Schools of dentistry, like other academic settings, provide a context for many ethical problems, including cheating on examinations, stealing books and school property, and straightforward physical abuses. In addition, dental schools, like medical schools, must deal with ethical situations that are peculiar to caring for patients. However, some of the ethical problems found in dental schools, especially those related to the completion of clinical requirements, are unique to the dental curriculum. In many of these problems, the ethically correct behavior is so clear that no real moral dilemma exists. Cheating on examinations is an example. Although we may not know how to avoid these ethical violations, we are at least clear that they are violations.
In the cases in this chapter, the ethical choices are somewhat less obvious. The first section focuses on cases that arise in the didactic and laboratory setting, the kinds of problems that can occur in preclinical years or, for that matter, in any academic setting. The second section presents cases where the moral conflict arises in the clinical training of dental students. Often the problem is one of conflict of interest between the education of the student and the clinical welfare of the patient.
Finally, there are problems that arise in the administration of a dental school: matters of fairness to students, conflicts among faculty, and so forth. These will be presented in the third section of the chapter.
The pressures of academic life for dental students are severe. Sometimes course requirements almost seem to the student to interfere with getting an education. Moreover, students increasingly come from different cultures and subcultures. Sometimes what seems clearly wrong in one culture may be acceptable practice in another. The first two cases in this section present these problems in the context of student laboratory work.
Tom Novak was a freshman dental student in a southeastern dental school. Sara Simms, a good friend, was one of several students vying for part-time employment that involved laboratory work for the orthodontic department. The department had asked all applicants to submit examples of laboratory work that they had done for courses in other departments. Sara had saved most of her laboratory projects but had disposed of the wax carvings of teeth that she had made for dental anatomy.
To solve the problem, Sara asked Tom if she could borrow his wax carvings to turn in. Tom felt uncomfortable with the request. It was not that Sara was a poor student; her carvings were as good as his. It was not even that she might beat him out of the job, because he was not interested in the position. But he was still uneasy about the request and felt that she should not have asked.
Tom has a feeling that something is wrong here. What, specifically, is his objection? Assuming that Sara’s work was as good as Tom’s, this is somehow different from cheating on an examination when one is unprepared and does not know the answers. Tom’s work was comparable to Sara’s, but that does not seem to be sufficient. Why not? Would not Sara be put at an unfair disadvantage if she did not have work of the same quality as hers to submit?
Assuming that the work was of comparable quality, this is a moral problem related to the principle of veracity. By submitting Tom’s work, although it is of comparable quality, Sara is being dishonest. The dishonesty in this case, where the result is the same as it would have been had she saved her own work to submit, may not be the same, but it is still dishonest.
Some might argue that what is wrong here is that the general practice of submitting another student’s work is bound to lead to bad consequences in the long run. That could be the basis of Tom’s discomfort. But others would claim that there is something intrinsically wrong with what Sara proposes.
A similar problemis presented in the following case, only here the instructor has reason to doubt whether the foreign student who makes use of another’s laboratory work has the same moral understanding of the act as do the instructor and the other students.
Dr Paula Stansbury has been teaching restorative dentistry for 25 years. A number of changes in dental education have occurred over the years, including—at least at her school—the enrollment of increasing numbers of foreign students. This leads to the obvious occasional challenges in communication, but Dr Stansbury has a growing feeling that there is a bigger moral challenge. She thinks that there might be differences in ideas of right and wrong between the foreign and American students.
One example involves student A, who was from a foreign country and who borrowed student B’s laboratory project, saying that he wanted to learn from what B had done. Student B had already completed the project and received his grade. Student A then turned in student B’s project as his own. Student A’s actions were discovered. When challenged, student A argued that he could not see what was wrong with his actions.
Dr Stansbury admits that it is hard to be sure that illustrations such as this do not stem from differences in individuals rather than in groups. In either case, she is frustrated and saddened by such examples, which seem to be on the rise, but she does not know what to do about them.
Compare the previous case with Case 54. What are the important moral differences? Notice that in this case, the student who submits a fellow student’s work is not being evaluated on work that he has demonstrated he is capable of doing, whereas in Case 54 the work submitted is known to be of comparable quality. Is that difference morally important?
