Begell House Inc.
Ethics in Biology, Engineering and Medicine: An International Journal
EBEM
2151-805X
2
2
2011
PREFACE: Bioethics in Oral Health Sciences
i-iv
10.1615/EthicsBiologyEngMed.2012005052
Amit
Chattopadhyay
Quest Arete Science, Oklahoma City, OK 73112, USA; La Trobe Rural Health School, La Trobe University, Bendigo, 3550 Australia; School of Dental Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
Editorial: A Bioethics Agenda in Oral Health Sciences
85-86
10.1615/EthicsBiologyEngMed.2012005048
Amit
Chattopadhyay
Quest Arete Science, Oklahoma City, OK 73112, USA; La Trobe Rural Health School, La Trobe University, Bendigo, 3550 Australia; School of Dental Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
Moving Ethics Curricula Forward
87-106
10.1615/EthicsBiologyEngMed.2012004846
Charles N.
Bertolami
College of Dentistry, New York University, 345 East 24th Street, New York, NY 10010
ethics
dentistry
professionalism
We do not really teach ethics, we teach about ethics−a subtle but crucial distinction. Ethics curricula are qualitatively inadequate to the extent that they focus on delivering content rather than on influencing lives. This article approaches ethics education from the perspective of 3 levels of learning: informative, formative, and transformative, and it asserts that conventional ethics courses confine themselves to informative learning but fail to transition effectively into the formative and transformative phases in which authentic behavioral change becomes plausible.
Two assumptions are made: (1) that students are no more ethical than the man in the street and (2) people always can change for the better. Although arguable, it is safer to make these assumptions because only in doing so is it possible to avoid designing ethics curricula solely for the purpose of delivering information, and thereby underscoring the importance of transitioning students through all 3 levels of learning. Transformative learning in ethics must be experiential, requiring a conscious and volitional effort by educators to inculcate realistic but heroic expectations for professionals whose work intrinsically embodies elements of the heroic. This is not that difficult if we can help students see their own heroic potential.
Bio-Ethics in Dental Education: Dental Public Health Residents' Perspective
107-114
10.1615/EthicsBiologyEngMed.2012004455
Evelyn
Lucas-Perry
Office of the Director, Office of Science, Policy and Analysis, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892
Aderonke
Akinkugbe
Office of the Director, Office of Science, Policy and Analysis, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892
bioethics/ethics
dental ethics
dental education
indoctrination
behavior change
critical reasoning
Recently, disparate views regarding the role and value of ethics in the dental curriculum have been published in dental literature. Some authors have stated that the time and approach to teaching ethics calls for serious consideration. They argue teaching ethics early in the dental curriculum makes students perceive ethics as an unimportant aspect of professional practice and hence not to be taken seriously as they would technical skills. More so, ethics courses are not targeted towards effecting behavior change, hence defeating the purpose of ethical professionalism.
Other authors agree that the ethics curriculum in dental education, although needing improvement, is accomplishing what is intended−that is, to instill knowledge and elicit a sense of moral obligation through critical reasoning. Bioethical dilemmas per se are not clearcut; hence, every ethical dilemma requires critical contemplation, which ethics education provides through didactic, case-based learning and small-group discussions. They argue that the decision about a change in behavior be left to the individual.
Two dental public health residents at the National Institute of Dental and Craniofacial Research present their views on what the focus of ethics education in dental schools should be−change behavior or provide knowledge for critical reasoning. One opines that the teaching of ethics should be behavior driven, analogous to the expectations of clinical dentistry requiring an actionable behavior−patient care. The other urges that the teaching of bioethics be geared towards instilling critical reasoning skills for contemplation as expecting otherwise would be considered indoctrination.
