Ethics and Law: ‘Truth’ and ‘Trust’ in a 21st Century Practice

Nick F. Forooghi, JD, Esq.

What is the “truth?” I have to take you through a philosophical discussion before we relate this article more directly to the dental profession. But trust me — no pun intended — you will be better for taking the trouble and following me on this short journey.

As professionals in any field, medical, dental, legal and others granted the privilege of a license to practice, we all have a fiduciary duty to the people we serve. We will revisit the implications and meaning of having a fiduciary duty, but it helps first to discuss a more fundamental word — truth. We can hardly find any philosophical work in the study of ethics without a discussion of what truth is and how it relates to, or inspires, other important ethical concepts.

I know some who read this commentary may perceive what I write to be a “statement of the obvious.” That is exactly the point. We take what is obvious for granted at our own peril. Truth as a concept worthy of discussion has been a core subject in philosophy for thousands of years. Ethics is often defined as “the systematic study of right and wrong.” Truth being a central topic of philosophy and so closely at the center of the study of ethics, also has a long history of systematic scholarly examination.

Our shared understanding of the word truth today has a major practical purpose in allowing each of us to navigate our daily lives both personally and in relation to other members in our society. This is the very purpose of a vast area of work referred to as “applied ethics,” which is concerned with the practical use of moral concepts in the real world.

Much in ethics and various philosophical ideas about ethics are organized around the definition of key concepts like truth, honesty and trust. Members of any society must have a relatively stable and common understanding of the meaning of these key concepts if we are to have a useful and practical application of laws and ethical codes in a given period of time. Concepts of morality and ethics evolve over time. Therefore, we have to discuss any constancy of ethical and moral concepts based on the period in which they are expressed. This in itself is a great area of examination and debate. Even then we have a need for a dedicated law professional (attorneys) to interpret the laws in countless practical applications (case-by-case application of laws).

There are several current theories of truth in philosophy. Our contemporary understanding of “truth” is closely aligned with the “correspondence theory of truth,” the idea that “what we believe or say is true if it corresponds to the way things actually are — to the facts.” [1]

But, how do we know what the facts are? How can you tell a lie from a truth?

If, as unfortunately has been claimed by some, there can be “alternative” facts, then logic would dictate that there can be alternative truths as well. What would that claim do to our essential need to rely on knowing what is “ethical behavior?” Examination of this issue should not be politicized, even though it unfortunately has been. This seemingly obvious discussion has very serious practical implications for science, and philosophy in general, and professional ethics more specifically relevant to our short discussion here.

Thinkers, philosophers, scientists and professionals have a duty to not allow artful obfuscation or playing with facts — otherwise called lying and intentional dishonesty — destabilize the idea that in each given set of circumstances there is indeed a single truth even if it takes some work to reveal it. Arguments are fine when we are in the process of examination but must end once reliable evidence is found and only after they have been tested by the rigor other peers in that field put them through.

This relationship with the truth and the belief that truth will be revealed through observation and corroborated independently by others you respect as colleagues is most crucial in teaching ethics in professional schools because the product of these schools is expected to be trusted professionals who the public can rely on for doing the right thing, the definition of being ethical.

Comparison of “Ethics” and “Law”

You can do what is needed to keep you out of trouble or you can aspire to do even more. I am reminded that my first encounter several years ago with teaching ethics in a dental school was to hear some version of the phrase “law is the lowest level of standards you have to meet, and if you fall below legal requirements you will be subject to sanctions and penalties.”

As an attorney who genuinely believes in the role laws play in any civilized society, I have been heard to confess that in my world “law” holds the place religion does for many. At first impression, I was aghast to consider the position of law as the lowest level of compliance below which you would get punished and that is all. The use of the word “low” can symbolize a sort of predisposition to quality of expectations. However, I came to agree that this statement was actually correct in a technical and concise way. The context where this definition arose from, and in a much-specified perspective, was a practical and truthful observation. Here is how I would restate the same relationship between law and ethics in a bit longer observation:

Laws exist to provide a moral standard that a society devising them intends to uphold. The laws are to be obeyed and shall be enforced by force of mandate or otherwise subject the violator to some fine or punishment. Laws set a boundary not to be crossed, but they do not set a higher and maximum limitation on how far above this standard one can go into where aspirational ethics and voluntarily observed morality reside.

Laws are therefore a subset of ethical standards that a society decides should be mandatorily honored. What occupies the aspirational moral space above the law is therefore still ethics. The law is not intended to be a cure-all for ills, moral dilemmas, disputes and bad things that can happen. Laws are intended to be perfect, but hardly ever are. This is why laws cannot fix all of our problems nor address all ethical challenges.

