Introduction —Dental Ethics for the 21st Century

Robert D. Stevenson, DDS

One hundred fifty-four years ago, just a year after the close of the Civil War, the leaders of the American Dental Association, itself just 7 years old, met to debate the adoption of a professional code of ethics. Many of the leaders opposed the code because they felt the good dentists didn’t need it and the bad ones wouldn’t pay attention. After heated debate, a simple code of ethics was adopted. Since 1866, the codes have been updated repeatedly to address relevant concerns of the dental profession. Despite these changes in applications, the underlying principles remain unchanged.

As the codes of ethics for the American Dental Association, the California Dental Association and other significant dental organizations have evolved, the expectations that were outlined have created a sense of professional unity. However, the discussion continues to this day as to whether the dentists who most need the codes will pay attention and whether those who pay attention really need the codes. This debate may never reach a conclusion.

Potter Stewart, a former associate justice of the United States Supreme Court, said, “Ethics is knowing the difference between what you have a right to do and what is right to do.” [1] This is precisely why it is important to review ethics on a regular basis: It is not always a simple matter to differentiate between the two.

In simple terms, ethics may be defined as the moral values that govern an individual’s behavior. As one considers this definition, it becomes apparent that in a world full of individuals, there may be endless interpretations and applications of the basic ethical principles. As we have seen in many events in recent years, this can lead to chaotic behavior and justification of wrongful actions. A lack of ethical awareness can lead to disastrous choices.

Dentists tend to pay less attention to ethics than to clinical dentistry and business practices. That could stem from the perception that ethics have little bearing on the modern dental practice when compared to clinical and business topics.

We are now well into the 21st century. Do ethics appear to be an antiquated view of life as spelled out by ancient philosophers? Or are they still relevant in our lives? Our contention is that ethics are alive and well and relevant. The important news is that the fundamental principles of ethics have not changed. They continue to provide a foundation for our choices. But the situations in which we apply these principles continue to change. Our objective in this issue was to provide some real-world applications of ethical principles: to translate thoughts on ethical behavior into actions. Ethics do have a practical side. When ethical principles are applied consistently, relationships with patients, staff and colleagues may be enhanced. Ethical behaviors reach far beyond the walls of one’s dental practice.

In this issue, Nick Forooghi, JD, an attorney who teaches ethics at the University of the Pacific, Arthur A. Dugoni School of Dentistry, leads off with a discussion of truth and trust as they relate to ethics and the law in dentistry. Kenneth Jacobs, DDS, a former member of the CDA Judicial Council, follows with an examination of the conflicts between the dentist’s roles as a professional and as a businessperson. Gary Herman, DDS, a former member of the Judicial Council and the Council on Ethics, Bylaws and Judicial Affairs, discusses the importance of the treatment plan in an ethical practice. Finally, Robert Stevenson, DDS, a former chair and member of the Judicial Council, examines how dentists can utilize ethical principles to make better choices.

We hope that our readers will gain a better sense of some of the practical aspects of ethics and remain committed to following our codes of ethics. Regardless of how ethical we think we are, there is always some room for improvement. We encourage the reader to look for the nuggets of wisdom that can be applied in their personal and professional life.

This issue is dedicated to the many volunteers and staff who have served on the Judicial Council over the years. It has been a privilege to serve with you and to serve our members as we promoted the ethical ideals of the California Dental Association.

CDA President Rick Nagy has added the following statement:

“On behalf of CDA, I extend my heartfelt gratitude to those who have served on the CDA Judicial Council and to the staff who assisted the council in leading and shaping dentistry’s future in the state of California. Through the years, the Judicial Council was tasked with promoting and maintaining high ethical standards within the dental profession as well as with developing a viable and legally enforceable code of ethics and interpreting and enforcing that code of ethics on behalf of the association, components, individual members and the public. With the recent governance changes, oversight of the code of ethics has moved to the CDA Board of Trustees. Thank you to Judicial Council members both past and present. Your service was a valuable asset to CDA and no doubt has left a lasting impression on the profession of dentistry in California.” [2]

REFERENCES

1. Evans WG. The motivation to be ethical. S Afr Dent J 2016 Jul;71(7):329.

2. Richard J. Nagy, DDS, correspondence with author.

GUEST EDITOR Robert D. Stevenson, DDS, practiced general dentistry in the Inland Empire area. He is an assistant professor at the Western University College of Dental Medicine and served on the CDA Judicial Council. Conflict of Interest Disclosure: None reported.