Need for an Ethical Framework for Testing for Systemic Diseases in Dental Clinics
115-136
10.1615/EthicsBiologyEngMed.2012004545
Marushka Leanne
Silveira
Division of Biostatistics & Epidemiology, University of Massachusetts, Amherst, MA
Amit
Chattopadhyay
Quest Arete Science, Oklahoma City, OK 73112, USA; La Trobe Rural Health School, La Trobe University, Bendigo, 3550 Australia; School of Dental Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
dental clinic
testing
systemic disease
ethics
Testing for systemic diseases in dental clinics is a potentially attractive avenue for oral health professionals and may be viewed as an opportunity to increase professional reach, expand practice, and improve financial returns. However, several ethical questions arise that must be addressed before such activities are adopted. (1) What should be the level of training dentists must acquire to deal with challenges associated with testing? (2) How well are dental practices aware of and compliant with the Health Insurance Portability and Accountability Act and procedures related to informed consent? (3) What is the evidence regarding acceptability and effectiveness of testing? (4) What should be the acceptable standard of practice for conduct of invasive and noninvasive tests? (5) What is the boundary delineating "testing" and "reporting" vis-a-vis counseling? (6) What is the value of testing without counseling? (7) What assurances need to be in place to ensure voluntariness of testing? (8) How would data from testing be used in "research," especially with the growth of practice based research networks? and (9) Does the American Dental Association Code of Ethics need to incorporate guidance for practicing dentists? We discuss how ethical principles can be used to develop a framework of guidelines for potential testing for systemic diseases in dental clinics..
Advances in Oral Fluid Testing: Proposed Property Rights, Violation of Privacy, and Revising Informed Consent
137-146
10.1615/EthicsBiologyEngMed.2012004857
Anthony
Vernillo
Department of Oral & Maxillofacial Pathology, Radiology & Medicine, and College of Dentistry, Center for Bioethics, New York University, New York, NY
Sudeshni
Naidoo
Department of Community Oral Health, University of the Western Cape, Cape Town, South Africa
Paul Root
Wolpe
Center for Ethics, Emory University; Atlanta, GA
biological property
privacy
blood
autonomy
informed consent
public health
saliva
biospecimens
Biotechnological advances in rapid diagnostic testing of oral fluids such as saliva or oral transudate have led to the identification of a wide array of pathogens, enzymes, gene products and mutations, and other biomarkers. A new paradigm related to property rights likely will emerge with more information obtained from testing an individual patient or research participant; oral fluids may be a counterpart to blood. Traditionally, blood has been subjected to a large variety of diagnostic testing for both medical and legal purposes. Should oral fluid, like blood, also be granted comparable legal and ethical protections? Concerns about violation of privacy, including genetic discrimination, have emerged with rapid testing of saliva. The management of salivary biospecimens must include considerations of property rights and financial compensation; the right to privacy; and re-evaluation of informed consent. The challenges of obtaining informed consent for rapid oral diagnostic testing from culturally diverse populations must be addressed to promote overall public health and research. Testing must also be affordable and accessible. Strategies that incorporate rapid oral diagnostic testing into oral health care should reshape and align dentistry with medicine, promote public health, and advance research investigations.
The Ethics of Globalizing Bioethics
147-156
10.1615/EthicsBiologyEngMed.2012004265
Stuart
Rennie
Department of Social Medicine & Center for Bioethics, University of North Carolina-Chapel Hill
Bavon
Mupenda
Centre Interdisciplinaire de Bioethique pour l'Afrique Francophone (CIBAF), Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
bioethics
capacity building
developing countries
research ethics
colonialism
neo-colonialism
In the last decade, there have been efforts to globalize the field of bioethics, particularly in developing countries, where biomedical and other research is increasingly taking place. We describe and evaluate some key ethical criticisms directed towards these initiatives, and argue that while they may be marked by ethical, practical, and political tensions and pitfalls, they can nevertheless play an important role in stimulating critical bioethics culture in countries vulnerable to exploitation by foreign agencies and/or their own authorities.
Publication Ethics of Authorship in the Oral Health Sciences
157-159
10.1615/EthicsBiologyEngMed.2012004505
William V.
Giannobile
Michigan Center for Oral Health Research, Department of Periodontics & Oral Medicine, University of Michigan, 1011 N. University Ave., Ann Arbor, MI 48109-1078
dentistry
publishing
research
literature
contributorship
scientific writing
Publication ethics is critical to the proper dissemination of research findings in all areas of science, including oral health research. This article highlights general principles in biomedical publishing, with particular attention paid to authorship of scientific articles in the basic, translational, and clinical areas of dentistry.
