Is Professionalism a Contact Sport or a Spectator Sport? 11th IDEALS Congress: Chicago David W. Chambers 6 August 2015 dchambers@pacific.edu www.dentalethics.org www.davidwchambers.com/gies-ethics/

Plan for the presentation Traditional model of ethics ACD and the Gies Ethics Project Nine studies of group morality Professionalism as a moral community Four thoughts

The Idealized Model

A More Realistic Model

ADA Membership as a Percentage of Active Dentists

A More Realistic Model

Percent of US Adults 19-64 with Dental Visit in Past Year

The ACD’s Commitment to Ethics One-day, small-group workshops Large-group presentations Three ethics summits; three position papers Partnerships with ADA, ASDE, and SPEA Scholarships for dentists interested in ethics Presentations in dental schools JACD, including “Issues in Dental Ethics” Online ethics CE courses Online digital ethics textbook Fifty-hour, whole-team office ethics audit and training program Eight Cases video project ACD Gies Ethics Project www.dentalethics.org

Dentists and Patients Make a Case for Treating Each Other Well

“Dentist Is Justified in Overlooking Harassment of Employee by Patient As This Is a Private Matter”

What Patients and Dentists See No connection between behavior and justifications Dignity matters to everyone, but dentists are more open to paternalism Dentists organize their relationship on the technical dimension Patients organize their relationship on oral health outcomes Chambers, D. W. Do patients and dentists see ethics the same way? Journal of the American College of Dentists, 2015, 82 (2), 31-47.

Do Dentists Say They Support Ethics?

“Would You Be Interested in This?” Exercise Means and (standard deviations) for difference of interest in reading a positive minus a negative article. Technic Financial Ethical Oral health .833 .325 -.0625 -.708 (1.17) (1.39) (1.44) (1.37)

What Has Changed in the Professions? Slight increase in legal Significant shift toward economic Mass increase in technical definition of professions Declining importance of ethics William M. Sullivan. Work and Integrity: The Crisis and Promise of Professionalism in America.

Ethics Education in the Schools CODA requirements Lecture, seminar format ~ 30 hours Lectures and seminars Dilemmas Ethical reflection on principles

Survey of Dental Ethics Educators Absence of full-time dental ethicists Average part-time commitment ~ 15% Borrowed from other organizations

Survey of Dental Ethics Educators Absence of full-time dental ethicists Personal commitment, passion Self-trained Loosely connected with groups and scholarship

Survey of Dental Ethics Educators Absence of full-time dental ethicists Personal commitment, passion Isolated Operate independent of rest of school, maybe better connected with profession Little evidence regarding impact Deans cannot name their ethicists

Focus Groups - Patients

Some of the Things Patients Say Dentists contradict each other Suspect “I am being sold” Cost is a barrier Technical competence assumed, pain not a concern

Focus Groups - Patients “I mostly try to avoid dentists. They always find something, even when I just went to someone else. I don’t say anything: I just stay away from them.”

Focus Groups - Dentists

Some of the Things Dentists Say Dentist-to-Dentist Issues Diversity of private standards, protective isolation Commercialism is becoming more common that service as a motive Mooching each other patients Claims to be better than colleagues Poor interprofessional communication

Some of the Things Dentists Say Dentist-to-Dentist Issues (each own standard) Dentist-to-patient issues Inconsistent messages to patients Commercial motives Patient as object, potential income Overtreatment, poor quality treatment

Some of the Things Dentists Say Dentist-to-Dentist Issues (each own standard) Dentist-to-Patient Issues (patient as objects) Dentist-to-Organization Issues Dentists acting independently, not cooperatively Outside intrusions – insurance, government Organizations not helping professional dentists Fragmentation of values and standards Loss of membership for various reasons

Focus Groups - Dentists “More and more we are looking to those outside the profession for help to advance our individual interests. The profession as a whole is not providing the leadership and the common core of values that I remember from the past.”