Teaching residents to act morally in the presence of risk

Health-care professionals often face complex ethical dilemmas in the workplace; some clinicians tackle ethical issues directly while others turn away. Regardless of whether a doctor is involved with private clinical practice, education, research or administration, they are not immune to facing moral dilemmas or experiencing unethical behavior. Moral courage takes into account the principles of ethics and the courage to act accordingly. Courage is not the absence of fear … it is doing what’s right even in the presence of fear.

Educators and scholars have disputed the diverse meaning of moral courage over the centuries. Ancient Greek philosophers Plato and Aristotle repeatedly used this term in reference to character on the battlefield, discussing courage as a trait set aside for situations where individuals feared death. Aristotle specifically discussed moral courage in the context of being able to wage war while being mindful of the possibility of injury or death. To Aristotle, bravery was a virtue that enabled Greek soldiers to respond appropriately to the fear of the battle.

How a doctor responds to ethical dilemmas depends on his or her (a) previous experiences with unethical behavior, (b) individual personality traits, (c) moral values, and (d) knowledge of social justice principles, for which moral courage is needed to confront unethical behaviors. As a result of cost control procedures, inadequate staff levels, shortage of clinicians in some areas delivering patient care, merging of health-care organizations and ineffective leadership, there is an increase of ethical dilemmas in the health-care milieu today and it directly affects all doctors.

The AAO’s Principles of Ethics and Professional Code of Conduct, Section VI, states, “Members may exercise discretion in selecting a patient into their practice, provided they shall not refuse to accept the patient because of the patient’s race, creed, color, sex, national origin, disability, HIV seropositive status or other legally recognized protected class.”

Although dental schools and hospital clinics often accept fee reimbursement from federal funding, most private practitioners do not. It is considered discriminatory for a dental school or hospital faculty to reject a patient based on a disability, even though a “contract” between the clinic and the patient at a screening evaluation might not yet have been established.

It would also be unwise to refuse a patient from your private practice if the reason is based on discrimination, including any of the reasons listed in the AAO’s Principles of Ethics and Professional Code of Conduct.

Even though there is no universally accepted Hippocratic oath for dentists, it should be stressed to our dental students that they must adhere to affirmations such as:

• I may not always do what’s right, but I will always try to do what’s right.
• It is sometimes hard to do the right thing and sometimes hard to know what the right thing is, but once you know what that is, do it!

A temperamental tolerance of courage over timidity is needed when facing risk management issues. The tenets of decision-making are related to ethics and social justice principles, which directly begs the clinician’s ability to serve the (a) individual, and (b) community (educational services, outreach programs, welfare agencies, public service, etc.), are risk management issues (Walzer, 1983). Such concerns are becoming increasingly more critical for the profession as well as society.

According to Wren (1995), “Since the function of leadership is to produce change, setting the direction of that change is fundamental to leadership.” Setting direction and planning are two separated activities — activities that coincide with teaching and which directly relate to teaching our dental students how to ethically and morally cope with adversity and risk.

Note: This article was published in Ortho Tribune U.S. Edition, Vol. 8, No. 1, Spring 2013 issue. A complete list of references is available upon request from the publisher.