Specifics of applying ethical principles in pediatric dental practice

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HSEI of Ukraine “Ukrainian Medical Stomatological Academy”, Poltava

Specifics of applying ethical principles in pediatric dental practice

Padalka A.I.

Kostenko V.G.

Sheshukova O.V.

Developing and choosing the most effective approaches to the management of young patients at the dentist's is one among the most relevant and challenging issues of health care that is determined by a number of physiological and psychological characteristics of children at different age levels. Being a highly skilled professional, perfectly handling the latest technologies and techniques, a paediatric dentist should have knowledge regarding children psychology and competencies to win child's favour. Moreover, a dentist should be very watchful and sensitive not only to children, but to their parents or family members as well in order to avoid or to lessen psycho-emotional conflicts; in case of clash dentists should act with tolerance, tact and patience. Therefore, ethics and deontology are important predispositions to build up effective therapeutic interaction between a physician and a patient.

This work is aimed to analyze and to assess the significance of the main issues and principles of medical ethics and deontology in the paediatric dental practice.

Ethics is the doctrine of morality, its origin and development, the rules and norms of human behaviour, their responsibilities when dealing with each other as well as with society, people's attitude to their work and the state they live in.

Medical ethics is a branch of ethical science that studies the objective foundations, the essence, specifics, structure and basic functions of the morale of health care workers. Within the scope of medical ethics, there are conventions existing in the medical settings and typical for medicine as an institution [10], in particular the relations between doctors and patients, possible contradictions between them, and ways to resolve conflicts. Medical ethics is paying more attention to studying the moral and ethical positions and profiles of patients. A modern patient is, as a rule, an active person whose attitude towards his or her health is becoming more and more conscientious. It is the patient who is increasingly seeking to make a decision together with his / her doctor concerning his / her health [9].

The general principles of medical ethics, which have been already laid down by Hippocrates in a well-known oath, are relevant in our time as well. There are eight basic principles of medical ethics [6, 7]:

Humane attitude towards the patient;

Non-malfeasance, or refraining from harming the patient;

Providing medical care to all who need it, regardless of race, political membership or religious confession;

Solidarity of all doctors in respect of the dignity of people;

Keeping a patient's personal health information private;

Protecting people's lives from excesses that can threaten them (for example, from environmental pollution);

Avoiding involving people into experiments;

Refraining from actions that can undermine the dignity of a doctor's profession.

The foundation of successful paediatric dentistry is based on the physician's ability to control the behaviour of the child through the procedures of dental check-up and treatment. Moreover, the paediatric dentist should build up the interaction in the way, which not only contributes to the improvement of the child's oral health, but promotes the positive attitude towards the importance of preventive oral care [3].

Among the most important tasks the dentists typically face during the first child's visit to a dentist's office is to make a positive impression on the child and his / her parents. Both the child and parents should be convinced that the doctors definitely want and can help them [8].

In order to provide a highly qualified medical care to children, a dentist should have not only deep theoretical background, be quite skilful in applying proper techniques; the dentist should also understand the psychology of the diseased child and his or her parents, to clearly realize the ethical problems existing in this area. One of the most important issues is to explain the characteristics of a disease to parents or relatives of the child in order to obtain informed consent for treatment. The doctor's skills to calm down or encourage the child, to inform parents about diagnostic methods, peculiarities of treatment plan, occurrence of possible complications, and at the same time to cheer them up and obtain full compliance regarding the treatment, and therefore the patient's outcome are considered as mandatory ethical requirements.

Communication is a milestone in the management of paediatric dental patients, the first step in making the first and favourable impression, the precondition for further cooperation between the dentist and the patient. While interviewing the child, it is not recommended to make any notes - careful listening and eye contact to gauge patient's attraction to the doctor are sometimes the only things the dentists should do. The dentist should not express his or her opinions on previous decisions regarding diagnosis or treatment in the presence of the patients and their parents. It seems to be reasonable and appropriate from the ethical standpoint to give some pieces of advice and recommendations as well as to make the final diagnosis only following a complete examination of the children [5].

It is important to remember that the relationship between the doctor and the patient should not overstep the limits of institutional communication. Most children become much attached to adults and even become jealous of them; therefore the dentists should be very tactful, sensitive and perceptive in getting in contact with young patients [4].

When communicating with the parents of small patients, the dentist should strictly follow some specific recommendations [2].

It is important to initiate contact with the child, because as soon as the parents note that the child does not resist the doctor, they begin putting trust in health care professional.

