Conflicts and Challenges of Truth-Telling in Dentistry: A Case-Based Ethical Analysis

Objectives: The basis of truth-telling is respecting the autonomy of patients and developing an ability to make informed decisions with valid consent. The purpose of this study was to ethically analyze the conflicts about truth-telling in dentistry. Materials and Methods: This case analysis focused on the issues of truth-telling in medicine and dentistry. The challenges encountered by dentists with respect to ethical issues related to truth-telling were discussed and analyzed by the research team. Results: The literature review showed that the issue of truth-telling in dentistry has been addressed from three aspects: Truth-telling about other dentists’ medical errors, truth-telling about dangerous, refractory, or incurable diseases, and truth-telling to children or incompetent individuals for decision-making. Conclusion: When the duty of the dentist in truth-telling is conflicted with some other moral obligations, the conflict between the prima facie duties arises. The principle-based ethical theories provide a suitable conceptual framework for moral judgement in such conflicts. In cases of conflicts related to truth-telling, a balance should be maintained between principles and rules such as fidelity, respect for autonomy, maintaining trust in dentist-patient relation, and best interest of patients. The decision in truth-telling should be made individually for each patient based on the specific contextual conditions.

A Relational Moral Theory

A Relational Moral Theory provides a new answer to the long-standing question of what all morally right actions might have in common as distinct from wrong ones, by drawing on neglected resources from the Global South and especially the African philosophical tradition. The book points out that the principles of utility and of respect for autonomy, the two rivals that have dominated Western moral theory for about two centuries, share an individualist premise. Once that common assumption is replaced by a relational perspective that has been salient in African ethical thought, a different comprehensive principle focused on harmony or friendliness emerges, one that is shown to correct the blind spots of the Western principles and to have implications for a wide array of applied controversies that an international audience of moral philosophers, professional ethicists, and similar thinkers will find attractive.

Introduction

Chapter 1 explains and motivates the project of advancing an African moral theory, after which it provides an overview of the book. An African moral theory is a basic, comprehensive principle distinguishing right from wrong actions that is informed by mores salient particularly in the sub-Saharan region. It is advanced as a rival to the principles of utility and of respect for autonomy, the primary Western answers to the important question of what all right actions have in common. Part I of the book discusses the meta-ethical issue of how to justify an African moral theory. Part II identifies three major candidates for a moral theory in the African tradition, and argues that one, grounded on communal relationship, is most promising. Part III argues that the relational moral theory does better than the principles of utility and of respect for autonomy at accounting for a wide array of applied controversies.

Decision-making in paediatric palliative care interpreting

The interpreting profession has long used metaphors or rule statements to describe and teach the ways in which practitioners make decisions (Dean & Pollard, 2011, 2018). Interpreting students are also often taught that the context of an encounter will dictate their decision-making by way of statements such as “it depends”. Such pedagogical statements can make talk between a practitioner and a medical professional about the responsibilities of an interpreter during medical encounters difficult. This study is based on the work of Dean and Pollard (2011, 2018) on value-based decision-making and is guided by the four principles of biomedical ethics (respect for autonomy, non-maleficence, beneficence and justice). It has sought to provide evidence of the existence, applicability and usability of these frameworks through a single case study of a real-life appointment in which a parent of a palliative care outpatient and a medical professional communicated during a consultation, aided by a medical interpreter.

‘Can you hear me?’: communication, relationship and ethics in video-based telepsychiatric consultations

Telepsychiatry has long been discussed as a supplement to or substitute for face-to-face therapeutic consultations. The current pandemic crisis has fueled the development in an unprecedented way. More and more psychiatric consultations are now carried out online as video-based consultations. Treatment results appear to be comparable with those of face-to-face care in terms of clinical outcome, acceptance, adherence and patient satisfaction. However, evidence on videoconferencing in a variety of different fields indicates that there are extensive changes in the communication behaviour in online conversations. We hypothesise that this might impact ethically relevant aspects of the therapeutic relationship, which plays a prominent role in psychiatry. In this paper, we review effects of video-based consultations on communication between therapists and patients in psychiatry. Based on a common understanding of video-based consultations as changing the lived experience of communication, we categorise these effects according to sensory, spatial and technical aspects. Departing from a power-based model of therapeutic relationships, we then discuss the ethical significance of this changed communication situation, based on dimensions of respect for autonomy, lucidity, fidelity, justice and humanity. We conclude that there is evidence for ethically relevant changes of the therapeutic relationship in video-based telepsychiatric consultations. These changes need to be more carefully considered in psychiatric practice and future studies.

