IN THE LITERATURE

Issue 1.1

Chiodo, GT, Tolle, SW: Cosmetic treatment, autonomy, and risks: "If you don't do it, I'll go to a dentist who will". General dentistry. 2001, Vol. 49,1: 16-28 (7 p.)
The article begins with two case scenarios involving patients who request cosmetic treatment against the dentist’s advice. The authors acknowledge that it is often impossible to dissuade such patients and discuss what is an appropriate response when patients (or their surrogates) exert their autonomy beyond the limits of standard treatment and in a way that compromises a standard risk/benefit ratio.

Chiodo, GT, Tolle, SW: Virtue versus ethical obligations: Working for system-wide change. General Dentistry. 2001, Vol. 49, 2: 138-143.
The authors point out that much of the ethical literature focuses on the individual encounter or relationship between a specific dentist and patient. They argue that this is an appropriate focus. Efforts toward social policy affecting health care in general (e.g., distributive justice in health care allocation and reimbursement) are virtuous but are not ethical mandates. While individual values may mediate the duty to advocate for many social issues, professional values that are oriented toward improving the health and well-being of all in a society require organized health care professions to advance these causes.

Cohen LA, Romberg E, Grace E: Revisiting the attitudes of dental faculty toward individuals with AIDS. Journal of Dental Education. Mar 2001, Vol. 65,3: 249-52
The authors compare attitudes of dental school faculty towards AIDS between 1989 and 1999 by repeating the same survey. Faculty responses showed little bias towards individuals with AIDS. There were no significant differences for patients with AIDS or leukemia. The survey confirms other studies showing a general improvement over the last decade. The findings regarding attitudes towards homosexuals were not as positive, showing that homophobia continues to be a problem.

Hofmann B, Eriksen H.: The concept of disease: ethical challenges and relevance to dentistry and dental education. European Journal of Dental Education. Feb. 2001, Vol. 5, 1: 2-8
Modern medicine and dentistry face fundamental ethical challenges. To treat or not to treat, that is the question! Can these challenges be met with a rigorous and consistent concept of disease? This is the key question of this article and the ensuing debate is of fundamental impor-tance in the teaching of ethics to medical and dental students. The investigation of traditional concepts of disease reveals that they are flawed and do not withstand ethical challenges. An alternative concept of human ailment is elaborated on, based on the triad disease, illness and sickness. This model is applied to representative cases in medicine in general and dentistry in particular. It is argued that the concepts of disease, illness and sickness represent a framework for analysing and coping with inherent ethical challenges. This reveals that medicine and dentistry are concerned both with biological explanations and with questions of the virtuous life, i.e., both with science

Jerrold, L: An affair to remember. American Journal of Orthodontics and Dentofacial Orthopedics. March 2001. Vol. 119: 327-329.
This Journal contains a regular section entitled: Litigation, Legislation, and Ethics. In this particular contribution, the author discusses the legal aspects of romantic affairs between dentists and their patients in reference to the ethical and legal requirement of informed consent. Such affairs can have a detrimental affect on patients’ informed consent and invalidate the consent. The dentist may be inclined to provide less explanation whereas the the romantically involved patient may not listen as critically to the dentist. Treatment without a valid consent can be grounds for a malpractice suit.

Masella RS, Meister M: The ethics of health care professionals' opinions for hire. Journal of the American Dental Association, Mar. 2001,Vol. 132, 3:361-7.
Serving as a forensic consultant or medical expert witness is a professional duty and social responsibility. While objectivity is a hallmark of ethical health care evaluation, conflict arises when medical experts exhibit bias and serve the hiring party's interests instead of the public's. The authors define different types of expert witnesses and examine the means for improving the quality of testimony. They conclude that biased testimony contributes to scientifically unfounded liability verdicts. The public ultimately pays for huge monetary settlements via higher costs for all goods and services. Financial incentives in the current professional and product liability system will make it difficult to institute court-appointed neutral expert panels on a widespread basis.

Privacy Protection in the Dental Office. An Interview with Dr. Richard Speers. Journal of the Canadian Dental Association. June 2001, Vol. 67, 6: 316-319.
In reference to recent Canadian legislative developments in the area of data collection and privacy protection, JCDA Editor Dr. John O’Keefe interviews IDEALS Board Officer Dr. Richard Speers about the implications of these developments for the dental office. The importance of patients’ privacy is discussed, drawing on different international approaches.