As the number of foreign-trained dentists continues to increase in California, the issue of the foreign degree and use of the D.D.S. and D.M.D. degrees in lieu of foreign conferred degrees continues to remain an issue. Why?
Let's look at where our dental society stands at this point in time:
- A dentist must use the specific degree that was conferred by the dental school from which the individual graduated
- The use of D.D.S. or D.M.D. can be used by a foreign trained dentist provided that the translation is literal
- If there is no direct, literal translation of a foreign degree to D.D.S. or D.M.D., then either the specific degree conferred by the dental school must be used by the dentist identifying himself/herself to the public or simply the title "Dentist" or "Doctor"
- The board of dental examiners cannot confer a degree or change a degree; it serves to determine if an individual passes the minimum standard set by the state
So what's the big deal? I only hope that before judgment is passed about this issue that we could examine some of the important principles involved in a logical sequence in offering some clarity, while covering some important points pertaining to dentistry in general.
The health professional, in this case the dentist, has made a commitment to the community at large once the degree is conferred upon the individual. This commitment entails important obligations for each dentist and for the dental profession in general. The basis of these obligations lies in a relationship between the profession as a whole, the individual professional, and the community at large. A very important characteristic feature of a profession is that expertise, which is a matter of great importance to the community. This expertise is exclusive in two ways. It involves both knowledge and experience that is sufficiently esoteric and that extensive education is required as a prerequisite to providing such care. This knowledge can only be gained by training from others that possess this expertise. It is because the community at large not only depends on this expertise, but also values it greatly and that it recognizes the importance of placing dental care decisions to a significant extent into the hands of these experts (initially dental schools). In doing this, the community at large does two things: It grants a great deal of decision-making power over people's well-being, but it also entrusts to them the task of supervising how they themselves use this power.
As health care continues to becoming more politically entwined, an erosion in trust occurs by default. There is a stark difference between the basis of decision-making power entrusted to a profession and the decision-making power granted to the politician. For one, there is little trust given to the politician by the public, and second, it operates on the assumption that the system of checks and balances and other systems of supervision will maintain a close watch on the politician's performance. So why does the community at large trust the members of the dental profession? (Keep in mind that dentistry is still considered one of the top two or three professions in regards to public trust.)
This high level of trust is founded on the premise that each individual professional is committed to using this trust or "power" of trust according to norms mutually acceptable to the community at large. These are norms that the community assumes the professional will use in such a way as to secure the well-being of the people, which they serve rather than placing their own personal well-being ahead of that of their patients. (This is a concept not well understood by many practice/financial consultants). This is also why the dentist has a responsibility to practice competently because something of genuine value for the patient is at stake. "Let the buyer beware" is not considered an adequate accounting of the relationship between dentist and patient even though the FTC would like to think so. Although both the dentist and patient have something at stake in their relationship, it is not based on a competitive spirit. This is opposed to the public's relationship with the town shoe cobbler. The dentist's recommendations are not only considered to be founded on expertise, but are also trusted to be offered principally for the sake of the patient's well-being, rather than principally for the salesperson. This is a noble characteristic of our profession. For this reason, we are obligated to cement that crown or onlay that has not been paid for or complete orthodontic treatment regardless of whether the patient will pay once we have initiated treatment.
When an individual becomes a dentist, then he or she takes on a commitment to act in his/her practice of dentistry. But what determines the content of these obligations? It might appear that the content is determined by the published codes of ethics of the various dental organizations. The fact of the matter is however, that it goes beyond this code. Thus every member of the dental profession has by reason of that membership, an obligation to do what is necessary so that the profession as a whole acts as it ought. Therefore, every dentist bears a share of the character of the dental profession as a whole from within and at some point needs to participate actively in the dialogue with the larger community that shapes the profession from without.
So what role do dental organizations published codes play? These codes should be considered to be first, very important efforts to articulate certain elements of the content of dentists professional obligations. They also represent important teaching documents to assist in the education and formation of all dentists about the obligations of the profession, especially since few dental schools have formal education in ethics. So what about dental practice acts legislated by the various states? Can they be considered authoritative statements about the dentist's professional obligations? Not really, since the contents of the dental practice acts vary greatly from state to state. Besides this fact, these practice acts only define minimum standards and for the most part are procedural in nature. Little substantive guidance about the professional obligations can actually be gleaned from them.
The task of dental organizations such as OCDS parallels the task of the individual dentist who is obligated not to misrepresent dentistry to the larger community. This is another reason the CDA and ADA's Principles of Conduct and Code of Professional Ethics exist. We must remember that the contents of this "Code of Principles" is not intended to be legislative in nature but as previously mentioned runs deeper than this. It represents one of the most important expressions of the dental professions' obligations in the dialogue between dentistry and the public, and also is the most important educational documents for dentists themselves regarding these obligations. In maintaining our humility towards the public we must keep in mind that this code by far is not complete nor is it meant to be, and has been formulated by conscientious, fallible, but committed professionals. As our society and its needs change, we continue to struggle with ethical dilemmas.
Please understand that the ethics committee's hope is to stimulate thought and dialogue on relevant ethical issues as they are presented. Various texts and periodicals are used as references in attempting to convey informed, objective information. As usual, we in the Ethics Committee look forward to any feedback in remaining sensitive to the membership we serve.
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