Dentistry Interview Ethical Scenarios - Tips, ​Techniques & Examples

A patient attends the surgery and refuses to have drilling done to remove caries as they strongly believe in a fully conservative approach to treatment. They do not wish to remove any more tooth tissue. What action would you take in this scenario?
 
In this scenario, one must first gain an appreciation of the case at hand. What points are being discussed and what is the ethical aspect here?
 
Thereafter, we move to autonomy. We must ensure patient confidentiality throughout whilst giving them the power to make their own decisions. In this case it is appreciating that the patient has the right to make a ‘no drill’ decision. It is essential at this stage that you explain to the patient what drilling entails and its risks and benefits. Its purpose. As more often then not, patients may make a decision based on misinformation. Thus, it is important to clarify understandings. Ask the patient why they don’t wish to have drilling done, whilst explaining to them why you feel it is beneficial in this clinical case.
 
Next, we move unto beneficence. This is ensuring that we always benefit the patient. This can present in two different lights. It could be educating the patient over the benefits of drilling (conservatively) if needed, in order to access the caries to prevent further problems. Or it could be giving the patient their right to make their own informed decision and maintain tooth structure should they wish to not have drilling done. If the latter is the case, the clinician can focus on more non-invasive treatment options such as oral hygiene advise, fluoride application or even prescription of a high fluoride toothpaste if indicated.
 
Thirdly, we move onto non-maleficence. This is ensuring no harm is done towards the patient. Again, this presents as two sides. If the patient does not remove decay via drilling if needed, the decay may get deeper and close to the pulp resulting in an exposure and apical pathology. This can then cause the symptoms to develop into a throb. On the other hand, forcing the patient to have drilling done could cause psychological and mental trauma.
 
Then we move unto justice. This is the pillar that focusses on ensuring the decisions you make are not causing harmful consequences to the community at large. For example, if the dentist didn’t make it clear why drilling may be needed in certain circumstances, the patient may spread misinformation in the community and this could cause problems.
 
From the above, we can see that addressing ethical scenarios can be complex and there is not one right or wrong answer. It comes with different perspectives. The assessor wants to see that you have been able to grasp the matter at hand and have been able to identify both sides of the argument. Thereafter, all points should be highlighted in a logical and coherent manner.