There is a second difference worth noting. While Dr Stansbury and most of the other students in the class probably would have no trouble concluding that submitting another’s laboratory work is unethical, there is doubt in Dr Stansbury’s mind that student A is making the same ethical judgment. The student says he could not see what was wrong with his actions. Is it possible that he comes from a culture in which such behaviors are tolerated or, indeed, considered acceptable?
If so, how should Dr Stansbury take that fact into account in deciding what to do? The issue here is whether there is a “true” right or wrong answer to this problem, or whether it is merely culturally relative. One approach to this kind of problem is to try to imagine that we do not know in which culture we are. Is there something so irrational about submitting another’s laboratory work, so contrary to reason, that all reasonable people, nomatter what culture they are from, ought to see its wrongness? Are there grounds here for recognizing extenuating circumstances? What should Dr Stansbury do?
The problem of what a professor who finds what she considers dishonesty in student performance should do suggests other moral dilemmas arising in student-faculty interaction. The next case asks whether faculty ought to consider their personal relationships with students they find engaged in academic dishonesty.
Dr Carolyn Pope was an instructor of removable prosthodontics. She had just seen Mary Heckman, a third-year student, forge a faculty member’s signature on a patient chart. Dr Pope had been walking by the student lounge when she saw Mary with her back to her, seated at a table. Dr Pope and Mary had known each other for years, beginning as family friends, and their friendship had deepened as faculty and student. Dr Pope was going to say hello to Mary, got close enough to see the forgery, and stopped. There was always noise in the student lounge, so Mary was unaware of Dr Pope’s presence.
Dr Pope was terribly upset and did not know what to do. Under the school’s guidelines, she was obligated to turn Mary in to the judicial board. However, she felt such a personal bond that she did not know if she could do it. She retreated, at least temporarily, and thought about what she should do.
Dr Pope’s first problem is determining how wrong her friend’s action really is. The forgery might have happened under a variety of circumstances. Mary might have been faking the completion of a certain key requirement. She might actually have done the procedure, seen that it was of poor quality, and then tried to avoid having her instructor see it. On the other hand, Mary might have been trying to avoid contact with an instructor with whom she had a personality conflict. Maybe the instructor was simply not around at the end of the clinic period when Mary needed the signature and Mary chose to forge it rather than to go to the instructor’s office. Is one of these forgeries more wrong than the other? Consider who the forgery affects in these different situations and how the consequences differ. Is the act of signing the instructor’s name equally wrong in all situations?
Next Dr Pope must figure out the role of her friendship with Mary in deciding what to do. Friendships, like professional relationships, are based on fidelity and loyalty. There could be a sense in which the two roles—friend and teacher—come into conflict, but it is hard to imagine that friendship could ever justify overlooking one’s responsibility to the integrity of the educational process. Likewise, Dr Pope’s long knowledge of her friend’s moral character could play a legitimate role in tolerating Mary’s indiscretion, but ignoring the forgery so threatens academic integrity and the school’s obligations to future patients that it is difficult to let the coincidence of the friendship override her responsibility as a teacher. Are there times when friendship generates an obligation of loyalty that would excuse a forgery?
There are reasons for the general rule against forging signatures. It is a legitimate and important objective of dental education to have professional supervision of the adequacy of a student’s skills. It is essential to the protection of future patients, who are the ones at risk if this rule is violated. That friendship should justify an exception seems odd. Are there any reasons why it would do so?
Many schools of dentistry have boards to review accusations of student misconduct. Called judicial boards or honor boards, they offer a way of adjudicating disputes about unethical conduct within the school community. Often they take on the atmosphere of a court with powers to discipline students who violate the norms of conduct. Unlike public courts, however, they may not have all of the trappings of due process, public accountability, and final authority of the more traditional public reviews. In addition, the allowable standard for conviction is almost always the “preponderance of evidence” rather than “beyond reasonable doubt.” The following case demonstrates the kind of challenge faced by student members of the review board.