INTRODUCTION
From the beginning of our time, we were taught about the word ‘ethics’ in our moral science lectures, but we never really paid attention to its actual definition. ‘Ethics’ comes from the Greek word ‘ethos’, which means ‘custom or character’. In research, we define ethics as the study of rules that are right or wrong or the behavior that is acceptable or unacceptable. The field of dentistry implies dental ethics as certain moral duties and obligations of dentists towards patients, professional colleagues, and society. This code of conduct has a legal entity of its own but, earlier, people were not aware of it, and thus, the flouting of such ethics was not reported as a matter of concern. So, to regulate the ethics, etiquette, and regulations of the dental profession, The Dentists Act, was passed in 1948, which extends to the whole of India.
PRINCIPLES OF ETHICS
A principle[1] is generally described as a foundational truth or proposition that serves as a fundamental for a system or belief or behavior or chain of reasoning. Similarly, the ethical principles shed some more light on a broader aspect of legal values as they are further divided into 6 types:
To Do No Harm (Non-maleficence – This principle was first expressed by Hippocrates and later recurring in the well-known Latin phrase ‘primum non nocere’ meaning ‘first, not harm.’ It is considered to be a rudimentary moral of society as it places a duty of care on the dentist to exercise utmost caution in his profession, to protect the unguarded patient from any harm.
To Do Good (Beneficence) – This principle fundamentally refers to the attribute of selfless service in medical care as the best interest of the patient must supersede any other consideration. Beneficence extends not only to the patient at hand but also to the surrounding spheres of the doctor’s life, like to socialize, and enhances his/her role in public health, prevention of disease, and research.
Respect For The Patient – This principle further includes two important aspects of ethical dentistry; Autonomy and Informed Consent.
- Autonomy – The paternal approach of Beneficence gives rise to the freedom of the patient to make his/her own choice and the subsequent respect given by the dentist for the same as there is a shared responsibility in decision-making.
- Informed Consent – This is a two-step process as the information is first passed on to the patient by the dentist and then the patient satisfies himself/herself to decide whether to agree or refuse the treatment. A full description of procedures carried out is stated and therefore is agreed upon by the signatures of the patient and a witness.
Justice – In dentistry, justice refers to fairness and nondiscrimination as a patient may not be discriminated against, for any reason, irrespective of his/her caste, creed, and gender. Moreover, the dentist must ensure that every patient gets equal access to the basic standard of care and his/her share in the limited care resources, in an impartial and just manner.
Honesty – This principle is governed by a 3-T attribute – ‘Truth, Trust, and Transparency as the patient have a legal right to expect true information about the treatment and prognosis from the dentist. That is why dentists are advised to follow two don’ts to establish a legitimate relationship with the patient; don’t hide treatment failures and don’t give false information.
Confidentiality – This ethical principle is governed by the patient’s legal right to expect that all communications and records about his/her care will be treated as ‘classified’ information. The consent of the patient is thereafter regarded as extremely important for the disclosure of any such particulars and reasons for the same have to be cited by the dentist, before the act of disclosing.
THE DENTISTS ACT, 1948
The Dentists Act of 1948[2] stands as an important landmark in the History of the Dental Profession and Dental Education in India. It is an act to make provisions for the regulation of the profession of dentistry and the constitution of Dental Councils. The Act was passed by The Parliament in association with the All India Dental Association on 29th March 1948.
The Councils incorporated under this Act are financed by The Ministry of Health & Family Welfare as the fundamental aim of The Dentists Act, 1948 is to keep track of the dental practice, registration of dental degree holders, and provide grants to Dental Colleges and Institutions. So, the avoidance of malpractices by the name of dentists for the protection of public health and safety was kept in mind, while framing the Act. In addition to this, The Consumer Protection Act (CPA) was instituted in 1986, and in 1995, ‘Health Professionals’ were added to it, for the safety of the public. There are various provisions under The Dentists Act, such as – “If any person is found to be misusing the title of ‘Dentist’, ‘Dental Surgeon’ or ‘Dental Practitioner’, is punishable on the first conviction with a fine of Rs 500/- and for subsequent conviction with imprisonment of 6 months or fine of Rs 1000/- or both.”
