Justice in Oral Health Care: Ethical & Educational Perspectives (Marquette Studies in Philosophy)


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Tool Sets Bathroom Accessory Sets. Close to Ceiling Lights Pendant Lights. Body Lotions Face Creams. Tents Accessories Lights Camping Bed. Billiard Fishing Toss Games. Business Writing Skills. Graphic Novels Comic Strips. My Wishlist. Know about stores. Products of this store will be shipped directly from the US to your country. Products of this store will be shipped directly from the UK to your country. Products of this store will be shipped directly from China to your country.

Products of this store will be shipped directly from Japan to your country. Products of this store will be shipped directly from Hong Kong to your country. Jordan Change Country. Shop By Category. My Orders. Track Orders. Change Language. Arabic English. Important Links. Follow Us. It is also a premise that delimits the ideas of social responsibility. It seems to me that a health professional is not only responsible for providing competent and ethical service to members of society who require it and can pay for it, but one who ought to accept social responsibility for public service.

Although social responsibility is not the exclusive domain of health professionals, in many cases what distinguishes a health professional from a trades- person or even other professionals is that the former has a fiduciary duty to the public it serves. However, the view of the health professional is often determined by the political and social systems into which the qualifying professional is placed.

In the practice of health care, therefore, the idea of social responsibility should be dependent on moral concerns that affect the welfare of all people, regardless of economic and social status. A responsible professional is one who is ethical, dependable and reliable in the delivery of service, while keeping up-to-date in the art and science of the profession.

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Although a responsible professional can be called to account for his or her actions, and is culpable, the notion of responsibility stands by itself and should not be dependent upon, or held to, because of fear of punishment, or the expectation of reward. The notion of social responsibility has the same roots. There exists a certain relationship between the idea of a profession and the idea of social responsibility. Professions exist within a social tradition that accepts the purpose of the profession in service to society. In this sense, a member of any profession acts not only in self-interest but also in the interest of the profession and the interest of society.

In the field of health care, the notion of social responsibility ought to penetrate perspectives governed by economic or legal factors. D were an ordinary dental health care professional that owned a private dental practice in a free market economy. D would not be considered an irresponsible person for not giving charity or not providing a service to someone who could not pay.

It would not be unlawful not to do these things. However, would it be socially responsible for a health care professional to provide services only for personal gain and deny services to others that could not pay—especially if Dr. This position is self-serving and is dominant in a free market system where access to goods and services are determined by ability to pay. This example becomes critical in the field of health care, where a patient in a vulnerable situation is highly dependent on the health care provider.

In the dental health care model of service delivery, largely based on fee-for-service, this is problematic. Social and economic standing can become critical factors in making treatment decisions. Within the fee-for-service model of dentistry as it exists in North America dental practitioners are not legally responsible for providing service to those who cannot pay for it. Just as a car dealer is not obliged to sell you a car if you cannot pay for it, a dentist is not liable, or responsible for providing care to those who cannot pay.

This is not within the legal responsibilities of the dentist. Although health care professionals are socially responsible for providing competent and ethical service, the law limits professional responsibility. Social responsibility is not achieved within the present model. Social responsibility exists within a larger professional and societal framework. Various professions are given recognition and freedom to operate as professions within society, and its members reap the related rewards status, income, prestige, etc. However, their services ought not to be exclusive.

What Is Justice?: Crash Course Philosophy #40

This should not be the case in matters of health care. We are unsettled by the idea of a society in which financial gain dictates social worth. A society that lacks the ethic of care and a sense of social responsibility towards the poor, the weak and the disabled is a society that is not as sophisticated as it perhaps could be. Moreover, there is a moral attachment associated with social responsibility, and moral issues affect the welfare of all humans. So, there is something unsettling about a society, which restricts care only to those who can pay.

However, social responsibility is also a matter of being able to choose to do what is good rather than being forced to do what others consider to be good. We are uncomfortable with the idea that moral principles, no matter how righteous they seem, should be imposed. In the field of dental health, practitioners assume the responsibility inherent in their choice of profession.