The doctor deserves trust and confidence and typically the children and their relatives consider their doctors trustworthy if they are harmonious as a personality, tolerant, attentive, optimistic, neat, having a healthy complexion, correct posture, nonsmoker.

Convincing and clear information about child's disease presented in a friendly and soft tone, indicating a high professionalism, entails trust in doctors and institutions.

Minimization of fear and anxiety in children and their relatives at the dentist's office is one of the main deontological tasks that can be achieved by using above mentioned doctor's personal qualities and some techniques like distraction, joke, etc.

Keeping some reasonable distance combined with utmost benevolence promotes mutual understanding in difficult situations.

The manifestation of such spiritual qualities as attention, kindness, benevolence set parents at ease.

Strong will, when presenting certain demands to parents, facilitates the treatment course, since parents sometimes lose control over their emotions and sometimes fail to understand that their behaviour can influence the child's condition.

Convincing the child and parents that they are exceptionally interested party in following dentist's recommendations eliminates many deontological difficulties.

Today academic society is actively debating about bioethics as a set of knowledge on biology and evaluation criteria of human relationships [11].

Dental ethics is a part of medical ethics that is as a subfield of bioethics (from the Greek bios - life and ethics - ethics, morals, customs) - a science of moral principles of human behaviour and life.

The field of bioethical regulation in dentistry covers:

the relationship between the doctor and the patient;

relationships within the professional group of dentists;

the relationship between dentists and other groups of healthcare professionals;

relations between property, ownership and profit in dental practice;

attitude to latest scientific achievements and criteria of their use in dental practice;

pros and contras on the market of medicines and materials used in dental practice;

aesthetic standards of dental care;

attitude of dentists to the social and natural factors affecting the health of their patients;

principles of identification of this professional group in society;

attitude to state power and laws that run in this society;

relationships within a professional group of dental professionals;

the moral status of the patient in terms of his health and the recommendations of the doctor [12].

An integral part of medical ethics is the deontology that is predominantly of applied character and bears the imprint of a particular medical profession.

Medical deontology puts forward special demands to paediatric dentists, firstly, because their professional activity is based not only on direct contact with children, but also on communicating with the immediate relatives who have their own perception of the health of their children as well as personal and age-related peculiarities [3]. Secondly, the fundamental difference between the deontology of the dentist and the child is based on the necessity to apply special communication skills with children based on knowledge of their age characteristics. Thirdly, we need deep knowledge not only of age-related pathology, but also of age-related physiology, without which it is difficult to detect early deviations, which testify to the disease of the organs of the oral cavity [8].

Paediatric dentists in their daily practice are dealing with children, their parents or other relatives. And each of these categories requires a correct approach. Nowadays, parents and other child's relatives or representatives are armed with knowledge about childhood diseases taken from special and popular literature, the media and the Internet resources. In some cases the enthusiasm they demonstrate for various up-to-the-minute remedies and methods of treatment and prevention that sometimes can be even advertised by healthcare workers and far from being based on evidence- base medicine principles, can seriously affect interaction between doctors and child's parents and therefore impede compliance.

The routine in organizing and providing paediatric medical care typically involves the following ethical and legal problems [1]:

the paternalistic (paternus means paternal) principle of doctor-patient interaction, when the doctors take upon themselves the responsibility for the treatment and its outcome, and pledge their commitment for the good of the patient making their own decision what is actually good or not for the child without involving child's relatives or representatives;

time-limited communication between dental care professionals and parents in emergency conditions;

parents' refusal to undergo diagnosis and treatment for confessional or ethical reasons, or due to the lack of awareness of some issues or prejudices, etc.;

negative influence of incompetent advisors (relatives, third parties including sorcerers, quacks, unevident medical information presented in popular mass media resources) on parents' decision making;

torpor of community associations or movements (e.g. groups of successfully recovered or treated patients, which disseminate the information among the parents about the peculiarities of the course and consequences of diseases, hospital and community ethical and legal committees and boards.

The paediatric dentists should build up their relationship with the young patients and their families based on the principles of humane ethics and morals, proclaimed with Hippocrates's oath and medical deontology. It is important to give the sick child as much time and attention as it can take to make accurate diagnosis, to provide full medical care and to substantiate the treatment plan and prevention measures. The dentists must remember that failing to communicate with the children and their parents is a major factor in their dissatisfaction. Not only making correct diagnosis, but also the successful treatment outcomes depend on well built-up communication and thus, mutual complete understanding between doctors and young patients.

References

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