Ethics and Aging: Challenges for the Dental Practitioner
161-170
10.1615/EthicsBiologyEngMed.2012004598
Sharmila
Chatterjee
Department of Epidemiology & Biostatistics, The George Washington University, Washington DC 20037; Sharmila Chatterjee's Analytical Science Initiative (SCASI), Gaithersburg, MD 20877; AMRI Hospitals, Kolkata, India
ethics
dental care
health care
aging
elderly
Advances in health care and public health practice are enabling Americans to live longer. The US Bureau of Census projects that the population aged 65 years and older is expected to increase from 40 million in 2009 to 70 million in 2030. Health and aging, often associated with real-life complexities and challenging physiological and psychosocial problems in the elderly, precipitate ethical dilemmas and raise the question of appropriate care. These elderly people have several comorbidities and lose their independence due to neurodegenerating diseases, providing several issues, such as extent of treatment, quality and validity of informed consent, autonomy, and health care resource allocation. A discussion on ethics related to health care practice in the elderly is therefore of particular importance in the light of such current demographic shifts. This article views these ethical issues through the perspective of oral health care and provides a review of some of the ethical dilemmas that caregivers including dental practitioners should be familiar with while caring for the elderly population.
Professional Responsibility in Dentistry: What It Is and How It Works
171-174
10.1615/EthicsBiologyEngMed.2012004859
Joseph
Graskemper
Stonybrook School of Dental Medicine, Department of General Dentistry, 7 Bellport Lane, Bell-port, NY 11713
dental
ethics
law
professional responsibility
Professional responsibility is wider in scope that just ethics and law. This article presents a decision-making model that may help clinicians, academics, and researchers obtain proper resolution to complex situations to fulfill their professional responsibility. It also presents an exciting challenge to incorporate a connectedness in the teaching of ethics, law, professionalism, risk management, and practice management to the next generation of dentists.
HIV and AIDS in India: Legal and Ethical Implications
175-185
10.1615/EthicsBiologyEngMed.2012004256
Karunakaran
Mathiharan
Forensic Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
Kannan
Ranganathan
Department of Oral and Maxillofacial Pathology, Ragas Dental College and Hospital, 2/102, East Coast Road, Uthandi, Chennai-600119
medical ethics
written consent
discrimination
Indian Penal Code
rights
Acquired immunonodeficiency syndrome (AIDS) has reached pandemic proportions globally. India has 2.31 million people living with human immunodeficiency virus (HIV)/AIDS, and the global estimate is 33 million. Growing disease burden presents varied ethical, moral, and legal dilemmas to the health care providers. Increasing awareness among the afflicted population brings up issues that define a health care provider's duties and rights. The health care provider has to deal with questions of confidentiality, information sharing about the HIV status of the subject with other health care professionals and the spouse or partner, maintenance of medical records, patient consent for testing in doubtful clinical cases, and treatment-referral related issues. The governing bodies in the Indian sub-continent, including the Indian judicial system, Indian Medical Council, Drug Controller General of India, the Ministry of Health, and National AIDS Control Organization (NACO), work along with inputs from voluntary/independent organizations to frame legislation pertaining to these concerns. This article aims to discuss the moral, ethical, and legal issues relating to HIV/AIDS from a health care provider's perspective, in the unique socio-medical setting in India.
Ethical Issues in Replacing a Periodontally Involved Tooth with Dental Implants: Thoughts, Beliefs, and Evidence
187-194
10.1615/EthicsBiologyEngMed.2012004888
Liran
Levin
Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, and Faculty of Medicine, Technion, IIT, Haifa, Israel
periodontitis
fixed restoration
splinted
overdenture
tooth-implant connection
implant failure
Over the past decade, the use of osseointegrated implants as a foundation for prosthetic replacement of missing teeth has become widespread. However, certain risk factors might predispose individuals to lower success rates and to a greater hazard for implant failure. The misleading public notion (sometimes supported by dentists) that implants will survive forever leads, in some cases, to early extraction of teeth. We, as dental professionals, should avoid basing our treatment planning on thoughts and beliefs and stick as much as possible to evidence-based practice.
Implants are not a magic solution for every diseased tooth. Implants probably will not survive forever and the procedure is not without risk. Although it seems tempting to get rid of an unhealthy tooth and replace it with an implant, this is not always the gold standard of treatment. Natural teeth can serve our patients for the long term with proper management and maintenance. The option of replacing the tooth with an implant should not be a major factor leading to extraction. Furthermore, we must remember that most of the available literature concerning dental implants is rather short term with regard to patients' life expectancy. Ethic considerations as well as careful explanation to the patient are of utmost importance in those cases.