The Dental Profession and Professional Ethics
Dentistry is a profession. Its members and students take this description of dentistry very seriously. Many practitioners of other occupations also call themselves “professionals.” The adjective “professional” is also frequently used by advertisers and marketers to describe services and products that have nothing to do with someone’s being a member of a profession. When used in these ways, the term “professional” doesn’t mean much more than “well made” or “well performed.”
For dentists and those studying to become dentists, however, dentistry as a profession has far more meaning than this. They would view themselves very differently if dentistry were not a profession. Calling dentistry a profession does not just say something about well-made products and exceptional services. Dentistry’s being a profession says something about dentists. It says they have made important commitments, not just to themselves and to one another but to the society at large as well. It says there are norms of conduct that they are going to live by in their relations with their patients, with one another, and with the larger community, norms that have been developed and shaped by generations of ongoing collaborations between the profession and the larger community. It says there are standards of competence that dentists will adhere to in their practice, standards based on an established body of expertise that dentistry as a profession has developed over time for the benefit of the community and that it continues to improve on.
This is a book about dentistry as a profession. It is about the commitments that a person makes when becoming a member of this profession and that a dental student should therefore be incorporating into his or her life in order to become a dentist. There is much literature and ongoing research on the knowledge base and technical skills needed for dentists to practice competently as their experience, knowledge, and technology advance and they continue to improve the technical aspects of their practices. But learning more about the ethical commitments at the heart of being a professional and improving one’s living of them also takes time, attention, and practice. The knowledge base of this aspect of professional dentistry, though, is much larger than the list of dos and don’ts of an ethics code. There are also practical relational skills and important skills of effective ethical thinking to be learned, internalized, and improved on. For this knowledge and these skills need not only to be freely committed to but to become matters of habit, which means a person needs to develop the skills of self-formation to continue to grow as a person and as a professional. The aim of this book, then, is to add to the reader’s knowledge base about dental ethics and dental professionalism and to describe some of the most important skills needed to grow in it.
The decisions a dentist or a dental student or any of us make involve not only questions about oughts and shoulds but also questions such as, What kind of person am I? and, What kind of person do I want to become? Addressing these questions carefully will often make our best responses to the oughts and shoulds much easier to identify. In this book, as in most professions, the concept of professionalism will be used to remind the reader of the importance of regularly asking questions such as, What kind of dentist am I? What kind of dentist do I want to become? What kind of person am I? What kind of person do I want to become?
What is professionalism? The concept professionalism is sometimes used in the negative—that is, with emphasis on what is missing when someone’s behavior falls short of the most minimal ethical standards of a profession, when the person’s conduct is such that it is hard to think of the person as acting like a member of that profession at all. It is obviously unprofessional in this narrow sense for a dentist to ignore an overhang in order to keep patients moving more quickly through the office or to inform patients only of treatments the dentist finds most profitable. The specific aim of this book, though, is to take seriously the idea that dentistry is a profession and that this says something about who a dentist is rather than merely implying that their services are well performed.
The focus of this book, then, will be on professionalism as something positive, something to be aspired to in everything a dentist does. Professionalism in this sense refers to the internalized and habitual ways of thinking and acting that characterize the life and practice of the most admirable members of the dental profession. Among these ways of thinking and acting are the distinctive skills of dental practice: First are those skills that are often called “technical” by which a dentist employs his or her professional expertise to actually benefit a patient, but equally important are ethical skills—skills in the realm of values and conduct, especially in the context of the dentist’s relationships to patients and others.
This book will focus primarily on this second aspect of dental professionalism. It will offer descriptions of the ways of thinking and acting that the ethical dentist aspires to, those that constitute admirable professional-ethical conduct. It will examine cases from dental practice that, though they are fictionalized, describe typical ethical challenges that dentists encounter in their practices and that focus on the most important ethical skills (that is, the relational skills, the skills of ethical thinking, and the skills of self-formation) that a dentist needs to develop into habits in order to grow in professionalism.
Practicing dentists are already aware of the kinds of ethical issues that arise in day-to-day practice. Most dentists already have established habits of ethical conduct that they have built up over years of practice and careful self-assessment. These enable them to focus on relating effectively to their patients and doing technically competent work without having to stop and carefully think through each ethical issue that arises—even though a new dental student observing these situations might well have to look at them very carefully. Even the wisest and most ethically experienced dentists, however, encounter new situations that require careful ethical thinking. The concepts and skills explained and demonstrated in the following pages, then, can be very helpful in these situations.
Many readers of this book, however, will be dental students, including dental students early in their programs who are not yet working directly with patients. A representative sampling of ethical decisions that almost every practicing dentist faces regularly, then, seems useful here: