What Would A Reasonable Dental Hygienist Do?

 As health care professionals, dental hygienists across the country are faced with unusual situations on a daily basis that can cause questioning of actions and/or inactions.

Being a professional comes with responsibility and it is that commitment that leads us to continually improve the care that we give. Professionalism is that part of who we are, that puts our clients’ interest before our own. It is the personal values and beliefs that we possess that guide our behaviour and motivate us to make intelligent decisions.

Possessing personality traits such as: honesty and integrity, being caring and compassionate, reliable and responsible, mature, loyal, able to self-analyze, being a good communicator and having a healthy respect for ourselves and others make us unique and effective health care-givers.

Ethics are a code of morals or standards of conduct and the values by which human beings live in relation to other human beings, nature, God and/or themselves.

We are ethical people. Each health profession defines professional ethics in written standards of professional behaviour. Every code of ethics for each health profession is slightly different but the underlying concepts are very similar.

The CDHA recently released the new Dental Hygienists’ Code of Ethics and we are fortunate to have this clarity and a process guide us, step-by-step to making the best decision possible for all involved in an ethical dilemma situation.

One change to the code is the inclusion of “Integrity”.

Integrity relates to consistency of actions, values, methods, expectations and outcomes. It includes the promotion of fairness and social justice with consideration for those clients more vulnerable. It conveys a sense of wholeness and strength, and doing what is right with honesty and truthfulness. (CDHA, 2012)

It means doing the right thing, whether or not anyone else is watching.

The five ethical principles that guide the profession of dental hygiene are:
Integrity – (as above)
Beneficence – the idea of caring about and acting to promote the good of another
Autonomy – the right to make one’s own choices
Accountability – taking responsibility for our actions or inactions
Confidentiality – our duty to keep secret any information a client tells us in the professional relationship

Dental hygienists often have to take action in situations with value-laden issues. Meeting a client who holds very different values about culture, sexuality or religion may stir feelings in you that can be destructive to the professional relationship. Learning how to use a systematic process of critical thinking when making clinical judgements begins with clarification of the problem and insight into your own values as well as those of the client.

An ethical dilemma occurs when two or more ethical principles are in conflict. During our practice, we face many professional and personal problems. Ethical decision making is a behaviour and can be taught and learned. There is always more than one solution for solving a dilemma and alternatives may include changing office policy, offering information to colleagues, informing clients of their need to seek care in another health care office or seeking another position. Each solution carries consequences. The option you choose may upset your employer, frighten the client, and involve performing an activity outside the scope of dental hygiene practice or perhaps having to leave a highly regarded position. That is why it is called a dilemma.

A very helpful process has been developed by the CDHA to enable us to work through difficult dilemma’s in a structured and efficient manner.

The Guidelines for Ethical Decision Making are as follows:

Step 1: Describe the issue and identify the nature of the problem.
Step 2: Gather information relevant to the challenge or problem including factual information about the situation.
Step 3: Clarify the challenge or problem.
Step 4: Identify options for actions, recognizing that the best option may not be obvious at first.
Step 5: Assess the various options in light of applicable policy, legislation or regulation in terms of advantages and limitations of each.
Step 6: Decide on a course of action, taking all the gathered information into account.
Step 7: implement your decision as thoughtfully and sensitively as possible.
Step 8: Assess the consequences of your decision.

If you are in doubt as to how to resolve an ethical dilemma, you may want to access a textbook, refer to a trustworthy internet site, discuss with a colleague, call your provincial association and/or regulatory body.

There are often no “right” answers, compromise is sometimes the best outcome that can be achieved. Having a process such as the one above, can help us to determine the best solution for all involved.

As published in Preventive Dentistry Canada - Vol.3 No.4 - Winter 2012