NEED OF THE HOUR
Dentistry is an honourable profession but the relationship between the patient and the dentist has changed substantially in the last 2 decades. Anxiety has become a driving force in the dental community due to the increased propensity of patients to file suits against dentists. Thus, awareness of ethics and medico-legal matters is crucial for every dental practitioner. Section 17(A) of The Dentists Act, 1948 is also a major source for dental rules and etiquette as it educates dentists to follow a certain ‘Code of Conduct’ in their dental practice. So the steps to be followed by the dentists include the: Patient consent must be obtained through a written statement, in the presence of a witness, before the commencement of any treatment procedure. Awareness about Dental Negligence should be necessitated by dentists and they should also know about the laws governing the same. Professional Indemnity Insurance (defense costs) should be insured to dentists as in the case of legal proceedings, it provides protection and financial support for outside the court settlement and other expenses. Records should be dainty and stored properly.
Some regulations are also expected to be followed by the government agencies and courts: Dental Insurance should begin in India in the pursuit of patients and to assist dentists to take better responsibility when providing services. The compulsion of Dental Indemnification must be directed to the Dental Council of India by the strict orders of The Health Ministry of India, as and when a dentist registers himself/herself with the Council. Fast-Track Courts must be established to hear cases related to dental immunity for rapid judgments in the best interests of the virtuous profession.
LEGAL CONNOTATIONS OF DENTISTRY IN INDIA[3]
Violation of genuine interests in the profession of Dentistry – Case: Dr. Jyoti Oberoi Vs. Avatar Kaur (January 2018, Mumbai) – A patient named Avatar Kaur approached Dr.Oberoi in Mumbai in 2016 for fixed dentures. Due to prior extensive damage to the teeth, Dr.Oberoi placed 11 implants with proper care and caution and scheduled a follow-up treatment for the placement of dentures in the coming months, but the doctor cited that Mrs. Kaur never showed up. Instead, the dentist was served with compensation-seeking suits, amounting to Rs 35 lakhs as the petitioner accused her of botched-up dental practice. The relevant authorities looked upon the matter and reported an absence of negligence on the part of the dentist and all charges were dropped against her after video evidence surfaced, showing the complainant eating without any discomfort.
Absence of Negligence on the part of Dentists – Case: Dr. Veeresh Magalad Vs. Abdul Khader Bagalkot (December 2017, Hubbali) – The patient visited the dentist with prior tooth pain and was advised to undergo extraction, but after the treatment, he experienced prolific bleeding and was immediately rushed to the Intensive Care Unit (ICU). However, he did not survive and a complaint was filed against the dentist under Indian Penal Code (IPC) Section 304. The findings of the investigation included the fact that the patient was already suffering from a systemic disease but the lack of knowledge thereof, resulted in the lack of communication with the dentist. Hence, the dentist was held not to be liable under the given circumstances as other precautionary measures were taken.
CONCLUSION
Hence, in a nutshell, it is imperative to know that Dental Healthcare is not a business and the dental profession has been extremely valued since time immemorial. But the recent legal attacks on the practitioners have raised a questionable stance on their safety and that is why adherence to The Code of Ethics is crucial for the continued trust of society in the dental profession.
Author(s) Name: Drishti Bansal (Dharmashastra National Law University, Jabalpur)
References:
[1] Biomedical Ethics (Second Edition) – Olinda Timms
[2] Dental Council of India – The Dentists Act, 1948 <https://dciindia.gov.in/Rule_Regulation/Dentists_Act_1948.pdf> accessed 01 March 2023
[3] Journal of Oral Health and Community Dentistry Volume 15 | Issue 3 | Year 2021 <https://www.johcd.net/doi/pdf/10.5005/jp-journals-10062-0114> accessed 01 March 2023
