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Ethics in Dentistry: Part I - Principles and Values

Course Number: 510


The principle of justice is concerned with providing individuals or groups with what is owed, due, or deserved. Some view justice as a duty for health care providers. The foundation of justice has frequently been described as the principle of equality; likes should be treated alike, equals should be treated as equals, and unequals treated as unequals. The obvious problem in this approach is that some mechanism or criteria must determine who is equal or unequal. Fundamental to the principle of justice is an effort to treat people who have similar needs in a similar or identical manner. All patients who seek treatment for the prevention of periodontal disease should receive the same level of care and attention from the dentist or dental hygienist regardless of personal or social characteristics. Naturally, this approach does not take money into consideration and that is unrealistic. Placing money aside is easy in a discussion but difficult in application in a capitalistic society. Regardless of age, gender, social status, religion, or other distinguishing factors, each person should be entitled to the same oral health care options when a similar health care need exists. That would be just.

Justice in dentistry is most often discussed in terms of public policy issues, referred to as distributive justice. Every society must address the problem of how its resources will be distributed because every society has a scarcity of resources. Resources are scarce whether referring to materials, specially trained individuals, money, or time. Distributive justice is concerned with the allocation of resources in large social systems. Policymakers must confront the issue of how society distributes its resources. This has implications for national health care policy and is a complex issue. Questions immediately arise around what kind of treatment will be offered, who will provide the treatment, and who will be eligible to receive the treatment?

If resources were unlimited, the problem of just allocation would be minimal. Unfortunately, that is not the reality of the world. Choices must be made, benefits and burdens must be balanced, and resources justly distributed. A lofty goal for most organized societies would be the just application of health care. However, no legal mandate exists for dental care to be available to all persons, and decisions are made daily according to the ability of the patient to pay for the services rendered. Thus the provision of dental care is applied unequally. People who present for treatment are, for the most part, are granted access to care based on their economic ability and not their dental needs.

The question of who should provide dental care when an economically impoverished individual with no financial means is in need of treatment is difficult to answer. Many dentists and dental hygienists provide charitable services on a regular basis, either in a private practice office or through participation in a community-based service clinic, because of their recognition of their obligation to serve society. Many dental public health practitioners and leaders consistently call for the profession to make oral health a much higher priority for federal and state decision makers.1

Complementarity is a term that is defined as doing the greatest good for the greatest number of persons. This term is closely aligned with justice and good stewardship of resources. Any discussion about the use and application of public policy is an example of complementarity, as is consideration of culture and language in health care services.