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    Maybe Not For Me: Ethics in Orthodontics

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    DominikaSkórka
    1) This document discusses ethics in orthodontics, specifically how to effectively communicate a preferred treatment plan to patients and parents while respecting their autonomy. 2) It describes three levels of influence - coercion, manipulation, and persuasion - and says that while coercion and manipulation are unethical, persuasion can guide patients to the optimal treatment in an ethical manner through shared decision making. 3) It emphasizes the importance of fully disclosing risks and alternatives to obtain informed consent or informed refusal, and documenting the discussion thoroughly.

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    Maybe Not For Me: Ethics in Orthodontics

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    DominikaSkórka
    48 views1 page
    1) This document discusses ethics in orthodontics, specifically how to effectively communicate a preferred treatment plan to patients and parents while respecting their autonomy. 2) It describes three levels of influence - coercion, manipulation, and persuasion - and says that while coercion and manipulation are unethical, persuasion can guide patients to the optimal treatment in an ethical manner through shared decision making. 3) It emphasizes the importance of fully disclosing risks and alternatives to obtain informed consent or informed refusal, and documenting the discussion thoroughly.

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    1) This document discusses ethics in orthodontics, specifically how to effectively communicate a preferred treatment plan to patients and parents while respecting their autonomy. 2) It describes three levels of influence - coercion, manipulation, and persuasion - and says that while coercion and manipulation are unethical, persuasion can guide patients to the optimal treatment in an ethical manner through shared decision making. 3) It emphasizes the importance of fully disclosing risks and alternatives to obtain informed consent or informed refusal, and documenting the discussion thoroughly.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    48 views1 page

    Maybe Not For Me: Ethics in Orthodontics

    Uploaded by

    DominikaSkórka
    1) This document discusses ethics in orthodontics, specifically how to effectively communicate a preferred treatment plan to patients and parents while respecting their autonomy. 2) It describes three levels of influence - coercion, manipulation, and persuasion - and says that while coercion and manipulation are unethical, persuasion can guide patients to the optimal treatment in an ethical manner through shared decision making. 3) It emphasizes the importance of fully disclosing risks and alternatives to obtain informed consent or informed refusal, and documenting the discussion thoroughly.

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    of 1

    ETHICS IN ORTHODONTICS

    Maybe not for me


    Peter M. Greco, Associate Editor for Ethics in Orthodontics
    Philadelphia, Pa

    I
    t's a classic borderline extraction case. Young Jimmy's recommend one form of treatment over another based
    profile displays lip incompetence with 5 mm of on the doctor's expertise and experience and the scienti-
    crowding and proclined mandibular incisors. The fic evidence. Persuasion is ethical because it guides the
    gingival thickness appears to be marginally adequate, patient toward the optimal course of therapy. It is a
    but both of Jimmy's parents required gingival grafting form of shared decision making whereby the clinician as-
    in adulthood. There's no doubt that his treatment plan sists the patient by engaging the patient in that which is
    should involve premolar extraction, yet his parents best for them. Persuasion fulfills the clinician's fiduciary
    won't hear of it. You know that otherwise the teeth cannot duty because it respects the disparity of knowledge
    be properly accommodated. After your review of the diag- between the patient and the doctor without taking
    nostic records confirms your clinical impression, you advantage of the patient.2 Advocating mandibular fixed
    again attempt to convey that the clear solution involves appliances rather than aligner therapy to resolve incisor
    tooth removal. Jimmy's parents flatty refuse. “We'll go root proximity is an example.
    elsewhere,” his dad remarks emphatically. “We totally Full disclosure need not list every advantage and
    trust you, but we can't see removing 4 perfect teeth.” So disadvantage of each treatment option, but it must high-
    you concede to a nonextraction plan, review the risks, light the salient points that affect the health of the pa-
    and schedule an appointment to place the brackets. tient.1 Alternative treatment options must include the
    The right to refuse treatment is equally as important risks and benefits as they apply. In Jimmy's case, the sta-
    as the right to consent to treatment. Informed refusal in- bility of his result and his future periodontal health are
    volves the mutual acceptance of a declined treatment equally important considerations to share with his par-
    course after the parent or patient comprehends the re- ents, as well as any other relevant information, such as
    percussions of the decision. The increasing number of profile concerns. Moreover, if the patient declines the
    pediatricians who report patients whose parents refuse primary treatment plan, you should not consider the
    immunization is an example in medicine. This figure decision to be an affront to their trust in you.
    rose from 75% in 2006 to 88% in 2013.1 Documentation of informed refusal should reflect the
    However, if we truly believe a treatment plan is ideal, benefits of your proposed treatment, your description of
    how can we effectively yet ethically communicate its ul- the risks if the patient does not proceed as per your
    timate value? There are 3 potential levels of influence recommendation, as well as the option to forego treat-
    that might affect a parent or patient's decision to accept ment altogether.
    or reject a preferred treatment plan. Coercion uses a We are ultimately responsible for the outcome of the
    threat of harm to emphasize a treatment regimen. Fright- treatment we provide, whether the patient accepts our
    ening the parent of an 8-year-old child by announcing preference or declines the treatment we propose. As an
    that palatal expansion is needed immediately or “many old professor once admonished, “Never forget that or-
    permanent teeth will need to be pulled” is coercive. Coer- thodontics is one specialty where there is retribution.”
    cion is unethical because its impact deprives the family of He elaborated by reminding us that we often see our pa-
    autonomy of choice. In contrast, manipulation is less tients as they age. “Unlike our medical colleagues,” he
    emphatic and involves a veiled deception by omitting said, “our treatment failures do not die as do theirs.
    or twisting pertinent facts. Manipulation promulgates Ours haunt us forever.”
    untruths and, therefore, violates both the ethical princi-
    ples of veracity and autonomy. An attempt to enroll a pa-
    tient in comprehensive orthodontic therapy for the sole REFERENCES
    objective of resolving sleep apnea is an example. Finally, 1. Scibilia JP. Document ‘informed refusal’ just as you would informed
    persuasion is the effort to advocate or emphatically consent. Available at: https://www.aappublications.org/news/
    2018/10/30/law103018. Accessed December 16, 2019.
    Am J Orthod Dentofacial Orthop 2020;157:443 2. Van Norman G. Informed consent: respecting patient autonomy.
    0889-5406/$36.00 Available at: https://www.csahq.org/docs/default-source/news-and-
    Ó 2020 by the American Association of Orthodontists. All rights reserved. events-docs/csa-bulletin-docs/volume-61-number-1/informed_con
    https://doi.org/10.1016/j.ajodo.2020.02.002 sent_61_1.pdf?sfvrsn52. Accessed December 9, 2019.

    443

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