Professionalism in Dentistry Veatch identifies eight general areas on ethical concern that were gleaned largely from surveys of practicing dentists. 1. 2. 3. 4. 5. 6. 7. 8. Quality of Care Advertising Self-regulation/ “Denturism” Patient Autonomy Conflicts with patients Justice 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 assistance; 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 profession. 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, 25). Thus, one solid view of a profession is this: 1.The fiduciary relationship with clients 2.A base in technical, specialized knowledge 3.A service rather than a profit orientation 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 COME FIRST. 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 commitments. Criticisms: 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 profession? 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 concerned.