Why dentistry needs its own way of respecting patients

There is no doubt that when we are thinking about the way in which we respect and relate to patients, no medical ethicist would engage in that dialogue without mentioning the principle of autonomy. Patient autonomy is widely regarded as the cornerstone of the clinician–patient relationship; it is through this principle that we claim we respect patients (US Department of Health and Human Sciences, 1979). Although not a commonly used term outside the professional arena, when we refer to autonomy we generally refer to some kind of ability or right of self-determination.

Beyond this basic idea of self-determination or self-management, autonomy can be a difficult concept to grasp. In fact as yet, despite our reliance on autonomy, the clinical professions have yet to settle on a clear definition. Lack of clarity naturally leads to difficulties in accurate and meaningful application in the clinical setting and confusion as to what is required from the clinical professional. Furthermore, this general broad brush approach to understanding the term and applying it in the clinical setting works from a presumption that all clinical situations are broadly the same, and as such should adhere to a broadly similar approach to ethics; the general observance of an ill-defined principle of patient autonomy. In order to give some meaning to this difficult concept in recent times, we have attempted to promote patient autonomy through an improved consent process, which involves greater explanation of procedure and information giving to patients. The general premise being that by giving patient's more information we can enable them to make more autonomous decisions about their care and as a consequence better respect them. I would wish to argue however that this is a far too generalised approach to be meaningful. In dentistry, particularly in primary care, the relationship between clinician and patient is more complicated than a simple permission from patients can account for. As we will see differing contexts and professional roles in primary care dentistry can lead to confusion on the patients' part or worse fail to prioritise matters of great importance to them. This makes our claims to respect patients, particularly through consent, in some cases ethically problematic. It also makes it hard for clinicians to draw accurate and meaningful limits around the duties required of them. It is for this reason that this article would like to argue for the development of new model of patient interaction, one that is specific to dentistry that adequately meets the needs of both patients and dental professionals.