Dentistry comprises many specialized professional associations. Each has its own mission and distinctive responsibilities to its members, the larger professional dental community, and society at large. Many dental associations have ethical guidelines outlined in their charters.
The purpose of this article is to discuss whether or not dental associations are living up to their commitments to society that these codes aim to summarize. When it comes to ethics, dental associations generally share 2 special characteristics:
1. Making good on the professional community’s claim and promise to offer unique knowledge and skills that the larger society recognizes as a specific type of expertise, namely, the ability to dependably assist others in meeting a particularly important human need. For dentistry, this need is achieving optimal oral health and its relation to achieving optimal general health.
2. Establishing and maintaining authority in matters relating to their professed areas of expertise. Therefore, in matters of oral health, it is dentistry’s expert judgments that count. Additionally, since the profession of dentistry determines who is a dentist and who is not, dentistry is also largely self-governing and self-regulating.
Dentistry’s professional authority, and the degree of influence that accompanies it, are only granted by society on 2 conditions:
1. that the dental profession and its members can be trusted to practice within their areas of expertise and, furthermore, exercise their social authority primarily for the persons they serve, which include their own patients and society in general
2. that the dental profession and its members can be trusted to act within a set of norms that are the product of an ongoing dialogue between the larger professional community and the larger society.
Ethical Obligations: Have Dental Associations Lost Their Way?
Most dental associations were founded to continuously extend and perfect the means of providing specific parameters of oral health care as the relevant scientific knowledge grew and new therapeutic technologies were developed. But have dental associations lost sight of the bigger picture? Throughout its history, the dental profession’s ethical commitments to the larger society have largely been focused on shaping the practice of individual dentists at chairside. Therefore, most organizational attention to the profession’s ethical responsibilities has made the individual dentist its primary focus. Because of this, transferring these individual practitioner commitments into the ethical norms guiding the conduct of dental organizations themselves has not received much attention.
What does it mean to say an organization has ethical responsibilities? Also, does the fact that an organization is a professional organization tell us something about these responsibilities? Some people may think—and some organizations may act—as if organizations don’t have ethical obligations and that only individual members are required to honor them. However, a strong argument can be made stating that that organizations also have ethical obligations. This is because organizations are capable of evaluating possible actions and then choosing an action and carrying it out. These are the same characteristics we look for when we claim that an individual has ethical obligations. In other words, without exception, every dental professional organization has ethical obligations that have been enforced by society and responsibilities that have been assumed by the profession. But, since our culture places much emphasis on individual liberty, this may be easily overlooked.
The most obvious organizational obligation is that, like the individual members of the dental profession, dentistry’s professional organizations must act primarily in the best interests of the dentists’ individual patients and also, when it comes to public health, the whole of society—especially in regard to oral and general health. Therefore, it is the first responsibility of every dental professional organization to give priority to patients’ and the public’s health over services to the members of the organization and the organization’s own interests (eg, internal efficiency of the organization, growth of its membership, getting good press, etc). This is precisely what differentiates a professional community and its organizations from trade associations, commercial organizations, and the uncountable mix of other kinds of communities that form our society. Trade associations are characterized as communities that put the interests of their members as their highest priorities; commercial organizations are built to prioritize their specific missions, including the earning power and other interests of their owners, over everything else.
The Primary Mission of Dental Associations
The primary mission of dental professional associations should be to serve patients’ and the public’s oral and general health and the dental profession’s other central practice valuesF-1 in many ways. These include advancing dentistry’s expertise, certifying the therapeutic value of new technologies and therapies, educating future and practicing dentists, educating the public, assisting dentists in the education of their individual patients, supporting and overseeing dentists’ efforts to conduct themselves in accord with the ethics of the profession, supporting and furthering dentists in their own efforts at nurturing mutual support and continuing education, and regularly assessing the organization’s own actions so it always has patients’ and the public’s oral and general health as its principal goal.
Most dental practices are also businesses; bottom line considerations are, therefore, frequent components of organizational decisions, even when relevant patient interests are given top priority.F-2 Much of the assistance that various dental organizations currently offer dentists, unfortunately, explicitly focuses only on the commercial success of dental practices, as if dentistry was first and foremost a business—not a profession at all—and that the relevant interests of patients, patients’ well-being, and patient satisfaction were only important for the sake of the practices’ financial bottom lines. At a minimum, such efforts communicate the wrong message (a purely commercial message) about dentistry to the public and to any dentist who does not pause to challenge it. Dentists who use such advice in how they run their practices also risk giving the public the wrong message themselves—that dentistry is no longer a profession and that this dentist, and possibly all dentists, generally have only their own interests, not their patients’, as their top priority.F-3
Commercially Focused, “Blended,” and Commercially Affiliated Dental Organizations
Some dental organizations, of course, are intentionally commercial organizations to begin with. As commercial organizations, their top priority is the commercial success of their owners. They sell products and services of interest to dentists, hence the word “dental” in their names; they are only indirectly, if at all, concerned with dentistry’s commitment as a profession to give priority to the relevant interests of patients.
