Professionalism in Dentistry: Profession or craft

Professionalism in Dentistry
Veatch identifies eight general areas on
ethical concern that were gleaned largely
from surveys of practicing dentists.
Quality of Care
Self-regulation/ “Denturism”
Patient Autonomy
Conflicts with patients
Intraprofessional relationships
Financial transactions
While this list may not be quite complete, it
does identify the broad areas the practicing
dentists are actually concerned with. In other
words, these are the issues encountered in
actual practice.
Dentists can claim for themselves at least
several of the most common characteristics
of professions and professionals:
1) Dentists possess a distinctive expertise
that consists of both theoretical knowledge
and skills for applying it in practice;
2) dentists’ expertise is a source of
important benefits for those who seek their
3) because of this expertise, dentists are
accorded, both individually and collectively,
extensive autonomy in matters pertaining to
it—that is, dentists are self-regulating.
There is, though, a fourth characteristic that
may be more controversial, that is the notion
that professions and professionals have
special obligations to those who are in need
of their services. Do dentists have
PROFESSIONAL obligations?
The Commercial Picture: The Dental Clinic
as a Quickie Lube!
Some History:
 1839: the founding of the American
Journal of Dental Science to
“disseminate correct principles and
expose error.”
 1840: the Baltimore College of Dental
Surgery was created, the first dental
school in the US.
 1840, the American Society of Dental
Surgeons was formed, the first
professional association.
What is a profession?
 The American College of Dentists
(ACD) defines a profession as: “an
occupation involving relatively long and
specialized preparation on the level of
higher education and governed by a
special code of ethics.”
 Paul Starr: “an occupation that regulates
itself through systematic, required
training and collegial discipline; that has
a base in technical, specialized
knowledge, and that has a service rather
than profit orientation, enshrined in a
code of ethics.” Starr’s is often
considered the most complete definition
since it includes service orientation and
self-regulation, both of which many
view as essential to defining a
 The fiduciary relationship.
Edmund Pelligrino: “Trust in professional
relationships is forced; it is trust generated
by our need for help. When we need a
doctor, lawyer, or minister, we have no
choice but to trust someone, though we
might prefer to trust no one” (qtd. in Veatch,
Thus, one solid view of a profession is this:
1.The fiduciary relationship with clients
2.A base in technical, specialized
3.A service rather than a profit
4.Enshrined in a code of ethics
5.Collegial discipline and self-regulation
Is dentistry a profession?: Yes.
1. Let’s ask: Why does the community
at large put so much of the trust in the
power that dentists have that I
mentioned before? The answer is the
institution of profession, as understood
in the normative sense. That is, each
profession and each individual
professional is committed to using its
power according to norms mutually
acceptable to the community at large
and to the expert group. These norms
assure the community that the experts
will use their power in such a way as
to secure the well-being of the people
whom they serve rather than placing
their own personal well-being ahead of
their patients. Yes, the PATIENTS
2. It is widely taken for granted that
dentists do have obligations to their
patients besides the marketplace
obligations of not coercing, cheating,
etc. Dentists have a positive obligation
to work for the patient’s well being by
meeting the patient’s needs for dental
care. Merely refraining from
wrongdoing is not sufficient.
3. Dental care is not viewed simply as a
commodity to be sold and bought
simply on the basis of people’s desire
to buy it. On the contrary, good dental
health is vital to people’s well being; it
is an objectively valuable necessity.
Caveat emptor is simply not an
adequate account of the relationship
between the dentist and the patient.
4. Although both the dentist and the
patient have interests at stake, the
relationship between them is not a
competitive one. The dentist has
obligations to the patient to act for that
patient’s well being in relation to oral
health and function, rather than solely
to maximize the dentist’s own
situation. That is, they need to work
cooperatively, not competitively.
5. Dentistry is a self-regulating
profession. And the ADA and other
associations have as much interest in
assuring that patients get proper care
as they do in preserving the profession.
6. The dental school is not merely a
training school. The knowledge is
handed over in the context of the
student’s understanding and
undertaking of professional
 Is the knowledge of the
“professions” any more specialized
than other fields?
 Can we know, fully what is in the
client’s best interest?
 The problem of reporting
incompetence, self-regulation. Is
that for the greater good or
primarily for the good of the
Bottom line: As professionals, we may
not always live up to our stated ideals as
fully as we might; many professionals have
a genuine desire to serve. Even if we don’t
always fulfill our ideals, the ideals of a
profession are still worthy aspirations for all