Ethics

💡BASIC ETHICAL PRINCIPLES

Principle	Definition	Example in Dentistry
Autonomy	Respecting a competent patient's right to make informed decisions	A patient declines extraction after understanding the risks and alternatives
Beneficence	Acting in the patient's best interests	Recommending effective preventive treatment
Non-maleficence	Avoiding or minimizing harm	Checking medical history and allergies before prescribing
Justice	Fairness in treatment and resource allocation	Providing the same standard of care regardless of wealth
Veracity	Being truthful	Explaining a poor prognosis honestly
Confidentiality	Protecting private patient information	Not discussing a patient's HIV status with other patients
Fidelity	Maintaining professional trust and commitments	Following through on agreed care and referrals
Accountability	Taking responsibility for decisions and actions	Reporting and managing a clinical error honestly
Respect for dignity	Treating each patient with respect and without discrimination	Providing privacy during examination

The four foundational ethical principles are:

Autonomy
Beneficence
Non-maleficence
Justice

Additional concepts:

Informed consent: Voluntary authorization following adequate information and understanding.
Professional integrity: Acting honestly and consistently with professional standards.
Conflict of interest: A secondary interest may improperly influence professional judgment.
Professional boundaries: Maintaining an appropriate clinician–patient relationship.

Informed consent is a voluntary decision made by a patient who has the relevant information and capacity to decide.

Consent is not merely a signature on a form.

Element	Meaning	Example
Capacity	Ability to understand, retain, weigh relevant information and communicate a decision	Assess whether a patient can understand the proposed extraction
Disclosure	Explain the nature of treatment, material risks, benefits and alternatives, including no treatment where appropriate	Discuss extraction, endodontic treatment and observation where clinically appropriate
Understanding	Patient comprehends the information	Ask the patient to explain the options in their own words
Voluntariness	Decision is free from coercion or undue pressure	Patient is not threatened into accepting treatment
Authorization	Patient clearly agrees to the proposed intervention	Verbal consent for an appropriate procedure or documented written consent where indicated

Type	Definition	Example
Express verbal consent	Agreement explicitly given verbally	Patient verbally agrees to a routine examination
Written consent	Agreement documented in writing	Patient signs a consent form for a surgical procedure
Implied consent	Agreement reasonably inferred from the patient's actions	Patient opens their mouth for a routine examination after the procedure is explained
Proxy/substitute consent	An authorized person decides when the patient cannot legally or validly decide for themselves	A legally authorized guardian consents for a child where required

Important points:

Implied consent is not sufficient for every intervention.
Major surgery, significant risks and other procedures may require explicit, documented consent under applicable standards and institutional policy.
A patient with decision-making capacity can withdraw consent at any time.
If consent is withdrawn, stop the intervention when safe to do so, explain the consequences, document the discussion and discuss alternatives.

💡CONFIDENTIALITY: WHEN CAN INFORMATION BE DISCLOSED?

Confidentiality is the duty to protect information obtained through the professional relationship. It applies to oral and written records, photographs, test results and conversations.

Situation	Appropriate Action
Patient asks you to share records with another clinician	Obtain appropriate consent or rely on a valid legal basis for direct care
Family member asks about an adult patient's diagnosis	Do not disclose without consent or another valid justification
Clinical audit or teaching	Use anonymized information wherever possible; follow applicable consent and institutional requirements
Court order or statutory legal duty	Comply with applicable law; clarify scope and seek professional/legal advice if uncertain
Serious risk of harm to the patient or another person	Consider whether disclosure is justified and necessary; seek senior, legal or professional advice where feasible
Suspected child abuse or neglect	Follow safeguarding and reporting duties under applicable local law; do not delay urgent protection
Accidental disclosure or data breach	Contain the breach, report through the appropriate process, document it and follow applicable notification rules

Where disclosure is justified:

Share only the minimum information necessary.
Disclose to the appropriate recipient.
Document the reasoning and action taken.

Confidentiality exceptions vary by jurisdiction and circumstance.

This involves balancing confidentiality, autonomy, prevention of harm and public health duties.

Scenario	Appropriate Ethical Response
Patient tells you they are HIV-positive	Keep the information confidential and provide appropriate care without discrimination
Patient's spouse asks whether the patient has HIV	Do not automatically disclose the diagnosis to the spouse
Patient with HIV is worried about telling their partner	Provide confidential counselling and support voluntary disclosure or appropriate partner-notification services
Patient refuses to inform a partner who may be at serious risk	Assess the specific risk, encourage disclosure, seek senior/public-health and legal advice, and follow applicable law
A law or valid court order requires disclosure	Follow the applicable legal requirement, sharing only the information required
HIV status is relevant to safe dental care	Use the information appropriately for clinical management and standard infection-prevention precautions; do not disclose it unnecessarily

If a patient refuses to disclose HIV status to a sexual partner

Maintain confidentiality while assessing the circumstances.
Counsel the patient about transmission, prevention and the importance of partner testing.
Offer assistance with safe, voluntary disclosure or partner-notification services.
If a partner faces a serious risk and the patient refuses to disclose, seek advice from the appropriate senior clinician, public-health service or legal adviser.
Consider disclosure without consent only where there is a valid legal or ethical justification under the applicable jurisdiction.
If disclosure is justified, disclose only what is necessary to the appropriate person and document the reasons.

Exam point:

HIV-positive status alone does not justify automatically informing a spouse, employer or family member. Voluntary disclosure and counselling are preferred, while specific local laws may apply.

These are general professional principles; check current Pakistani legal requirements for the exact scenario.

