Leadership Ethics Fundamentals David W. Chambers, EdM, MBA, thics is about what is right and 1.1 Legal PhD, FACD good. Only we humans are con - Others decide for you what is legal and Ecerned to live in a world where impose penalties when the rules are Abstract care is taken to bring about the flourish - broken. Dentists do not decide what is Ethics is about studying the right and ing of both ourselves and others, including legal and they accumulate no points the good; morality is about acting as one those we have not met personally. It is for following the law (points are only should. Although there are differences what makes us special. That is why it is subtracted for breaking it). among what is legal, charitable, profes - human nature to strive to live moral lives. Here are some examples of breaking sional, ethical, and moral, these desirable Aside from acting morally because the law. “Upcoding”: submitting an characteristics tend to cluster and are treasured in dentistry. The traditional it is “the right thing to do,” everyone insurance claim for more highly reim - approach to professionalism in dentistry benefits from living in an ethical world. bursed procedures than the ones is based on a theory of biomedical ethics When patients believe that dentists have actually performed; negligent practice advanced 30 years ago. Known as the the patients’ best interests in mind they that results in injury to a patient; or principles approach, general ideals such extend trust to the professional as a failure to report suspected child abuse. as respect for autonomy, nonmaleficence, whole. This increases the likelihood that The “standard of care”—the minimal beneficence, justice, and veracity, are offered as guides. Growth in professional - patients will seek care, makes it possible level of treatment given patients by ism consists in learning to interpret the to provide treatment without having to dentists in a community—is actually a application of these principles as one’s justify every activity, and allows dentists legal construct. It is defined by the jury peers do. Moral behavior is conceived as a to organize professionally to promote in malpractice cases. continuous cycle of sensitivity to situations high standards. Civil disobedience, disregarding the requiring moral response, moral reasoning, It is also known from research in law in order to make a point, is a risky the moral courage to take action when necessary, and integration of habits of corporate America that companies that position for professionals. The high moral behavior into one’s character. This have a reputation for high standards road is to participate in politics, either essay is the first of two papers that provide enjoy greater customer satisfaction, fewer in Political Action Committees or by the backbone for the IDEA Project of the law suits from employees or customers, becoming a political candidate. College—an online, multiformat, interactive more customer and staff loyalty, higher “textbook” of ethics for the profession. profits, and even have employees who 1.2 Charity are physically healthier. Ethics promotes Volunteer and charity work are essentially personal, community, and practice the flip side of legalism. Dentists decide flourishing. what they want to give and there are only points added for participation. 1. Varieties of the Right and the Good No one blames others for not going There is actually a family of behaviors beyond expectations. that address the right and good in related Charity includes mission trips and ways. Ethics is one approach, but so is volunteering at local health fairs. It is behavior that is legal, charitable, profes - unreimbursed and underreimbursed sional, and moral. All are desirable and care (pro bono work), and even general generally cluster together, but there are differences of emphasis. 41 Journal of the American College of Dentists Leadership good citizenship. America is among the should be returned to the referring gen - on everybody else following the rules. most generous nations in the world. The eral dentist upon completion of specialty Morality is about action, not knowledge American Dental Association estimates care. The code also states that a dentist of the rules. Professors of ethics can the value of dental care for which den - who observes gross or continued faulty cheat on their husbands. Dentists who tists are not fully compensated at about care on the part of a colleague is expected are being sued for violating standards of 5% of all dental care. That is an amount to report that fact. Professional codes professional conduct probably know the roughly equal to the total federal and also contain statements about how state practice act better than the most state dental contributions for Medicaid, professionals should treat patients. For morally upright dentist. prisons, uniformed services, Indian example, a compromising condition in In the end, the moral dentist is Health, and others. the patient’s mouth should be explained the one whose actions bring about As a general rule, professionals are to the patient, even when the dentist healthy patients, harmonious practices, both legal and charity minded. But there was responsible for causing the damag - positive communities, and a stronger are a few dangers in this direction. So- ing situation. profession. They are the ones who called “Robin Hood” practices involve Codes of professional conduct were would be most missed, not because of illegal redistributions of the wealth. A historically known as Codes of Profes- what they always said, but because dentist may post-date an insurance claim sional Etiquette because they govern the of what they always did. to make it easier for the patient to get relationships among practitioners. They Moral practitioners behave legally, reimbursement for an otherwise uncov - are developed by professionals and are charitably toward all, professionally, ered procedure. This is illegal, but very for their use. Patients and public entities and act from a firm theoretical ground - charitable. (It also contributes to the are not invited to participate in the ing in an ethical framework. But it is dentist’s financial and reputational bot - creation or updating of professional their life pattern of moral behaviors that tom line, makes the dentist an arbiter of codes, nor are they expected to comment sets them apart as being the ones we worthy causes, and is all accomplished on them. all want more of. with someone else’s money.) 1.4 Ethics 2. Ethical Analysis 1.3 Professionalism In its pure form, ethics is the study of Obviously the task of building a moral Groups from the United States Senate to right and wrong, good and bad. This is community in dentistry is not simple or the local plumbers’ union make rules an academic pursuit, largely confined easy—otherwise it would have been done governing the behavior of their members. to departments of philosophy in univer - by now. Sometimes there is disagree - These rules guide how members are sities. Bioethics or the ethics of dentistry ment over whether a particular action expected to behave toward each other would be properly termed “applied leads to a necessary good; sometimes and toward others. Such “codes of con - ethics.” It is about reflecting on princi - there is disagreement over what to do duct” are often written down, but there ples and learning to give good reasons when something rotten is found. Ethics are always numerous informal rules for behavior. On this view, moral is an art, and a group performing art that can only be learned on the job. philosophers and bioethicists work to at that. Informal rules have the advantage of define what is ethical and practitioners The field that covers dental ethics is making it easy to spot someone who seek to clarity how these principles called bioethics or professional ethics. does not belong. Professional codes are apply in various situations. As a discipline it is barely 30 years old. usually aspirational, meaning that they The goal of bioethics is to offer guidance define a generalized ideal rather than 1.5 Moral Behavior to healthcare practitioners and policy hard-and-fast criterion that cause Moral behavior is patterns of action makers about how to act. The center someone to be sanctioned. that are consistent with the best theories of the approach is something called the For example, the ADA Code of of ethics. It is about individuals and practical ethics syllogism. With roots Professional Conduct (not the ADA particulars. We might ask ourselves: If all the way back to Aristotle, the practi - Principles of Ethics ) states that patients we were on trial, accused of being ethi - cal ethics syllogism works something who have been referred to a specialist cal, would there be enough evidence to like this: get a conviction? Ethics defines the Principle: All ethical healthcare theoretical context; moral behavior is professionals strive to benefit their the evidence. When con artists, cops, patients. 42 and politicians go bad, they are counting 2011 Volume 78, Number 3 Leadership Analysis: In the current situation, are examples. These cases can be tricky, action A would provide a net benefit varying from state to state in the legal to the patient. sense. It is almost never the case, cer - tainly, that patient’s lack of autonomy Moral behavior: If Doctor D is an transfers any authority to the practitioner. ethical healthcare professional, he or Neither should the principle of she will do A in this situation. patient autonomy be misunderstood as Notice in this form of ethical reason - meaning that dentists are ethically ing, there is a major premise or principle bound to do whatever patients request. that encompasses practitioners, patients, Especially, when dentists can see that a and situations generally. But that is patient is requesting something that, in insufficient to guide action in all cases.