Chapter 06: Ethical Decision Making in Dental Hygiene and Dentistry
Beemsterboer: Ethics and Law in Dental Hygiene, 3rd Edition
MULTIPLE CHOICE
- Which of the following is associated with making a choice rather than resolving a dilemma?
| a. | Careful decision making |
| b. | Issues of right and wrong |
| c. | Weighing options |
| d. | A variety of answers, each of which has an element of rightness |
ANS: B
The dental hygienist is faced with many choices and dilemmas. Some of these choices will be simple issues of right or wrong, whereas others may be ethical dilemmas that require careful decision making. Ethical problems arise when the hygienist is caught between two competing obligations. Professionals face situations that require carefully weighing options. Often no right or wrong answer exists. Instead a variety of answers may be possible, each of which has an element of rightness about it.
DIF: Recall REF: p. 53 OBJ: 1
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
- The two aspects that are involved in ethics are the ability to discern right from wrong and
| a. | complying with laws enacted by the state legislature. |
| b. | complying with rules established by the state board of dentistry. |
| c. | the commitment to act on a decision. |
| d. | maintaining the status quo. |
ANS: C
It is the commitment to act on a decision. Although they may utilize information regarding laws and rules established by state legislatures and boards of dentistry, many ethical decisions are instead made in the context of professional, social, and economic pressures. Often, the decision requires resisting the status quo. According to the text, “courageous professionals are encouraged to persevere in standing up for what is right even when it means they may do so alone.”
DIF: Comprehension REF: p. 53 OBJ: 1
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
- The goal for the curricula established in 1989 by the American Dental Educational Association (ADEA) was to develop a commitment by students to
| a. | moral principles. |
| b. | moral distress. |
| c. | ethical dilemmas. |
| d. | moral dilemmas. |
ANS: A
The guidelines stated that the curriculum should provide opportunities for refining skills of ethical analysis so students are able to apply ethical principles to new and emerging problems in the profession. The goal was to develop a commitment by the students to the moral principles that are the basis for the profession’s contract with society. Moreover, students should be encouraged to develop an attitude that ethical decision making is a process involving lifelong learning and commitment.
DIF: Recall REF: p. 53 OBJ: 1
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
- Ethical decision making is
| a. | inherently understood by children. |
| b. | learned in curriculum in professional school. |
| c. | acquired through continuing education classes following the period of formal education. |
| d. | learned throughout a lifetime. |
ANS: D
Ethical decision making is a process involving lifelong learning and commitment. Childhood experiences, professional curriculum, and continuing education are not sufficient because people and perceptions of society change over time. Additional types of dilemmas and ethical problems can and will arise. Major advances in technology and the changes in delivery and payment systems in dentistry will further alter the scope and depth of ethical challenges facing dental hygienists and dentists.
DIF: Comprehension REF: p. 54 OBJ: 1
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
- The ethical awareness of an individual is called moral
| a. | dilemma. |
| b. | distress. |
| c. | sensitivity. |
| d. | uncertainty. |
| e. | weakness. |
ANS: C
How the dental hygienist responds to ethical issues that arise in practice depends on the ethical awareness of the individual, known as moral sensitivity. A situation can be perceived by one individual as having an ethical component but not by another. Campbell and Rogers categorized moral problems as moral weakness, moral uncertainty, or moral dilemmas.
DIF: Recall REF: p. 54 OBJ: 1
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
- Which of the types of moral problems categorized by Campbell and Rogers exists when obligations or responsibilities are in conflict?
| a. | Moral uncertainty |
| b. | Moral dilemma |
| c. | Moral weakness |
| d. | Moral distress |
ANS: B
A moral dilemma exists when obligations or responsibilities are in conflict. A large portion of the bioethics literature deals with moral dilemmas that often involve matters of life and death. A moral uncertainly is defined as the question of whether a moral obligation exists and its scope. A moral weakness exists when moral responsibilities point in one direction and personal inclinations in another.