Going back to what I hope universally was taught in your dental school days, in some form or another, is the definition of ethics noted above: “Ethics is a systematic study of the concepts of right and wrong.” It is impossible to relegate determination of all that could be right or wrong to our jurisprudence. This is why we need to know and hold some truths to be self-evident.

Facts matter because they point to the truth. This has little to do with the law and everything to do with ethics, and we need facts we can trust.

Ethics is the realm of concepts like “veracity” and “trust” not only to the extent mandated by standards of law but following the aspirational quest for what is right. This is where students and all of us need to always return to.

When laws might prove inadequate or stand in waiting for evolution of ethics to a critical mass that will allow a new standard to become a new mandate, we only have our aspirational and voluntary understanding of ethics, morality and common ethical concepts like truth and trust to fall back on. Facts matter because they point to the truth. This has little to do with the law and everything to do with ethics, and we need facts we can trust.

Anchoring Dental Education in Trust and Truth

It pays to remind ourselves of Immanuel Kant’s posit that ethical and moral imperatives arise from morality in what is considered a rational capacity in all humans, which compels them to form what we term and refer to as “humanity.”

The concept of humanity manifested in individuals builds societal relationships and is reflected in groups large and small. Kant delineates certain “moral laws” that are to be absolutely honored and not violated in these interactions and relationships. Veracity (truthfulness) is the one we are concerned with here. As we already noted, without a healthy respect and solid belief in what truth means to our everyday lives and especially in a professional setting, there can be no trust.

Kant’s ideas and work on morality and ethics have had a great influence on dental professional organizations’ views on professional ethics and societal responsibilities of dentists in the U.S. and the professionals who belong to those organizations. This is where philosophy manifests in professional day-to-day practice and serving patients.

The American Dental Association (ADA) makes use of a more concise and carefully selected subset of normative principles and imperatives that have been adopted as essential to the profession of dentistry here in the U.S. and, by extension and connection, by all individual state dental profession organizations and bodies in their individual language and impressions. They have been interpreted and applied in various forms that conform to the same and similar group of principles and ethical values. The same attention and focus are paid to how these expressions are to become deeply embedded in dental professional education.

In the preamble of the ADA’s Principles of Ethics and Code of Conduct, we read:

“The American Dental Association calls upon dentists to follow high ethical standards which have the benefit of the patient as their primary goal. In recognition of this goal, the education and training of a dentist has resulted in society affording to the profession the privilege and obligation of self-government. To fulfill this privilege, these high ethical standards should be adopted and practiced throughout the dental school educational process and subsequent professional career.

“The Association believes that dentists should possess not only knowledge, skill and technical competence but also those traits of character that foster adherence to ethical principles. Qualities of honesty, compassion, kindness, integrity, fairness and charity are part of the ethical education of a dentist and practice of dentistry and help to define the true professional. As such, each dentist should share in providing advocacy to and care of the underserved. It is urged that the dentist meet this goal, subject to individual circumstances.

“The ethical dentist strives to do that which is right and good. The ADA Code is an instrument to help the dentist in this quest.” [2]

By calling it essential to a dental education to honor these principles, the ADA is asking each and every person who is involved in professional development of dentists, and most certainly in their educational experience, to honor and uphold these specified values. But how do we honor and embed “qualities of honesty, compassion, kindness, integrity, fairness and charity” in dental education?

Each of these imperatives is worthy of scholarly discussion and consideration that would take up volumes, and they do. We will here suffice to declare that the principle of veracity and its relational reference to law, trust and what we commonly refer to as truth is and has always been the foundation of an ethical professional practice.

In most recent years, the combined effects of proliferation of internet connectivity and social media, primarily Facebook, and platforms functionally designed and presented similar to Facebook (e.g., Reddit or Twitter), have pushed veracity and truth into the arena where doubt and skepticism usually dwell more often than scientific, evidence-based truth.

Until a few years ago, the words “fake” and “hoax” were not often used in common conversation. Now they are out in full force challenging the veracity of what we hear, read or think we learn. What we think we know, what we believe to be true is challenged constantly. One of the toughest challenges of our day is learning how we can agree on what the facts are when the sources reporting the news are in the thousands. We no longer have a Walter Cronkite [3] to trust and rely on to report the facts. Fact checking is no longer a job title limited to media publications, and we need a user-friendly set of tools all consumers can access.

