Professor Sees a Need to Straighten Dentistry Ethics

When dentists peer into patients’ mouths, perhaps they also should look into their own souls.

This is the opinion of Dr. Clifton O. Dummett, a professor at the USC dental school, who believes it is time for a “crusade” to renew the importance of ethics--as a part of professional education and as a lifelong guide to professional conduct--in his and other disciplines.

Dummett, who has taught a course on dental ethics for many years, most recently raised the issue in last month’s edition of a professional journal, the Compendium of Continuing Education in Dentistry.

Longtime Concern of Guyana Native

But Dummett’s interest in ethical conduct is a longtime concern, as shown by the list of speeches, papers and commencement addresses on ethics listed in his resume. And in an interview, the 66-year-old native of Guyana said he plans to spend whatever time remains for him banging the drum for this cause.

In his article, Dummett said that a 1983 report from “one of the nation’s smaller states . . . revealed alarming violations of professional ethics and morality.” These violations of professional conduct for one 12-month period included “gross immorality, incompetent dentistry and crimes involving moral turpitude. . . .”

The long list in Dummett’s article included “controlled substance violation, insurance fraud, irregularities in dispensing, prescribing and administering drugs . . . alcoholism and drug abuse” and investigation of unsanitary conditions in a dental office.

Dummett is particularly disturbed by a number of studies that have found that both medical and dental students become more cynical as their education progresses.

Decline Traced in Dental School

One study involving 270 California dental students cited by Dummett in his article found that professional ethics “declined steadily from the first to the fourth year (of dental school.)” By the final year, he added, students had reached a “nadir of ethicality.”

As they progressed through dental school, Dummett wrote, “More students held the view that the average dentist is frequently unprofessional, if not thoroughly unethical.”

The same study also found that students with high college grades and middle-class backgrounds “scored low on ethics, while students with low college grades and poorer, more humble backgrounds tended to score higher.”

Another study, Dummett reported, found that cynicism was rife among medical students who were likely to “doubt the sincerity of persons expressing high-minded ideals and standards.” The skepticism about ideals sprang in part from the fact that medical students heard or saw little during their training that reinforced their own early ideals.

Dummett said there are a variety of reasons for what he perceives to be a drop in ethical standards. These include increased competition among the ever-growing number of dentists, competitive pressure in professional schools, the current commercialization of dentistry and health care that has turned patients into “consumers” of health services and, perhaps most importantly, the emphasis on technical training at the expense of ethical and bioethical instruction.

“I think that part of this (ethical decline) is due to the fact that in dental schools they (students) have come in contact with some-- some-- teachers who are so enthused about what they can do and what they have been able to make--I’m talking about the material rewards of dentistry--that the tendency is to press that more than relationships to patients,” Dummett said.

While ethics is part of the curriculum in all dental schools, Dummett said, the subject is often tucked into courses that cover a multitude of other subjects, or students are taught the subject far too briefly. For instance, at USC dental students take ethics for only one quarter in their four years of schooling. Dummett would like to see the subject taught every year.

Dummett realizes that his stress on ethics as a part of curriculum is not received favorably in some quarters, especially by those who believe that undergraduate education provides enough exposure to ethical considerations.

But, Dummett insisted, “You tend to lose sight of the importance of something unless you can relate it specifically to what you’re doing. As a matter of fact, I’ve heard in my classes and talking with students that you can’t teach students ethics, they’ve got to be born with a sense of ethics. I’ve always said if that’s the case, I would be very, very despondent. . . . We can be taught, we can be trained not to inflict injury on somebody else just to advance our own interests. And this is exactly what ethics and morality and religion are all about.”

Systematic Study

If students get a background in basic ethics, then it may be possible to go on to bioethics, Dummett said. In his paper, Dummett explained that bioethics has been defined as “the systematic study of human conduct in the life sciences and health care, insofar as that conduct is examined in light of moral values and principles.”

Dummett would also like to see more courses on dental history offered. Such classes, he said, would provide a perspective on the profession, including such issues as advertising. There is an “uncanny similarity” between dental advertisements of the turn-of-the-century and today, he wrote. The “unwitting imitations of the past” now published in newspapers, journals and telephone directories include “an accent on cosmetology” and other services that could be labeled deceptive, Dummett contended in his article.

While he isn’t against all advertising, Dummett said it should not be misleading and should conform to educational materials published by groups such as the American Dental Assn.

Dummett said that his career has been spent largely at universities and public institutions--including Meharry Medical College in Nashville, Tenn., where, at age 28, he was the youngest ever dean of a dental school. Such a career probably has given him a different view of dental issues than the typical private practitioner, he said.

But, he added, his convictions have practical applications as well. There is, he explained, a “necessity for the profession to take a good look at these two subjects (ethics and bioethics) and see whether we can’t have a crusade . . . not only because it’s the right thing to do but also from the standpoint of self-protection because the people today are much more involved about their rights. The people are aided and abetted by very erudite social workers and, of course, very sharp lawyers. And between a disgruntled patient and the lawyers a dentist can be in a lot of trouble.”