The Ethics of Uncertainty

The ethics of uncertainty is an approach to ethical decision-making under conditions of uncertainty. Two legal cases involving patients in the minimally conscious state—Robert Wendland, and a U.K. patient known as M—illustrate the difficulty and complexity of making decisions when so much is unknown about the experiences and minds of these patients. The ethics of uncertainty refocuses ethical enquiry concerning patients with disorders of consciousness, placing less emphasis on their contested personhood and more on inductive risk, on respect for autonomy, and on justice, especially epistemic justice, and the duties of privileged epistemic agents like physicians and medical staff. It encourages an expansive All Things Considered approach to ethical decision-making where the goal is not to arrive at clean, consistent, abstract, ideal decisions for an ideal world, but to enable decision makers facing complexity and uncertainty to fulfill their duties as moral and epistemic agents.

Is There a Moral Intention to Reproduce Someone Else?

"Moral intentions could be used as criteria for actions. In medical practice, moral intentions take an interesting form when the problem is related to post-mortem reproduction. This paper will attempt to 1) interpret the problem of intentions from principalist perspective in medical ethics; 2) relate the problem of intentions to post-mortem reproduction; 3) develop an existentialist account for intentions and post-mortem reproduction. Peter Zhu’s case is the latest ethical challenge in post-modern reproduction. Its moral sensitivity is high due to his presume intent to reproduce and the possibility for post-mortem reproduction using donors’ material and a surrogate mother. If we presume that the concept of presume intent lies with the general idea for intentions, we must tackle the problem from the perspective of respect for autonomy. The problem with intentions is that the prospective intentional action to reproduce belongs to one person only. Yet it appears that someone else is going to perform this action and someone else will finish it. Who should we hold responsible for this action: the person who intended to do it or the person who is intending to perform it and finish it? In Peter Zhu’s case, there are participants with different intentions that are with different moral value. The existentialist account of post-mortem reproduction and intending to reproduce will try to present why we should be careful with respect for autonomy. The ethical and existential consequences of such reproduction are that the future child would be brought to a life of suffering and vagueness. "

South African traditional values and beliefs regarding informed consent and limitations of the principle of respect for autonomy in African communities: a cross-cultural qualitative study

Background The Western-European concept of libertarian rights-based autonomy, which advocates respect for individual rights, may conflict with African cultural values and norms. African communitarian ethics focuses on the interests of the collective whole or community, rather than rugged individualism. Hence collective decision-making processes take precedence over individual autonomy or consent. This apparent conflict may impact informed consent practice during biomedical research in African communities and may hinder ethical principlism in African bioethics. This study explored African biomedical researchers' perspectives regarding informed consent and potential limitations to the principle of respect for autonomy in African communities. Methods We conducted a qualitative study based on in-depth interviews with 12 biomedical researchers, five females and seven males aged 34 to 74 years, currently working at an African university. Interviews lasted 35–40 min each and involved semi-structured open-ended interviews, which allowed participants to offer information about their perceptions and feelings regarding respect for autonomy and informed consent as practised in Africa. Empirical data from the interviews were recorded, transcribed, and analysed using thematic content analysis, together with an interrogation of relevant scientific literature about African communitarian ethics, making evaluations and drawing inferences consistent with the empirical bioethics approach. Results Based on these interviews and analysis of relevant literature, we found that informed consent is difficult to apply in an African context because it derives from a Western conception of libertarian rights-based autonomy. Most respondents pointed out that it was challenging to implement informed consent in the African setting. Furthermore, communalism, customary beliefs, spirituality, and relational autonomy are predominant in most African communities, as exemplified by the African moral philosophies of Ubuntu/Botho and Ukama, which emphasize communitarianism over individual rights. We also found that language, education, poverty, and cultural beliefs are barriers to obtaining proper informed consent in African communities. Conclusions We conclude that there are limitations to applying the principle of respect for autonomy and informed consent in African communities, especially in the context of human biomedical research. We recommend using a more relational approach, such as Ross’s prima facie duties, to implement informed consent in African communities.