Substance Abuse: Filling the Holes that Dental Restoration Cannot

Posted: December 21st, 2022

Substance Abuse: Filling the Holes that Dental Restoration Cannot

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Substance Abuse: Filling the Holes that Dental Restoration Cannot

Code of ethics in healthcare serve fundamental roles in guiding health practitioners’ conduct their duties professionally and without violating existing regulations and client desires. [A1] A code of ethics defines roles and responsibilities with a profession and offers direction to the professional for dealing with common ethical concerns (2, 4). [A2] Such codes are important because they create an ethical measure that is undisputable and non-negotiable in all settings and roles (7). Often, nursing organizations and practitioners create the codes to show their awareness of their professional dedication to society (6, 8). The study compares and contrasts the directives of three codes of ethics guiding dentist operations in three jurisdictions; Jamaica, the United States, and Alberta, Canada. The paper pays considerable attention to how the code of ethics guide dentists to avoid doing harm by taking appropriate measures when they feel they are not able to provide needed services for one reason or the other. Hence, the analysis compares and contrasts how each code of ethics require dentists to observe nonmaleficence, which is one of the chief principles of healthcare ethics. The analysis pays more attention to substance abuse as a potential factor that could deter dentists from providing appropriate care, and a practice that puts patients at considerable risk of being harmed[A3] . The developers of the code of ethics in the different countries consider substance abuse as a threat that requires effective mitigation to prevent patients from potential harm. [A4] 

Jamaica Dental Association Constitution, By-Laws and Code of Ethics

The Jamaica Dental Association Constitution that outlines the code of ethics for dentists provides much insight into the concept of doing no harm (nonmaleficence) in Section III of the category that outlines the primary ethical principles [A5] (5). The section clarifies that dentists have a role to safeguard the patient from harm. However, the harm is different from that of abuse and neglect, and mostly focus on the dental care a patient receives (5). The directive requires practitioners to prevent harm by focusing on three critical aspects; maintaining and enhancing their clinical proficiency by constantly updating their skills and knowledge and knowing when to refer a matter to another health care facility, colleague, or specialist by understanding and accepting their constraints ([A6] 5). The third factor that the code of ethics requires of dentists as a way of averting possible harm to the patient is to rely on guidance and to be purposeful in providing care to professional applicable to dental care specialists.

Section III.D- Personal Impairment of the Jamaica Dental Association Constitution provides information that would help to understand why dentists must take precaution when they affected by drugs in one way or the other, and may cause harm in the course of service delivery[A7] . The section directs that dentists have an ethical responsibility to offer service free from the deficiency of their capacity to attend to patients that results from misusing alcohol, controlled substances, and other substances that have hallucinating effects (5). The guideline further illustrates that dentists have an ethical obligation to first consult and share ideas with practicing colleague who is affected, and to guide the practitioner to seek intervention for the problem.

The code of ethics in Jamaica provides guidance notes that provide further guidance on how to help affected dentists due to drug abuse, and who may subject the patient to considerable harm. [A8] The guidance notes directs that in engaging the colleague, the practitioner has a further ethical mandate to give direction to the colleague to self-report the problem to the Jamaica Dental Association (5). Moreover, the directive requires dentist to notify the Association and clarify that the issue require urgent attention to facilitate access to needed care. The guidance notes further directs that impairment of a dentist that deters their capability to offer care appropriately or puts patients at risk or affiliates of the dental group shall cause a situation where the dentist restricts their service delivery to areas that do not require active engagement with patients (5). Furthermore, the guidance notes emphasize that once the impairment is eliminated, the restrictions are eradicated. Altogether, the code of ethics does not castigate practitioners who are unable to serve due to drug abuse and instead acknowledges the need to provide needed attention to improve their condition and ability to serve.

ADA Principles of Ethics and Code of Conduct

The American Dental Association (ADA) formulated a code of ethics to guide dentists in their everyday activities. [A9] Similar to the code of ethics for dentists in Jamaica, the ADA Principles of Ethics and Code of Conduct elaborates the need for dentists to observe the principle of nonmaleficence in Section 2 (1). [A10] Specifically, the code addresses issues concerning effects of substance abuse on dentists in section 2.D. and subsection 2.D.1, titled Personal Impairment and Ability to Practice, respectively (1). The part labeled 2.D. clarifies that it is unethical for a dentist to serve while abusing drugs and alcohol, or other chemical forms which deprecate their capacity to practice. The code in the U.S. is similar to the one in Jamaica in the way it urges dentists to compel chemically hampered practitioners to seek intervention. Furthermore, the code in the U.S. takes a similar form as the model in Jamaica that requires dentists with first-hand awareness that a workmate is offering services when under the influence of drugs have an ethical obligation to report such cases with proof to the relevant committee dealing with social issues affecting those practicing dentistry (1). Section 2.D.1 goes ahead to inform that a dentist who contracts any illness or become unable to serve due to certain impairments in a manner that might endanger dental staff or patients, with guidance from a specialist, confine their operations to areas that do not put others in considerable threat of being harmed [A11] (1). However, the code of ethics applied in the U.S. provides additional informational information that misses in the guideline used in Jamaica, which is that a dentist who is under instructions to restrict the actions of their practice should assess the identified impairment and implement additional restrictions to the actions of the practitioner’s practice, as directed.  [A12] 