Social responsibility cannot and should not be imposed—it ought to be embraced. We need to examine why some see the issues as unproblematic that others see as iniquitous. Understanding the different ways social responsibility is constructed provides an insight into what people see as reasonable and justifiable. For instance, the social responsibility to treat dental pain, regardless of compensation, is an ethic that dentists hold sacrosanct. No one should be left in desperate dental pain. This is a widely accepted code among dentists generally and within dentistry in particular.

It provides an agreed upon space for talking and thinking about social responsibility. However, many dentists find it difficult to extend themselves beyond this code. Does this mean that dentists consciously seek to exclude oral health care from those who are vulnerable?

The moral resolve to provide dental care for the vulnerable and less advantaged is influenced by the different ways dentists experience the economic, educational, political and professional realities of the system, and how they position themselves within it.

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We need to understand, therefore, what it is that influences how we experience these realities and how we decide to position ourselves accordingly. There are those who are critical of it, while others present it as an inevitable and necessary part of the dental health care system.


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The critics point to its hegemonic function in dentistry and resist what they consider an unacceptable construction of their professional identity and what it means to be a dentist and a professional within health care. They invoke issues of professionalism and rights to health care to support their position and criticisms. They are critical of the image of dentists as commercial entrepreneur, seen first as business-persons with a primary desire to economic success.

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They express a strong concern about a profession that they feel is absorbed by a corporate mentality, driven by profit. They hold firm to a professional identification more closely related to what they believe health care ought to be— accessible, universal and equitable. They stay that the dental health care system as it is currently structured in North America is seen to give certain segments of the population and unfair advantage in accessing care.

So what are some of the issues at stake? A growing consumerism On one of the information bulletin board at a prominent dental school we noticed an advertisement for a continuing education seminar by Dr. Paddi Lund. Paddi has an amazing story to tell and his philosophy of work will revolutionize the way you envision and operate your dental business. The message to all dentists, new and established alike is that they should all be striving to be like Dr.

They have several practices and they employ associate dentists working for the National Health Service and off they go…they just sit back and watch it role in! Now the dentist I worked for had two associates and he made probably thousand pounds a year. He left at half four and he got in at ten. Now, private dentists make thousand pounds a year. They are the seven series BMW guys and they make huge amounts. Dental marketing experts, for example, use the profit motive to have dentists rethink their professional worth. They capitalize on and perpetuate the pervading business culture and profit orientation, and its growing acceptance within dentistry.

Many of you find it hard to justify raising your fees when it is suggested by me and others. The role that dentists play in our society is very important. Do you want some justification on raising your fees? I think it would be hard to find anyone who thinks basketball is more important to society than dentistry. Again, whether he is working or not.

In fact, he could go to bed at p.

Justice in Oral Health Care : Ethical and Educational Perspectives

How long would it take you to save up for such a car? The average dentist makes less than two tenths of one cent for every dollar he makes. Do you want a little more help in realizing the insignificance of your income? Well think about this: Michael Jordan would have to save per cent of his income for the next years to have a net worth equivalent to that of Bill Gates.

The tacit assurance that dentistry is a business still implies that the prime imperative is to increase profit. Although entrepreneurial thinking is a vital ingredient for the everyday running of a dental clinic, and some of the decisions taken by clinicians are often clearly business oriented, it as been well argued that this does not have to translate into a defining construct of dentistry. An exclusively entrepreneurial approach to health care creates an inherently conflicting situation and a sense of discomfort for health care providers.

It compromises the fiduciary relationship between the provider and patient, and this creates a moral conflict. Social responsibility as a professional construct Those who oppose the business discourse either absolutely or in part tend to invoke the virtues of being a health professional to defend their position. In turn, they use a professionalism discourse to counter the market-driven model of dental health care. They believe that the concepts of social responsibility and professionalism are interdependent. Within this construct, to be regarded a profession dentistry must also accept a strong sense of social responsibility that ensures access to care.

Dentists are seen as having certain standards or principles to uphold, regardless of the economic structures within which the dental health care system is embedded. It is certainly not easy to maintain a balance between desires for professional autonomy and control, social status, and financial success within a framework of social responsibility, particularly under the existing dental health care system, with its business- like organizational and institutional structure where dentists have not been required to integrate social responsibility into who they are.

