What’s Ethical?

by Dr. Nkansah

Strictly speaking, “ethics” is a plural noun that is supposed to relate to moral principles. Try as we might to define ethics and to follow them in our personal and professional behaviours, we sometimes fail. This is because while our professional codes of ethics may be objective, ethics themselves are not. Context shouldn’t affect morals (and by extension ethics), but it does. Take an example that I recently came across of a man who planned to kill his favourite son at the request of a voice. This father was about to carry out this deed when another voice stopped him. Crazy, right? Except that the father and son were Abraham and Isaac, and this biblical story is told as an uplifting one about faith, commitment and righteous fear. What would have happened if J Lo would have recreated her “Booty” video on The Ed Sullivan Show the week before Elvis Presley appeared in 1957? You know, the one where they didn’t show Elvis below the waist for fear of the effect that his pelvis would have on the country. Go ahead and watch both video clips, then try to put them into context with each other. By the way, did you like “Booty”? Your liking it or not may be a question of taste, not of ethics. But maybe you didn’t watch the (whole) thing because you felt that it was violating your principles. We’re back to ethics, but just yours individually, not “ethics” writ large.

At times, I think that ethics in dentistry is an endangered species. After all, as dentists, we can operate in a near-vacuum of ethics by just staying in our offices. This fact is a bit of a buzz-kill in the face of some of our career positives: independence, respect (albeit somewhat Machiavellian), the opportunity for varied personal interactions, and a better-than-average income. Statistically, dentists are part of the “one-percenters” of income earners. I think that’s pretty good, yet for some that doesn’t seem to be enough. With the less-than-healthy combination of high overhead office costs, the stresses associated with small business ownership, Type A personalities, and egos, some of our colleagues engage in behaviours that call their ethics into question. Every other month, Royal College of Dental Surgeons of Ontario sends out summaries of discipline committee hearings. A quick read of the reports from the second half of 2014 tells of false claims to insurers, tax evasion, overcharging for lab fees, excessive treatment fees, and treatment beyond the member’s expertise. There was also one case of sexual misconduct. While I know no more than what I read about the cases, they did not appear to be mistakes; they appeared to be choices. However, in each of these cases, the members (your colleagues and mine) fought against the charges, meaning they thought that at some level their actions were justified. That’s interesting (to me).

Interesting because maybe I’m not thinking about this correctly. Again, in each of these cases, the dentists mounted a defense for their behaviours. Dr. Mahzarin Banarji, a psychology professor at Harvard University has briefly discussed the phenomenon of the compromise of ethical standards. According to her and others, the problem may be our limited capacity to deal with all of the information/factors at play in decision-making. Harm may not be the intent, just the result of a decision made from “some information [playing] a disproportionate role in decision making, [our] ability to generalize or overgeneralize, and the commonness of wrongdoing that typifies daily life”.1 Well, that changes the context a bit. The actions may not be right, but they also might not be “bad”. Maybe it’s a function of the modular mind. That is, depending on what part of our brain/mind we are using, we can feel differently about the same thing. After all, the Montagues hated the Capulets but Romeo still fell in love with Juliet.

As dentists, we are given a lot of responsibility. With that responsibility, we look to earn trust at the same time as we earn a living. In our professional lives, we make dozens if not hundreds of decisions every day. None of them should be taken lightly, and given our “neural democracy”, those decisions do not come easily.2 The double-edged sword of our responsibilities is that while they have been given to us, they could also be taken away. To the public and to the government, all dentists are pretty much the same, specialities and subspecialties be damned. In that way, your actions could affect me directly and vice versa. For evidence of that, look no further than the unfortunate situation at Dalhousie University’s dental school. I’ve been questioned about it a lot and I have no connection to any of the people involved. While unquestionably, these not-yet-dentists exercised incredibly poor judgment, they only decided to stop once they got caught. And would the concern be as great if women were the perpetrators? Context and ethics.

Benjamin Franklin said that “an ounce of prevention is worth a pound of cure”. With those words in mind, periodically check your professional conduct. The wind in your ethical sails should come mostly from our society’s and our regulators’ guiding principles. Test your ethical seaworthiness from time to time with your most objective friend. Tell them a professional-decision story, real or imagined, then listen, just listen, to their response. Then evaluate yourself and see how you fared in your test of you. Hopefully, it will have been an affirming exercise. If not, correct your course and head for smoother waters. Boating analogies aside, what you do matters to me. Really.OH

Dr. Nkansah is a specialist in Dental Anaesthesia with a private practice in Toronto. He is a member of the editorial board of Oral Health and is an Assistant Professor with the University of Toronto, Western University and Sunnybrook Health Sciences Centre.

Banaji, M. Our Bounded Rationality. In: Brockman, J (editor). This Explains Everything. New York: Harper Perennial; 2013. p. 94-95.

Eagleman, DM. Overlapping Solutions. In: Brockman, J (editor). This Explains Everything. New York: Harper Perennial; 2013. p. 91-93.