Alberta Dental Association and College- Code of Ethics

Similar to the other two codes of ethics, the one that is applicable in Alberta stresses on the need for dentists to adhere to the principle of nonmaleficence. [A13] The document informs that dental practice should not leave a patient in worse condition than if no intervention had been offered (3). The code of ethics applicable in Alberta asserts that it is known that such conditions may unintentionally emerge as a result of uncontrollable conditions, irrespective of that intention. The code provides information that misses in the other two documents, which is that should the dentist cause harm to the patient, it is their obligation to disclose it to the patient. Article A3 of the document (Fitness to Practice/Incapacity) [A14] further directs that a dentist may encounter behavioral or medical complications to competence (3). The code require dentists notify the Alberta Dental Association and College when a severe injury, infection, or medical problems has tampered with or may perpetually affect the practitioner’s ability to offer services safely and without putting patients at risk (3). The section further clarifies that it is unethical for a person practicing dentistry to abuse drugs and urge colleagues to take appropriate measures to assist affected members (3). Furthermore, the document is similar to the other two in the way it directs dentists who have knowledge that a colleague suffers the effects of drug abuse to give such report to the College.

Summary

The paper identifies a code of ethics as a fundamental tool for dentists in different countries. The code of ethics in Jamaica, the U.S., and Alberta show some similarities including emphasizing the need to help impaired dentists to seek medication for their inability to serve and high likelihood of causing harm due to effects of drugs, alcohol, and other chemical agents. Besides, all the analyzed codes of ethics encourage impaired dentists and those undergoing treatment to limit active engagement with patients because the interaction increases the probability for causing harm. However, each code of ethics provide some specific information that make them unique and applicable within their jurisdiction. The documents emphasize the need for dentists to stay away from alcohol, drugs, and other substances that may deter their ability to practice and increase their likelihood of causing harm. Each dentist, especially those affected by drug abuse, have an obligation to understand the content of the code of ethics to seek needed attention.

[A15] 

References

1. ADA Principles of Ethics and Code of Conduct. ADA. Available from: https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/about/ada_code_of_ethics.pdf?rev=82d95a7422ac47f6bd7cb856be68e359&hash=B429E3FC0E5A2131978DAB037CA73F70 [Accessed 5th March 2022].[A16] 
2. [A17] 
3. Alberta Dental Association College. Code of Ethics. Alberta Dental Association College. Available from: https://www.dentalhealthalberta.ca/wp-content/uploads/2021/01/ADAC-Code-of-Ethics.pdf [Accessed 5th March 2022].
4. Ilkafah, I, Anestesia, P, Joni, H. Factors related to implementation of nursing care ethical principles in Indonesia. Journal of Public Health Research. 2021; 10(2): https://doi.org/10.4081/jphr.2021.2211
5. Jamaica Dental Association. Jamaica Dental Association Constitution, by-laws and code of Ethics. Jamaica Dental Association. Available from: https://jamaicadentalassociation.org/assets/doc/by-laws.pdf [Accessed 5th March 2022].
6. Katelin, H, Christine, G, Connie, U. Ethics education in nursing: Instruction for future generations of nurses. OJIN. 2018; 23(1): Available from: https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethics-Education-in-Nursing.html
7. Priyadarshini, P. Ethics in nursing research. European Journal of Molecular & Clinical Medicine. 2020; 7(7): 6080-6086.
8. Varkey, B. Principles of clinical ethics and their application to practice. Medical Principles and Practice. 2021; 30(2): 17-28.

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 [A1]Opening statement (hook).

 [A2]Definition of code of ethics.

 [A3]Purpose and scope of the study.

 [A4]Thesis statement.

 [A5]Section addressing nonmaleficence in the Jamaican code of ethics.

 [A6]How dentists can prevent harm to patients.

 [A7]The section emphasizes the need to act when one is affected.

 [A8]The section highlights the need to help affected dentists.

 [A9]Opening conclusion.

 [A10]The section describes the provisions of nonmaleficence in the document.

 [A11]Similar features with the Jamaican code of ethics.

 [A12]Information showing how the document differs from that which is applicable in Jamaica.

 [A13]The section illustrates how the code of ethics for Alberta compares and contrasts with that of Jamaica and the U.S.

 [A14]The specific section that addresses drug abuse among dentists.

 [A15]The summary is a recap of the major arguments in the paper.

 [A16]Vancouver requires, name, title, name of website, link, and access date for websites.

 [A17]Vancouver requires, name, title, journal title, published date, volume number, and issue number for journal articles.