Law and Ethics
In this essay an event within a dental practice will be critically analysed from a legal and ethical perspective. All information referring to the patient, places and incidents have been kept anonymous and in line with the Data Protection Act (2018).
Scenario
I arrived to work and the dentist I worked with mentioned he was not feeling well, said he could not focus properly due to experiencing sleepless nights but was unable to afford to cancel patients.
Our first patient was a filling on her lower right-hand side. After using local antithetic (LA), I noticed she was numb on the lower left-hand side. She took a seat in the waiting room while she went numb.
I informed the practice manger what had happened, she advised the dentist to seek medical help to make sure this never happened again and sent him home. She called the patient through, explained that the dentist had to leave due to a family emergency, apologised for having been numbed up but not having treatment and reassured her that she will be seen as soon as possible.
I will now discuss the legal and ethical aspects that relate to the scenario.
Law
Law is a system of rules which particular countries or communities recognises as regulating the actions of members and which it may enforce by the imposition of penalties (Oxford Dictionaries | English, 2018). There are different areas of law (Allaboutlaw.co.uk, 2018), the main one that will be looked at is Civil Law.
Civil law is the counterpart to criminal law within English legal system. It relates matters and disputes between individuals (Contactlaw.co.uk, 2018). It covers everything that does not come under criminal law and is broken down into specialist fields (Contactlaw.co.uk, 2018). Under common law, voluntary organisations and individual volunteers have a duty of care to each other and others who may be affected by what they do (Hse.gov.uk, 2018). If something goes wrong, individuals may, sue for damages using the civil law if they’re injured as result of another person’s negligence (Hse.gov.uk, 2018). However, for negligence claim to succeed, the person that was injured must show the defendant had a duty to take reasonable care towards them, and they have suffered the injury through a breach of that duty (Hse.gov.uk, 2018).
If the dentist had not been stopped from doing treatment further he would have been at risk of negligence. This can be linked to Donoghue V Stephenson [1932] which established modern law of negligence, also defined as the “neighbour” principle (Leoisaac.com, 2018). This situation the dentist put his own needs of not wanting to lose money by not working before the safety of patients with care and skills that another dentist would have given.
Duty of care or ‘The professional duty of candour’ the General Dental Council (GDC) states that every healthcare professional must be open and honest with patients when something goes wrong with treatment or care which causes, or has the potential to cause, harm or distress (Gdc-uk.org, 2016). In this case the patient was kept unaware by the dentist and practise manager that he had numbed the wrong side of the mouth and could have potentially filled the incorrect tooth.
Had she been made aware what happened and felt that she wanted things taken further to Civil Court, The Bolam test would have been used to determine if duty of care had been breached. Bolam v Friern Hospital Management Committee (1957) is a case that lays down the typical rule for assessing appropriate standard of reasonable care in negligence cases involving skilled professionals (Timms Solicitors, 2018). Under Bolam, the patient would have to prove medical negligence firstly show that there was duty of care between the doctor and patient, which is usually straightforward, secondly that the act or omission of the doctor breached the duty of care (TheFreeDictionary.com, 2012). The dentist failed the duty of care as the patient was not informed of his mistake.
As a result of the above situation, the patient was unnecessarily given LA which carries risks such as Bells Palsy and nearly given a restoration that was not needed, all due to the dentist prioritising his financial needs over his own and patient’s health. Consequently, duty of care was breached and an injury was caused.
Ethics
Ethics is system of moral principle, they affect how people make decisions and lead their lives (Bbc.co.uk, 2014). It seeks to resolve questions of human morality by defining concepts such as good and evil, right and wrong, virtue and vice, justice and crime (En.wikipedia.org, 2018).
There are four basic principles medical ethics. Each address value that arise within interactions between providers and patients. The principles address issues of fairness, honesty, and respect for fellow human beings (dummies, 2018).
First Autonomy, everyone has the right to control what happens to their bodies. This principle simply means that informed, competent adult patient can refuse or accept treatments, drugs, and surgery according to their wishes (dummies, 2018). People have the right to control what happens to their bodies because they are free and rational. These decisions must be respected by everyone, even if those decisions are not within the best interest of the patient (dummies, 2018). The patient had given permission for LA so controlling what happened however was not informed of the area which needed to be given leaving her unaware that she had been numbed in the wrong area.
Secondly Beneficence, healthcare providers must strive to improve their patient’s health, do the most good for the patient in every situation (dummies, 2018). Nonetheless what is good for one patient may not be good for another, each situation should be considered individually. Other values that might conflict with beneficence may need to be considered (dummies, 2018). If the dentist had been focused on treatment needed to be done and had doubled checked before giving LA this scenario could have been avoided.
Thirdly Non-maleficence, “First, do no harm” is the bedrock of medical ethics (dummies, 2018). Every situation, healthcare providers should avoid causing harm to patients. You should also be aware of the doctrine of double effect, where treatment intended for good unintentionally causes harm. This doctrine helps make difficult decisions about whether actions with double effects can be undertaken (dummies, 2018). The dentist failed to comply with this by giving LA unintentionally on the wrong side.
Finally, Justice this principle demands that you should try to be as fair as possible when offering treatments and allocating scarce medical resources (dummies, 2018). You should be able to justify your actions in every situation (dummies, 2018). The dentist should have been thinking of his patients more when he made the decision to continue working even though he was not at his most competent to be providing the best of care.
Conclusion
Legally the dentist has an obligation to protect and care for patients. By not making the right decision to not attend work until he was medically fit and well he was putting all patients at risk of potential serious harm.
Ethically, the patient was denied Non-maleficence, after being given unnecessary LA on the wrong side of the mouth and denied Justice as she was not informed what had happened to be able to get the apology she deserved or be able to make the decision to take things further if she wished.
The author feels the practice manager made the right choice sending the dentist home and not allowing him to return until he was well enough to provide treatment at a safe level however should have got him to be honest to the patient on what had happened and not helped cover his mistake up.
Reference List:
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