Ethical decision making is not always easy.... but when you let you guide by the 4 principles, you are safe.

Respect for autonomy: respecting the decision-making capacities of autonomous persons; enabling individuals to make reasoned informed choices.

Beneficence: this considers the balancing of benefits of treatment against the risks and costs; the healthcare professional should act in a way that benefits the patient

Non maleficence: avoiding the causation of harm; the healthcare professional should not harm the patient. All treatment involves some harm, even if minimal, but the harm should not be disproportionate to the benefits of treatment.

Justice: distributing benefits, risks and costs fairly;  patients in similar positions should be treated in a similar manner.

Yes, it is always recommended to gain confidence of your patient first whatever you are going to do, otherwise if it fails you have to make an extra exit door at your clinic.....

Ethical decision making is not always easy.... but when you let you guide by the 4 principles, you are safe.

Respect for autonomy: respecting the decision-making capacities of autonomous persons; enabling individuals to make reasoned informed choices.

Beneficence: this considers the balancing of benefits of treatment against the risks and costs; the healthcare professional should act in a way that benefits the patient

Non maleficence: avoiding the causation of harm; the healthcare professional should not harm the patient. All treatment involves some harm, even if minimal, but the harm should not be disproportionate to the benefits of treatment.

Justice: distributing benefits, risks and costs fairly;  patients in similar positions should be treated in a similar manner.

I totally agree with Ina Schueler in her guiding four principles. However, perhaps this extensive theme merits some further discussion. Dr. Rashid poses several questions that require specific answers: The first one, if our patients should be the first priority and given consideration, the answer is an unequivocal yes – anything else would indeed be unethical. In fact, I have problems imagining a case when an alternative answer could be justified. If that were the case, why would any patients in their right minds be willing to pay for the dentist’s service?

His next question is: Due to complexity of prosthodontic treatment, patients sometimes do not understand the quality of treatment provided. First of all, it is the indisputable responsibility of the dentist to present for the patient all professionally acceptable treatment options with all ramifications thereof, and indeed, to see that the message is understood.

Undoubtedly this is a tall order; particularly if the patient’s cognitive capacity is waning. However, no effort should be spared to that end. It certainly involves a verbal and sometimes written explanation. It occasionally necessitates a demonstration of problems and corresponding treatment options using casts mounted in an articulator. The main reason why this goal is not obtained is that insufficient time is allocated to the task, which in itself is unethical. In the discussion of the options with the patient, as Schueler so succinctly puts it, the benefits of treatment should be balanced against the risks and costs.

Dr. Rashid’s final question is: Is it always possible to gain complete trust of a patient. If not then what do we do? The answer to the first part of the question is no. In all dental practices, sooner or later, trust between dentist and patient cannot be achieved – despite all efforts. To the last part of the question my advice is then under no circumstances to undertake treatment, which may quite likely be a recipe for a plethora of problems – some of which can be quite costly. One has no obligation to treat anyone, except for acute conditions. Better to refer the patient to a colleague who may be more successful in gaining trust, and thereby a reasonable chance of a successful outcome.

Wow ... what a question.

No matter what you do when interacting with fellow human beings, there will be successes and failures.

We are all so different.

I suppose what drives us on as professional healthcare providers is to keep the failures down to a minimum, and knowing what to do to turn them into successes, which of course may start off with an apology and onward with a referral as has been mentioned in an earlier reply, and perhaps continued interest and empathy.

If only we knew at the beginning of our careers, what we know now ........

Happy 2016 ... with hopefully as many successes as is possible.

Dear David Lee,

Thank you very much. Appreciated and a happy new year !

Dear Colleagues,

You know, only we need is love but... how to keep it without confidence. It is evident that the crucial point in the patien-dentist relationship is trust rather than altruisme. In addition, we live in a world of respected autonomy. But, as mentioned above, we are not obliged to be dentist to every patient. The trust obtained along knowing each other - problems and capacities, is the best starting point when treating patients. Getting older I realized that we should   not get disappointed if any this does not last for ever. I agree with other opinions that keeping the good relationship and empathy is very important. Please let me know mention an addition point: Professional integrity consists also in the awareness of the  individual limitations and the TRUST BETWEEN COLLEAGUES. As soon as we start accepting the other colleague expertise with respect and honest criticism and selfcritism, we'd be more successful in our effort to justify complex and expensive prosthetic treatments as well as any other procedure.

Happy and prosperous New year. Thank you for being together in this challenging adventure the dentistry is .