A subtler issue concerns what might be called “blended” dental organizations. These professional organizations arise particularly in the development of new therapeutic technologies when there is a special need to assist dentists in understanding and properly using these technologies. In order to stay abreast of relevant technological developments, these organizations may invite (or at least permit) non-dentists (usually those who work for or own the commercial organizations engaged in this technological development and clinical research) to become members of said professional organizations.
Another scenario is when a professional organization may develop close affiliation with relevant commercial organizations. The key here, again, is the profession’s commitment to give priority to relevant patients’ interests and relevant aspects of public health. These must clearly remain the guiding principles of the professional organization’s governance and action. Fostering the various commercial interests of those who are not members of the profession must not weaken the organization’s commitments as a professional organization, and efforts at cooperation/collaboration between the 2 groups within the organization must be carefully managed to avoid sending the public or the dental community any other message.
In Closing
What’s equally important as professional organizations engage more and more in their professional responsibilities to meet, mix, interact, and deliberate with the huge variety of other communities (both professional and non-professional) in society is that professionals must remain humble; the hubris of privilege must be dropped. Dental professionals must listen to the voice of others yet still hold dear to the profession’s obligation to serve people’s oral health and general health, the profession as a profession, and the whole of society.
Footnotes
- On dentistry’s Central Practice Values, see Chapter 5 of Dental Ethics at Chairside by David J. Sokol, David T. Ozar, and Donald E. Patthoff (Georgetown University Press; 2018).
- Giving patients’ interests top priority is a more complex idea than its wording suggests. See Chapters 4 and 5 of Dental Ethics at Chairside on the interests of patients that are relevant in these decisions and Chapter 6 about how to think about obligations and responsibilities when these conflict in a particular decision.
- See Chapters 10 and 13 to 15 of Dental Ethics at Chairside for a discussion of the ethical challenges of running a business while remaining true to the profession’s commitment to give priority to relevant patients’ interests and the companion challenge of making business-appropriate decisions without sending the wrong, excessively commercial message about the practice and dentistry in general to patients and the public.
Dr. Patthoff is a general dentist in Martinsburg, W Va. He was a principal research investigator at the Martinsburg VA dental clinic and is a past president of the West Virginia Dental Association and the American Society for Dental Ethics (ASDE) (formerly the Professional Ethics in Dentistry Network). He co-authors a dental ethics column in AGD’s Impact magazine and is an ethics consultant to the ADA’S Council of Ethics Bylaws and Judicial Affairs. He is also a co-author of Dental Ethics at Chairside and is editor-in-chief of the Journal of Laser Dentistry. Dr. Patthoff chaired the dental sessions of Engineering Conference International’s 3 conferences on light-activated tissue regeneration as well as 2 on photobiomodulation for the Optical Society of America. He is editor-in-chief of the Journal of Laser Dentistry and chairs the ethics committees of the Academy of Laser Dentistry, WVU Medicine Berkeley Medical Center, and the George Washington Institute of Living Ethics. He is also a liaison to the International Dental Ethics and Law Society from the ASDE. He can be reached at donaldpatthoffdds@gmail.com.
Dr. Ozar is emeritus professor of philosophy at Loyola University Chicago, where he taught professional and healthcare ethics from 1972 to 2015. He developed and taught a course in professional ethics in dentistry at Loyola’s School of Dentistry from 1981 until the school closed in 1994 and has lectured and consulted for dozens of dental schools and dental professional societies. He founded the ASDE in 1987 and was its executive director until 2005. He was the founding editor of “Issues in Dental Ethics,” a regular feature of the Journal of the American College of Dentists, and has authored numerous additional articles on dental ethics, professional ethics, ethics education, and contemporary social issues, including more than 30 essays with co-author Dr. Patthoff in Impact. The third edition Dental Ethics at Chairside, was published by Georgetown University Press in spring 2018. He is an Honorary Fellow of the American College of Dentists and the American College of Legal Medicine, and, in his honor, along with the late Thomas Hasegawa, DDS, the ASDE named its annual student dental ethics prize “The Ozar/Hasegawa Ethics Award.” He can be reached at dozar@luc.edu.
Disclosure: The authors report no disclosures.
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