Meanwhile, we have to remind ourselves that words like veracity need to return to the solid ground where politics and points of view of current events cannot challenge their meaning. In every classroom, and especially in professional schools where we attempt to teach the ability of differentiation between “right and wrong,” we have to go back to the basics and remind everyone that truth does exist, ethics matter and trust means nothing without that context supporting it.

Advancing knowledge and progress in science might change our ability to affect outcomes, but that does not make yesterday’s truth a lie today. It means simply that we are learning more and can prove what we know is in fact true.

Evidence-based practice finds and holds its place of honor only when empiricism and the quest for truth, which can withstand trial and reproduction and scrutiny of our peers, are the solid and unbending standards of measurement. Our understanding of ethics and moral imperatives such as veracity, truth and trust should not be easily malleable.

The ADA’s principles of ethics and code of professional conduct define veracity as follows:

SECTION 5: PRINCIPLE: VERACITY (“TRUTHFULNESS”) The dentist has a duty to communicate truthfully. This principle expresses the concept that professionals have a duty to be honest and trustworthy in their dealings with people. Under this principle, the dentist’s primary obligations include respecting the position of trust inherent in the dentistpatient relationship, communicating truthfully and without deception and maintaining intellectual integrity.

CODE OF PROFESSIONAL CONDUCT 5. A. Representation of Care. Dentists shall not represent the care being rendered to their patients in a false or misleading manner.

In addition to reminders of the philosophical underpinnings of professional ethics, we should not end this article without mentioning the phrase that is the exclusive cornerstone of any profession purposed and oriented to serve the public and that is also regulated and licensed; (not all professions are). That phrase is “having a fiduciary relationship.” A patient or client places their trust in someone else who has specialized knowledge and skill the patient does not have, and the expectation that things will go well defines the fiduciary duty we have as professionals.

Medicine and dentistry, and other fiduciary professions including law, are not just another business. We spend ample time in dental school ethics classes to delineate “health care” from “commerce,” even as health care is also in part commercial. While there is a long list of differences between commerce and care, the most important one of all is that the patient (the client) places their trust in us to do what is best for them. They are the end itself and not the means for any other purpose. They trust a professional provider when they are at a disadvantage of not possessing the knowledge and training the provider has, and they hope to benefit from the provider’s knowledge by simply trusting the provider to do the right thing.

I would be remiss if in closing I fail to mention that I started writing this piece well before the COVID-19 pandemic and the crisis that ensued had taken hold. In the aftermath of the outbreak, I have realized how critical this conversation about truth and applied ethics is to the health of our institutions. It should not be lost on anyone that our society is still debating whether or not there is in fact a true crisis or, as some surprisingly claim, a manufactured political crisis. Wearing a mask, a simple scientific measure with well-established and tested reasons why it could be helpful, has become a political issue. It makes me sad when widely proven and reliable scientific knowledge is questioned carelessly; of course, this should make all of us very concerned. Not trusting politicians is an age-old truism whether justified or not. But when we fail to defend well-established scientific facts and our scientists have to be careful about expressing their professional opinions, it should be alarming to all. It shows how vulnerable truth can be to attacks motivated by a variety of other ends in mind. It is not dramatization to claim that the future of our society and trust in our organizations depend on how well we all defend the scientific method and existence of an empirical truth, continuing emphasis on importance of ethics and ethical thought and actions in all spheres of life. The scientific method took centuries to become a normal path for meaningful investigation. Galileo’s factual and provable belief that the Earth revolves around the sun was deemed heretical by the Catholic Church, and he was compelled to submit to a trial for holding such heretical belief. Truth might be illusive, but we know the way to find it is through methodically finding facts and patiently defending findings we believe to be true. Placed in proper perspective, this subject is about much more than truth, trust, law and ethics, but a discussion like this is a great place to start for any licensed professional entrusted to serve others.

REFERENCES

1. Moore GE, Bertrand R. Truth, section 1.1.1 The origins of the correspondence theory. Stanford Encyclopedia of Philosophy.

2. Principles of Ethics and Code of Professional Conduct. Preamble. Chicago: American Dental Association; 2018:3–4.

3. Martin D. Walter Cronkite, 92, dies; trusted voice of TV news. The New York Times July 17, 2009.

AUTHOR Nick F. Forooghi, JD, Esq., is a practicing attorney and an educator. He is the executive associate dean at Lincoln Law School in San Jose, Calif., and an assistant professor of professionalism and ethics at the University of the Pacific, Arthur A. Dugoni School of Dentistry in San Francisco. Conflict of Interest Disclosure: None reported.