As a result, interpretations of social responsibility are often shaped by an indispensable priority on professional autonomy and control over how the dental care system should operate within the free market. Regardless, the image of the dentist is a professional imbued with trust, and possessing expert knowledge not available to the laity. Professionals, therefore, are expected to use their knowledge and skill in the interest of the public good, for which they are granted a number of privileges: self-governance, autonomy, self-regulation and the like.

The knowledge professionals acquire through their specialized education and training cannot be seen as proprietary or taken to be exclusive or discriminating in who receives care. However, dentistry, some argue, fights hard to protect its privileges, but fails to uphold its obligation to ensure that all members of society have access to their services. Some see dentistry as a symbol of affluence and of the affluent. The implication is that the elite— that dentists too are seen to have become—shape, reproduce, and perpetuate a particular kind of social inclusion and exclusion around dentistry, defining what it means to be a dentist and to whom their services belong.

Although the dental profession, like most professions, is governed by a code of conduct and ethics within which members can be called upon to account for their decisions and actions, insistence on access to care is not seen an integral part of this. A responsibility for those who cannot afford care is not seen as part of these codes.

Social responsibility as an individual choice construct A well-organized society is one where there is a healthy balance between individual pursuits and working to advance the common good. We are living in time where even professionals are seen as having less commitment to their profession as a whole and more to themselves as benefactors of the profession to which they belong. Some argue, however, that the social net is woefully inadequate and that the dental profession ought to make a contribution to meet the shortfall.

Social responsibility within this construct is vested in the concept of community, not individuals. Those who locate both the dentist and the patient in social communities see a collective responsibility for ensuring access to care and the subject of community is the element of concern, not simply the individual. But the ways large, complex societies are structured tend to create depersonalized tendencies among individuals and communities. This is also a function of the various socializing factors that affect an orientation to social responsibility.

Education plays a significant role in determining what constitutes acceptable professional practice and how dentists ought to interpret professional principles within the context of their communities. What students are taught and how they are taught is inextricably linked to particular orientations to social responsibility. If the delivery of dental care is to balance between the focus on the individual patient in the dental chair and a wider commitment to the oral health of society, then dental education must reflect that.

The currency to graduate in most dental schools is not community service but to do well in a credit-based curriculum with an emphasis on the surgical art and science of dentistry. If students are influenced by an educational milieu that favours technical and clinical competencies over civic duty, then social responsibility will remain peripheral to professional practice.

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Moreover, the types of students who apply and are admitted into dental school also influence and are influenced by a particular discourse. The typical student comes from an upper or upper-middle class background and lives a privileged life; their socio-economic experiences are too far removed from the problems and issues facing disadvantaged segments of the population.

The typical student who enters dental school is seen to be more individualistic and concerned primarily about a career that enables the earning of a good income and the achievement of a lofty social status. There is a connection also between the types of students attracted to dentistry and the way the profession is structured.

Those with a strong orientation to social responsibility tend to choose professions that enable and nurture this ethic. Dentistry however is caught in a self- perpetuating cycle where the prevailing conduct of practice is driven by a corporate ethos and a discourse that attracts individualistic and materialistic oriented students who perpetuate the accompanying norms and standards within a system that is private and situated in the free market. Here, the market plays a fundamental role in how some dentists constitute their professional identity both collectively and individually.

Many have argued it extensively and the literature confirms it—entrepreneurial and marketization forces have given rise to an increasing discomfort about the nature of dentistry as a health profession and about the professional identity and professional development of dentists as health care providers who cater almost exclusively to the more affluent members of society. Within this context the existing dental professional identity is seen by some as problematic.

The problem of access to dental care is said to be obscured by the influences of entrepreneurialism and by liberal individualism—seen by many as central tenets of western capitalist societies. Social Responsibility Reconsidered The problems addressed through theoretical conceptions of justice do not respond well to the discourse that develop and evolve in relation to the micro and macro levels of economic, professional and political influences on health care.

