Following the establishment of the Turkish Republic in 1923, the first department of medical ethics (deontology) and history of medicine was established by Suheyl Unver in 1933 (1). However, works on history of medicine were initially more prominent at the time, which may partly be due to the fact that the two disciplines were studied within the same department and the founding scholars of the discipline at the time primarily dealt with history of medicine. On the other hand, this does not imply that topics of medical ethics were not given emphasis. As a matter of fact, compulsory medical ethics lectures are known to be a part of the medical education even in the pre-Rebuplic era, going back to as early as the 1876-1877 period. These lectures had been given by Nahabed Roussignan for a short time in 1876, and later on by Hovsep Nouridjan(2). Nouridjan also had published his lectures as a book in 1877 under the title “Précis de deontologie medicale. Cours Elémantaire Professé A l’Ecole Imperiale de Médecine de Constantinople”, a work reported to be one of the earliest examples of its kind in Europe(3).

It should also be noted that during the early times following the establishment of the first academic department in 1933, the “deontology” school of thought appear to be the dominant perspective in the examination of ethical issues. Although this term is commonly associated with a well-known theory in ethics and particularly with the works of Immanuel Kant today, in Turkey it actually represented an approach to medical ethics where the responsibilities of the physicians, certain legal regulations and rules of etiquette were given significant emphasis. However; this approach rarely, if ever, examined contemporary concepts such as patient autonomy and its implications in detail.

On the other hand, following the enactment of a number of legal regulations on organ transplantation, abortion, (and more recently on clinical drug trials and patient rights) in the last three decades in Turkey, original works on medical ethics that examine ethical issues in medicine from a broader and more contemporary perspective started to appear in Turkey’s scene. Prof. Emine Atabek’s work, “Tibbi Deontoloji Konuları” (Medical Deontology Topics), can be considered to be one of the earliest and best examples of such works(4). These developments, along with the rise of the concept of patient autonomy in the international biomedical ethics literature, fueled the interest in medical ethics in Turkey in various academic circles including law, philosophy and medical sciences. Today, there are around 20 medical ethics departments in faculties of medicine in different parts of Turkey, and the number of medical ethicists -although still very limited and inadequate- are also increasing. It should also be noted that while the names of the departments remain as “deontology”, medical ethicists in Turkey now frequently endorse a patient-autonomy centered approach, contrary to the more paternalist tone of earlier writings. Furthermore, there is now a growing Turkish medical ethics literature and the issues examined range from topics such as informed consent and euthanasia, to more current issues such as stem cell research(5). In addition, professional platforms such as Turkish Bioethics Association (TBA) and its activities are contributing a great deal to the development of the medical ethics as an interdisciplinary field of academic study(6).

In the light of this historical background, it can be concluded that Turkey’s medical ethics scene has undergone a major transformation in the recent 20-30 years, and this situation has also influenced the relatively new field of dental ethics. A good example of this is the dental ethics lectures that have been given for the last 10 years in Marmara University Faculty of Dentistry. However, currently, there are around 18 faculties of dentistry in Turkey(7) and the overall level of dental ethics education in Turkey is probably far away from the ideal. The major reason for this problem is the absence of specific departments within the administrative structure of dentistry faculties. As a result, the lectures are conducted by departments of medical ethics of faculties of medicine. On the other hand, there is actually considerable and growing interest in dental ethics. Ethics sessions are being held in national congresses of dentistry(8) and the Turkish Dental Association (TDA) is also supporting studies in the field. In addition, TDA has its own dedicated ethics committee.

Lectures

Dental ethics lectures are given by the staff of the Department of Medical Ethics and History of Medicine of Marmara University Faculty of Medicine. The department has three members (Prof. Sefik Gorkey, Dr. Gurkan Sert and Dr. Tolga Guven) who have backgrounds in dentistry, law and medicine, respectively and this allows an ideal distribution of lecture topics among the members. The lectures are given throughout the second semester of the final (5th) year of the dentistry education and half of these lectures are devoted to history of medicine and dentistry lectures. Each lecture lasts approximately 2 hours and due to the large number of students (approximately 130), classroom lecture format has been chosen.

Lecture topics have been classified in accordance with a system prepared by Prof. Dr. Sefik Gorkey. This system allows the classification of topics in biomedical ethics from a dental ethics perspective. There are basically three main groups of topics (See Table 1). The first group of topics includes issues that may rarely be necessary for a dentist in practice, although they are very important issues in the overall context of biomedical ethics (euthanasia and abortion). These issues are, therefore, considered to be more specific to medical ethics. Lectures on these topics aim to provide general -but not very detailed- knowledge about the ethical aspects of these issues. Questions about these topics are rarely covered in the written exams.

The second group of topics is far more extensive. They are examined under 3 subgroups (denoted as A, B and C in Table 1). Among these, the subgroup of topics in column A (Informed consent, patients rights, research ethics etc.) are considered to be necessary for both medicine and dentistry students, and the content of the lectures in the faculty of dentistry are more or less identical with those conducted in the faculty of medicine.

The third group of topics (Dental interventions for aesthetical purposes, orthodontics and ethics) is almost exclusively related with the practice of dentistry. These lectures are conducted by Professor Dr. Sefik Gorkey.

In addition, there are certain topics which primarily belong to Group 2, but their possible relevance for the practice of dentistry are different from each other. For instance; ethics in oncology is situated between Group 1 and Group 2 (denoted with the letter B), since this issue is considered to be more closely -although not exclusively- related to medical ethics. On the other hand, ethical aspects of advertising and HIV/AIDS related ethical issues are situated between Group 2 and Group 3 (denoted with the letter C), since the issues in this column -and particularly HIV/AIDS- are very closely related with dental practice and has important implications for every dentistry student as well as practicing dentists(9). Therefore, a question on at least one of these issues generally appears in the written exams.

Dental ethics lectures also covers information about the legal aspects of dental practice. Currently, there are no departments of health law or medical law in the faculties of law in Turkey, although there is growing interest in these fields by law scholars. Lectures on the civil and criminal liability of physicians in the faculties of medicine are sometimes covered in forensic medicine lectures. However, one of the members of our department has his bachelor’s degree in law, and medical law is one of his main fields of interest. Therefore, our department has the chance to include lectures on the legal aspects of dental practice and legal liability of dentists within the scope of dental ethics lectures. These lectures also include examples of decisions of Turkish courts of law on topics relevant for health care professionals. In addition, students are provided a list of legal regulations relevant for dental practice.