💡PATIENTS UNDER 18 YEARS OF AGE

For FCPS scenarios, distinguish consent for treatment, assent, confidentiality and safeguarding.

Situation	General Approach
Child requiring routine dental treatment	Explain the procedure in age-appropriate language and obtain consent from the legally appropriate person as required
Child understands the procedure but is not legally able to provide full consent	Seek the child's assent as well as legally valid consent from the authorized guardian
Minor refuses treatment despite guardian consent	Explore the child's concerns, assess understanding and urgency, and seek senior advice rather than routinely using force
Minor is mature enough to understand a decision	Take their views seriously and assess competence according to the applicable legal framework; do not assume maturity automatically removes legal requirements
Emergency treatment is necessary and a guardian is unavailable	Provide urgently necessary care within the applicable emergency and legal framework, documenting the reasons
Suspected abuse or neglect	Prioritize the child's safety, follow safeguarding and reporting requirements, and disclose only necessary information to the appropriate authority
Minor requests confidentiality	Respect privacy as far as possible, explain the limits of confidentiality and assess whether disclosure is required for safety or by law
Parent requests the child's records	Consider the parent's legal authority, the child's capacity and applicable confidentiality and data-protection rules before disclosing

Key distinctions:

Consent: Legal authorization for the intervention.
Assent: A child's affirmative agreement when they are not legally able to provide full consent.
Best interests: Decisions should prioritize the child's welfare, safety and health.
Safeguarding: Protecting a child from abuse, neglect or serious harm.

Pakistan's current legal and professional requirements should be checked for exact scenarios, especially where a minor is mature, refuses care or requests confidential services.

💡GIFTS FROM PATIENTS

There is no universal monetary threshold that applies to every country, hospital and dental practice. The appropriate response depends on the gift's value, circumstances, local policy and whether it could influence—or appear to influence—professional judgment.

Gift or Situation	Recommended Response	Reason
Small box of chocolates, flowers or a thank-you card	May be acceptable if local policy permits	Often a modest expression of gratitude
Homemade food or a small cultural gift	Consider accepting if appropriate, modest and permitted by policy	Be sensitive to cultural meaning while maintaining boundaries
Gift intended to be shared with the whole team	Often easier to accept if policy permits	Reduces the appearance of personal favouritism
Expensive watch, phone, jewellery or luxury item	Politely decline	High value can compromise or appear to compromise professional independence
Cash or a substantial monetary gift	Generally decline or refer to institutional policy	May resemble a tip, payment for preferential treatment or conflict of interest
Gift offered before treatment in exchange for priority	Decline	Creates a clear risk of unfair treatment and conflict of interest
Repeated gifts from one patient	Discuss and usually decline if excessive or if boundaries are affected	Repeated gifts can create pressure or an expectation of special treatment
Gift that is intimate or overly personal	Decline	Risks crossing professional boundaries
Gift or inheritance mentioned in a will	Seek professional and legal advice; generally avoid personal benefit where a conflict exists	Raises concerns about influence, vulnerability and financial interest
Gift that exceeds hospital or clinic limits	Decline or follow the formal declaration process if applicable	Institutional rules may be stricter than general ethical guidance

💡ETHICAL SCENARIOS: RAPID RECALL

Scenario	Principle
Patient refuses competent, informed treatment	Autonomy
Acting in the patient's best interests	Beneficence
Avoiding preventable harm	Non-maleficence
Fair distribution of resources	Justice
Telling the patient the truth about prognosis	Veracity
Protecting private medical information	Confidentiality
Taking responsibility for a clinical error	Accountability
Child agrees but cannot provide full legal consent	Assent plus legally appropriate consent
Patient's HIV status requested by a relative	Maintain confidentiality unless a valid exception applies
Expensive patient gift	Decline or follow applicable policy
Small token of gratitude	Consider context and clinic policy

💡FINAL FCPS RAPID-RECALL TABLE

Question Clue	Answer
Categories without order	Nominal data
Ordered categories with unequal/unknown intervals	Ordinal data
Equal intervals without true zero	Interval data
Equal intervals with true zero	Ratio data
Long tail to the right	Positive skew
Long tail to the left	Negative skew
Positive skew: typical relationship	Mean > Median > Mode
Negative skew: typical relationship	Mean < Median < Mode
Outlier-sensitive measure of spread	Range and SD
Spread of the middle 50%	IQR
Variability among observations	SD
Precision of an estimated mean	SE
Closeness to the true value	Accuracy
Closeness of repeated measurements to one another	Precision
Measures the intended construct	Validity
Consistent results on repeated measurement	Reliability
Agreement between categorical raters adjusted for chance	Cohen's kappa
Agreement/reliability for quantitative measurements	ICC
Internal consistency of questionnaire items	Cronbach's alpha
Detects most people who have disease	High sensitivity
Correctly identifies people without disease	High specificity
Probability of disease after a positive test	PPV
Probability of no disease after a negative test	NPV
Disease prevalence increases	PPV usually increases; NPV usually decreases
Patient refuses a competent, informed treatment	Respect autonomy
Best interests of the patient	Beneficence
Avoiding preventable harm	Non-maleficence
Fair distribution of resources	Justice
Child agrees but cannot provide full legal consent	Assent plus legally appropriate consent
Patient's HIV status requested by a relative	Maintain confidentiality unless a valid exception applies
Expensive patient gift	Decline or follow applicable policy
Small token of gratitude	Consider context and clinic policy

💡BASIC ETHICAL PRINCIPLES

💡INFORMED CONSENT

Elements of informed consent

Types of consent