Health policies and practices reflect health care increasingly as a monopolized commodity serviced extensively for profit. Clearly, the moral resolve to provide dental care for the poor, the aged and the disabled is seen to be affected by the different ways dentists experience the economic, professional, educational, and political realities of the system, and how they position themselves within it.

If social responsibility is constructed from within an economical discourse, then the dental health care system will be shaped predominantly by individual and collective concerns over economic priorities. The practical implication is that under the existing dental health care system, with its business-like organizational and institutional structure, financial concerns will influence the policies and decisions on how dental health care is delivered, thus determining who will be able to access care. If it is constructed from within a professional discourse then accessibility will depend on whether notions of professionalism and the related privileges of self-governance include the principled acceptance of a commitment to society to place a high priority on the welfare of all its members and not just those who are socio-economically advantaged.

Correspondingly, if social responsibility is constructed from within an individual choice discourse, then accessibility will depend on the way the system is structured—in the health of individual patients through individual dentists versus the health of communities through a community of practitioners.

Likewise, the politics of dental health care will also influence issues of accessibility. From the perspective of social responsibility as a political and organizational discourse there remain unresolved political differences between what is considered a fair allocation of resources to dental health care in particular, to provide a reasonable compensation to providers and an adequate range of services.

All things considered, therefore, this chapter provides a beginning for examining further how different stakeholders can be more sensitive to the discourses that inform what is aspired to and what is actually practiced. Curriculum focus: traditional dental education confronts the new biology and social responsibility. J Dent Educ. The social responsibility model. Response to the social responsibility model: the convergence of curriculum and health policy. Improving the oral health status of all Americans: roles and responsibilities of academic dental institutions: the report of the ADEA President's Commission.

Department of Health and Human Services, Discursive constructions of social responsibility. Unpublished doctoral dissertation. The University of British Columbia, Routledge, London. Discourses and cultures of teaching. In: Hayes, E. Jossey-Bass, San Francisco. Social conditions as fundamental causes of disease. Journal of Health and Social Behavior ; Extra issue: Oral disorders, systemic health, well-being and quality of life.

A summary of recent research evidence. Health Measurement and Epidemiology Report No. Determinants of dental care. Can J Public Health ; Accessed February 9, World Health Organization. Spring, , pp. Accessed February, 16, National Center for Children in Poverty. Columbia University. Mailman School of Public Health. Accessed on February 22, Income distribution and mortality: cross-sectional ecological study of the Robin-Hood Index in the United States. Brit Med J. Unhealthy societies: the affliction of inequality.

London: Routledge, Tackling inequalities in health: an agenda for action. Kings Fund, London.

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London: Routlage, Health matters: a sociology of illness, prevention and care. Open University Press, Buckingham. Internet Journal of Health Promotion, Interpretive ethnography: Ethnographic practices for the 21st Century. Sage, Thousand Oaks, CA. Pasantia: a process for engaging communities in dialogue.

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Justice in Oral Health Care: Ethical & Educational Perspectives (Marquette Studies in Philosophy) Justice in Oral Health Care: Ethical & Educational Perspectives (Marquette Studies in Philosophy)
Justice in Oral Health Care: Ethical & Educational Perspectives (Marquette Studies in Philosophy) Justice in Oral Health Care: Ethical & Educational Perspectives (Marquette Studies in Philosophy)
Justice in Oral Health Care: Ethical & Educational Perspectives (Marquette Studies in Philosophy) Justice in Oral Health Care: Ethical & Educational Perspectives (Marquette Studies in Philosophy)
Justice in Oral Health Care: Ethical & Educational Perspectives (Marquette Studies in Philosophy) Justice in Oral Health Care: Ethical & Educational Perspectives (Marquette Studies in Philosophy)
Justice in Oral Health Care: Ethical & Educational Perspectives (Marquette Studies in Philosophy) Justice in Oral Health Care: Ethical & Educational Perspectives (Marquette Studies in Philosophy)
Justice in Oral Health Care: Ethical & Educational Perspectives (Marquette Studies in Philosophy) Justice in Oral Health Care: Ethical & Educational Perspectives (Marquette Studies in Philosophy)

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