DIF: Recall REF: p. 55 OBJ: 1
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
- Each of the following is categorized by Campbell and Rogers as one of the three categories of moral problems EXCEPT one. Which one is the EXCEPTION?
| a. | Moral dilemma |
| b. | Moral distress |
| c. | Moral weakness |
| d. | Moral uncertainty |
ANS: B
Moral distress has been added for situations in which the health care provider is frustrated from feelings of powerlessness when a perceived wrong is occurring but he or she is unable to act. It is the feeling experienced when an individual cannot do what he or she believes ought to be done because of a system issue, resistance of a powerful person, or a restraint in the situation. The use of this term came from the nursing profession to describe situations in which the nurse feels powerless to act ethically.
DIF: Recall REF: p. 55 OBJ: 1
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
- According to Campbell and Rogers, which of the following terms is used to describe a situation where moral responsibilities point in one direction and personal inclination in another?
| a. | Moral distress |
| b. | Moral dilemma |
| c. | Moral weakness |
| d. | Moral uncertainty |
ANS: C
An example would be the dental hygienist who wants to go to lunch early and forgoes providing a patient with needed dental health education. Moral distress is not one of the original categories of moral problems. It occurs when a perceived wrong is occurring, but the health care provider is not able to act. Obligations and responsibilities are in conflict when there is a moral dilemma. Moral uncertainty occurs when there is a question of whether a moral obligation exists and its scope.
DIF: Recall REF: p. 54 OBJ: 1
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
- Each of the following is one of the “four A’s” of The American Association of Critical Care Nurses (AACCN) EXCEPT one. Which one is the EXCEPTION?
| a. | Act |
| b. | Affirm |
| c. | Assess |
| d. | Associate |
| e. | Ask |
ANS: D
The “four A’s” to rise above moral distress are ask, affirm, assess, and act. The goal in this model is to preserve the integrity and authenticity of the health care provider.
DIF: Recall REF: p. 55 OBJ: 1
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
- Which of the following is the first of Dr. John S. Murray’s seven critical checkpoints to use in ethical decision making?
| a. | Ascertain what principles need to be expressed and defended in the situation—focus on one or two of the more critical values. |
| b. | Evaluate the circumstances to establish whether moral courage is needed in the situation. |
| c. | Consider the possible adverse consequences/risks associated with taking action. |
| d. | Determine what moral values and ethical principles are at risk or in question of being compromised. |
ANS: B
The correct order is: (1) Evaluate the circumstances to establish whether moral courage is needed in the situation, (2) Determine what moral values and ethical principles are at risk or in question of being compromised, (3) Ascertain what principles need to be expressed and defended in the situation—focus on one or two of the more critical values, and (4) Consider the possible adverse consequences/risks associated with taking action. The rest of the seven are: (5) Assess whether or not the adversity can be endured—determine what support/resources are available, (6) Avoid stumbling blocks that might restrain moral courage, such as apprehension or other reflection leading to reasoning oneself out of being morally courageous in the situation, and (7) Continue to develop moral courage through education, training, and practice.
DIF: Comprehension REF: p. 55 OBJ: 1
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
- The goal of an ethical decision-making model is to
| a. | provide a cookbook process for determining a solution to a problem. |
| b. | provide a framework for making the best decision in a particular situation. |
| c. | provide a matrix for determining the solution so the provider does not have to think about the situation. |
| d. | make a decision about right and wrong. |
ANS: B
The goal is to provide a framework for making the best decision in a particular situation with which the health care provider is confronted. An ethical decision-making model is a tool to help develop the ability to think through an ethical dilemma and arrive at an ethical decision. A number of models are presented in the ethics literature, all of which are somewhat similar in design and content. Most of these models use principle-based reasoning, an approach derived from the work of philosophers Beauchamp and Childress. An ethical dilemma is not a simple decision of right and wrong.
DIF: Recall REF: p. 56 OBJ: 2
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
- Which of the following is true concerning the ethical decision-making model presented in the chapter?
| a. | It is a four-step approach diagrammed as a square grid. |
| b. | It is a four-step approach diagrammed as a circle. |
| c. | It is a six-step approach diagrammed as a square grid. |
| d. | It is a six-step approach diagrammed as a circle. |
ANS: D
The model provided in the chapter is a six-step approach derived from the decision-making literature as interpreted by Atchison and Beemsterboer and used in the early 1990s with dental and dental hygiene students in a combined ethics course. The model has been diagrammed as a circle to emphasize the use of past information and experiences on current and future decision making.
