook.

Answer 16

do not accept the request. maintain the professional boundary, and the impact that inappropriate use could have on patient trust.
explain sensitively to sarah about the situation so as not to hurt her feelings.

Question 17

what is meant by “competent”

Answer 17

this involves the capacity for consent, and varies between adults and children. the patient needs to be able to understand the information he is given in order to five informed consent. adults can make a living will, and are deemed as competent. however, if they are confused or have a mental disorder then they are not competent.
children need to be gillick competent, which means again that they must be able to understand the treatment and what it means. children under 16 can give consent if they are mature enough and understand not just the procedure but also the consequences.

Question 18

do you think it is right for patients to make the choice as to what is in their best interest?

Answer 18

patients should be able to make decisions about their care, and question their dentists to ensure the provision of safer care. however, they may not have the backgroun knowledge to make the best decision, and can make decisions based on things they have seen online, which are unreliable.

Question 19

what would you do if you became aware of breaches in confidentiality

Answer 19

the breacher in question could be dismissed, and face a GDC performance committee. there are many potential consequences of such an action, including the patients and their relatives and friends who attend the practice losing trust in the professions, and may even fail to seek treatment in the future for fear of having their confidentiality broken as well

Question 20

what would you do if one of your patients confided in you that they are being abused

Answer 20

keep the secret from others at the request of the patient, but advise the patient to seek support from the police. if unsure on how to proceed i would contact the dental defence organisation for advice. make a note in the patients record of my clinical observations

Question 21

a patient asks for a copy of their notes. what would you do?

Answer 21

tell them to contact the dental records department. the data protection act declares that patients have the right to access their dental records, so i would not refuse them

Question 22

a patient wishes to tell you something, but before they do they make you promise not tell anyone. what do you do?

Answer 22

advise the patient that until i know what it is they want to tell me, i cant promise that i will keep it a complete secret. i may need to talk to others to offer help or advice. although, whatever you tell me, i will do my best not to disclose the secret to anyone who has no need to know.

Question 23

do you think it is right of parents to conceive a second child to cure a disease in the first child?

Answer 23

you could argue yes because this could help save the first child’s life. however, some would argue that there is no guarantee the second child is a suitable donor or wont have the same disease as the first. the second child could feel that they were born only to be used rather than loved. so no, i dont think personally that it is right to conceive another child with the only intention being to use them to save the first child.

Question 24

what does the confidentiality nhs code of practice states what about the sharing of patient information for a referral

Answer 24

explicit consent is not usually required for informationd disclosures needed to provide healthcare.

Question 25

up to how many weeks can pregnancy be legally terminated

Answer 25

24

Question 26

a HIV positive patient was bleeding from a laceration and needed urgent treatment, but you dont have gloves. would you put yours or the patients safety first

Answer 26

my own safety. i would give some dressings to the patients and advise them to apply pressure to the wound while i went and found some gloves.

Question 27

what does it mean to say that capacity is decision specific

Answer 27

a young person who has the capacity to consent to a relatively straightforward procedure may not have the same capacity to consent to a more complex procedure

Question 28

should vaccinations be compulsory

Answer 28

they stop the child being infected or infecting others. risks of no vaccine outweight vaccine.
autonomy = the parents have the right to refuse a vaccination
beneficence = immunisations are safe
non maleficence = small risks. others can be risked if someone is unvaccinated
justice - do they have an ethical responsibily to have their child vaccinated

Question 29

why may a dentist break confidentiality

Answer 29

in each situation the dentist should ask if the lack of information would put someone at risk.
if someone is epileptic and drives, it should be reported to dvlA
child or domestic abuse should be reported
in conclusion, if they have information which can prevent harm to others, it should be reported

Question 30

how would you choose which patient on a wiating list gets an organ transplant

Answer 30

• full history of each patient
• who is more likley to survive the surgery and its complications
• who could do the long term immunotherpay
• likely duration of the benefit
• discuss with rest of the teamm

Question 31

should the organ transplant system be an opt in or an opt out

Answer 31

• opt out violates autonomy
• gift freely given
• organs could be taken from someone before they can register on the opt out
• it would relieve the burden of the family of having to decide if they should given the organs or not
• soft opt out would be good because organs are only taken if the family member is present, and is compatible with the idea of giving