Farhan Raza Khan BDS, MSc, MCPS, FCPS
Ethics is a discipline that is concerned with the morality and philosophy of goodness. The roots of ethics are derived from the religious writings. Bioethics is the philosophical study of ethical considerations related to health sciences including, biology, biotechnology, nursing, medicine and dentistry. The contemporary field of bioethics has emerged as a distinct academic discipline in 1960s1.
Dentistry is a dynamic and ever changing discipline. The knowledge base in dentistry is increasing on an enormous pace. Accessibility of information technology, availability of educational resources and introduction of evidence based practice has changed the face of the discipline. In past, too many patients considered dentists as dental mechanics whose business is confined to moving, removing, restoring or replacing teeth2. Although, some phases of dentistry are still mechanically driven and undoubtedly dentists are the individuals with finest digital dexterity but the contemporary dental professional has now evolved into an oral physician, a health advocate, a researcher and an educator. This evolution is mainly attributed to the discovery of association of dental diseases with systemic health.
In order to serve as useful members of society and to serve their role as an expert in the management and prevention dental disorders, the dentists in their formative years should be exposed to the concepts of ethics. An individual can gain cognitive knowledge and can develop motor skills but it’s the inculcation of right attitudes that defines his personality. Although, introduction of dental ethics in the dental curriculum is the need of this hour but just delivery of few lectures won’t make a difference.
Students learn by observation so they need role models in the form of their college teachers who are champion of ethics. Unfortunately, the state of affairs is presently not favorable. Dental teachers do deliver lectures and carry out demonstration in their academic institutions but only a small number actually practice dentistry there. Thus, students have limited opportunity to learn right sets of attitudes such as professionalism, time management, honesty, devotion and respect of patient’s confidentiality etc. from their mentors. This translates into producing dental graduates who are knowledgeable and enthusiastic about improving their skills but are ethically immature and thus likely to fail when encountered with ethical challenges. Additional limitation is the relative lack of formal training in ethics of the teachers themselves. Another dimension is ethical conduct of dental research. There is a tremendous rise in the number of dentist carrying out research. The reason behind this phenomenon may be a requirement fulfillment of an advanced degree, a prerequisite for institutional promotion or for professional recognition. The net result is that there are dentists who are initiating research without receiving its fundamental training. The undergraduate curriculum in Pakistan should make way to accommodate topics such as risk-benefit balance, informed consent process, identification of vulnerable participants, patients right of confidentiality, data safety monitoring, research participant recruitment procedures, conflict of interest etc. These can only happen if there are adequate numbers of faculty who are formally trained in clinical research and actually active in conducting research in their academic institution. The firsthand experience of learning research at undergraduate level will be a milestone in the development of future generation of dentists.
Lastly, it’s the responsibility of the leadership of dental institutions, Pakistan Medical and Dental Council and other stakeholders to mandatorily formulate institutional ethical review committees (ERC) that can oversee the matters related to ethics in research. Absence of an ERC would increase the risk for patients treated and subsequently used as research subjects in such institutions. Similarly, investigators will be vulnerable too as there would be no check points where quality of their protocol and execution of their research activity is monitored. Students will suffer the most; as they would learn the incorrect ethical practices and would likely to continue with those. For example plagiarism, students and residents can easily slip down into the beautiful
bobby trap of plagiarism. Most peer review processes can readily detect the copy paste approach and can result in professional defame of the authors. The due accountability of such incidents requires an ERC to be functional. Needless, to say that primary aim of an ERC is to prevent research misconduct rather than to penalize the persons who indulge in such acts.
The next challenge for the dental curriculum designers in Pakistan is how to inculcate rapidly evolving subjects (such as dental implantology) and accommodate teaching of ethics and training of research in the existing four years’ curriculum. It’s probably a high time for the dental fraternity to upgrade to a five year BDS curriculum where aforementioned subjects can be instilled into the teaching of the next generation of dental care providers.
REFERENCES
- http://www.ich.org/LOB/media/MEDIA482.pdf
- Eliades T. Research Methods in Orthodontics. Springer, Heidelberg, 2013
- Assistant Professor & Director Operative Dentistry Residency Program Aga Khan University, Stadium Road, 74800 Karachi, PAKISTAN
Corresponding author: “Dr Farhan Raza Khan” < farhan.raza@aku.edu >