DIF: Recall REF: p. 56 OBJ: 2
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
- The process of ethical decision making is static, meaning that truth is immutable. Dental hygienists are confronted with many questions to consider, and they must filter out their own values and beliefs to eliminate bias in the decision.
| a. | Both statements are true. |
| b. | Both statements are false. |
| c. | The first statement is true, the second statement is false. |
| d. | The first statement is false, the second statement is true. |
ANS: B
The process of ethical decision making is dynamic, evolving as additional information comes into play. Dental hygienists are confronted with myriad questions to consider, requiring them to factor in the code of ethics and their own values and beliefs before arriving at a decision. The evaluation process involved in an ethical dilemma is not unlike that which occurs when the practitioner is faced with a clinical or scientific problem. Careful attention to and systematic analysis of the evidence, facts, and details will help the health care provider reach an appropriate decision. Applying the decision-making model gives the dental hygienist a tool to use throughout professional life.
DIF: Comprehension REF: p. 57 OBJ: 2
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
- Which of the following is the first step in the ethical decision-making model presented in the text?
| a. | State the options. |
| b. | Identify the ethical dilemma or problem. |
| c. | Apply the ethical principles to the options. |
| d. | Collect information. |
ANS: B
The correct order of the six-step ethical decision-making model presented in the text is: (1) identify the ethical dilemma or problem, (2) collect information, (3) state the options, (4) apply the ethical principles to the options, (5) make the decision, and (6) implement the decision.
DIF: Recall REF: p. 57 OBJ: 3
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
- Which of the following is the most critical step in the ethical decision-making model?
| a. | Apply the ethical principles to the options. |
| b. | State the options. |
| c. | Collect information. |
| d. | Identify the ethical dilemma or problem. |
ANS: D
Identifying the ethical dilemma or problem is the most critical step in the process. Many situations are simply never perceived to be ethical problems or dilemmas. Once the problem has been recognized, the decision maker must clearly and succinctly state the ethical question, considering all pertinent aspects of the problem. If the ethical question does not place principles in conflict, it is a simple matter of right and wrong and no process of ethical decision making is required.
DIF: Recall REF: p. 57 OBJ: 3
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
- Brainstorming to identify as many alternatives or options as possible is part of which of the following steps of the ethical decision-making model?
| a. | Collect information. |
| b. | State the options. |
| c. | Implement the decision. |
| d. | Apply the ethical principles to the options. |
ANS: B
This is the third step and follows identifying the ethical dilemma or problem and collecting information about it. Often the best decision is not the first one that comes to mind. This step forces us to stop and view the situation from all angles to identify what other people might see as alternative answers to the problem.
DIF: Recall REF: p. 57 OBJ: 3
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
- Which of the following steps of the ethical decision-making model is characterized by developing a list of pros and cons?
| a. | Apply the ethical principles to the options. |
| b. | Collect information. |
| c. | State the options. |
| d. | Identify the ethical dilemma or problem. |
ANS: A
Focus on the ethical principles and ethical values and concepts. State how each alternative will affect the ethical principle or rule by developing a list of pros and cons. In the pro column, show alternatives that protect or hold inviolate each principle or value. In the con column, state how an alternative could violate the principle or value. This process will enable you to see which ethical principles are in conflict in this situation.
DIF: Recall REF: p. 57 OBJ: 3
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
- The ethical decision-making process is futile if no action is taken, because no action represents tacit approval of the situation.
| a. | Both the statement and reason are correct and related. |
| b. | Both the statement and reason are correct but NOT related. |
| c. | The statement is correct, but the reason is NOT. |
| d. | The statement is NOT correct, but the reason is correct. |
| e. | NEITHER the statement NOR the reason is correct. |
ANS: A
Many appropriate decisions are never implemented because this step is omitted. Remember that no action represents tacit approval of the situation.
DIF: Recall REF: p. 57 OBJ: 3
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
- According to a 1990 survey of ethical issues in dental hygiene conducted by Gaston and colleagues, each of the following is one of the most frequently encountered practice dilemmas EXCEPT one. Which one is the EXCEPTION?
| a. | Observation of behavior in conflict with standard infection control procedures |
| b. | Nondiagnosis of dental disease |
| c. | Overdelegation of procedures to nonqualified personnel |
| d. | Failure to refer patients to a specialist |
ANS: C
They found that the three most frequently encountered practice dilemmas were observation of behavior in conflict with standard infection control procedures, failure to refer patients to a specialist, and nondiagnosis of dental disease. One of the conclusions drawn from this study was that serious ethical dilemmas are encountered by most dental hygienists, prompting the authors to advocate increased education of hygienists in the recognition and resolution of ethical problems.
DIF: Recall REF: p. 58 OBJ: 4
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
- Dental hygienists usually are employed by a dentist or groups of dentists, which is problematic, because an ethical conflict or dilemma can be intensified when a subordinate observes an unethical action performed by an individual in a position of power.
| a. | Both the statement and reason are correct and related. |
| b. | Both the statement and reason are correct but NOT related. |
| c. | The statement is correct, but the reason is NOT. |
| d. | The statement is NOT correct, but the reason is correct. |
| e. | NEITHER the statement NOR the reason is correct. |
ANS: A
This arrangement can place the hygienist in a difficult situation when inappropriate care or unethical practices are observed, especially when the dentist employer is involved in the action. In these situations, if the dental hygienist advocates the good of the patient, his or her continued employment may be in jeopardy—thus causing moral distress. Conversely, if the dental hygienist remains silent, professionalism is compromised and no one speaks for the interests of the patient.
DIF: Recall REF: p. 58 OBJ: 4
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
- Which of the following steps is being implemented by Joan Lakeside, in the hypothetical case presented in the text, when she checks her oral pathology book and looks at photographs of squamous cell carcinoma?
| a. | Identify the ethical problem. |
| b. | Make the decision. |
| c. | Implement the decision. |
| d. | Collect information. |
ANS: D
Step 2 involves gathering all pertinent information. The decision maker must gather information to make an informed decision. The ethical problem identified in Step 1 is whether or not to call the patient regarding the lesion in his mouth. Step 3 is to list the possible options, and Step 4 is to apply ethical principles to the options.
DIF: Comprehension REF: p. 56 OBJ: 5
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
- Which of the following choices in the hypothetical case presented in the textbook applies the principle of beneficence as well as autonomy?
| a. | Go back to Dr. McVey with the textbook and restate her suspicions in an attempt to convince him to refer the patient for a diagnostic biopsy. |
| b. | Go to another dental practitioner and describe the situation, hoping the other practitioner will intervene. |
| c. | Call the patient directly and advise him to seek another opinion about his lesion. |
| d. | Do nothing and wait until the patient comes in for his next appointment. |
ANS: C
Calling the patient directly applies the principles of autonomy and beneficence. Autonomy is involved because the patient came in for an examination and has a right to know that he may or may not have a disease. Beneficence—doing good for the patient—is applicable because doing nothing could cause the patient great harm if the lesion were found to be cancerous. The first option—talking to Dr. McVey and convincing him to call the patient back in for another examination—applies the principles of nonmaleficence and autonomy. Going to another practitioner would violate confidentiality. The last option—doing nothing and waiting for 6 or 7 months—many involve respecting the autonomy of the dentist.
DIF: Comprehension REF: p. 60 OBJ: 5
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
- Which of the following options was recommended for Joan Lakeside according to the hypothetical case presented in the textbook?
| a. | Showing her oral pathology textbook to Dr. McVey and attempt to convince him to refer the patient. |
| b. | Go to another practitioner herself to try and gather support for her position. |
| c. | Call the patient herself and recommend another opinion. |
| d. | Do nothing and wait for the patient’s next appointment. |
ANS: A
Joan decided to approach Dr. McVey again and try to convince him to call the patient in for another appointment. If she is unsuccessful in convincing her employer, she will call the patient directly.
DIF: Recall REF: p. 60 OBJ: 5
TOP: 7.0 Professional Responsibility | 7.1 Ethical Principles, including informed consent
