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One important reason for ensuring that dental students develop good professional practice based in an understanding of ethics and law is that they take very considerable responsibility for the care of patients, much more so than do medical students. The GDC guidance on the Duties of a Dentist states clearly that students must:

  • Be aware of the responsibilities that they will accept when entering the dental profession

  • Meet the standards of competence, care and conduct set by the Council

  • Make the care of patients their first concern3

Medical education has faced the same issues 4 and teachers of ethics and law in British medical schools have developed a consensus document which defines a basic core curriculum in medical ethics and law, outlining the concepts, arguments, skills and attitudes that medical students should understand and know how to apply in practice by the time they qualify. This arose out of an initial conference of teachers in ethics and law in London Medical Schools in September 1996. It was subsequently extended to a national consultation and agreed by teachers throughout the UK in 1997. 5,6

This present paper takes the consensus that has been developed in medicine, and develops it for dentistry, using the core document as a basis. In so doing we recognise that dentistry is a self regulating profession with its own particular moral issues, but they must be understood in the context of the ethical and legal principles which govern all health care. The resulting consensus document for dentistry has been agreed to by teachers of ethics and law in dental schools nationally at a meeting held in January 1998 as part of a project funded by the Kings Fund on Developing a Model for Teaching of Ethics and Law in Dentistry.7 We propose a minimal core programme of work consistent with the stated objective of the General Dental Council. While schools will always remain flexible in developing their own particular course, some organisational principles are also summarised which we believe to be important for the successful implementation of any proposed undergraduate programme.

Ethics and law in the dental curriculum

Within the dental curriculum the teaching of ethics and law is often both eclectic and scarce. If they are lucky, students receive only a few lectures during the entirety of their clinical studies, often just before finals and sometimes accompanied by small group discussions. The tutor might or might not have academic qualifications or other relevant experience in either moral philosophy, moral theology or law. Such teaching was and sometimes still is optional, not formally assessed on a par with other clinical studies, and not necessarily even formally timetabled. As a result, attendance is sometimes poor and audiences self-selected. The impact of such teaching on the rest of the clinical curriculum is likely to be suboptimal. At some schools, however, where teaching has been more extensive and systematic, student feedback is good.

The curriculum proposed here (see Table 1) demands a balanced, sustained, academically rigorous and clinically relevant presentation and assessment of both ethics and law applied to dentistry, and of the relationship and tensions between them. Clinical relevance and the duties and educational needs of students should be stressed. Teaching should reinforce the overall aims of dental education: the creation of good dentists who will enhance and promote the general health and oral health and welfare of the people they serve in ways which fairly and justly respect their dignity, autonomy and rights. A foundation course at the outset of clinical studies provides a firm basis for subsequent development of a modular clinical teaching programme which is problem based and integrated throughout the clinical course. Concepts introduced in the foundation course are then revisited and applied to clinical situations as students gain in experience. These goals will be achieved through:

  • Ensuring that students understand the ethical principles and values which underpin all good clinical practice

  • Enabling students to think critically about ethical issues in healthcare, to reflect upon their own attitudes and beliefs, to understand and appreciate alternative and competing approaches, and to argue and counter-argue in informed discussion and debate

  • Ensuring that students know the main professional obligations of dentists in the United Kingdom as endorsed by the institutions which regulate or influence dental practice — particularly those specified by the General Dental Council

  • Giving students a knowledge and understanding of the legal process and the broad legal obligations of dental practitioners sufficient to enable them to practice dentistry effectively and with minimal risk

  • Enabling students to appreciate that ethical and legal reasoning and critical reflection are natural and integral components in their clinical decision making and practice

  • Enabling students to understand that almost every decision they make in ordinary clinical practice has an ethical and legal content, as well as the more extraordinary situations in dentistry.

Table 1 Table 1
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Core content

There is widespread agreement about the acceptable ethical and legal requirements of good and safe dental practice and little debate about the related understanding, attitudes and skills that this requires. Relevant issues, problems, concepts and arguments are now explored in standard textbooks of medical and dental ethics, in introductions to medical law and in much professional literature. Students must learn sensitively to apply their growing intellectual understanding of the ethical and legal underpinning of good practice in their evolving clinical experience and in their own professional relationships with patients, other health professionals and other members of society. Table 1 on page 218 suggests a core list of topics which should be covered in the undergraduate curriculum in ethics and law applied to dentistry.

The topics outlined here are considered to be the minimal for inclusion for dental students. Other important topics, for example the 'new genetics' issues around reproduction and care of the dying, could be included by individual schools. We acknowledge that there are other aspects of the law which relate to dental practice, such as employment law, health and safety at work, radiology, drug prescribing and forensic dentistry, which might well be taught in other courses, such as in practice management. Furthermore this list refers only to the UK. There are, for example, different institutional and legal frameworks in the Republic of Ireland (eg the Dental Council of Ireland and different health service structures).

The general organisation of clinical teaching in ethics and law

The specification of these core topics is in no way meant to beg questions about how they are introduced, discussed and analysed throughout the curriculum. For example, some teaching programmes will be more directed towards ethical than legal analysis; others more focused on some issues (eg informed consent) than others (resource allocation). Which foci are selected will and should depend in part on the interests of lecturers and their clinical colleagues. In the specification of the 'core' it would be wrong excessively to determine its specific content. For example, no specific texts or readings are recommended, but all the topics specified ought to be addressed.

Success in presenting such a core programme within a general clinical curriculum entails more than getting the content right. There are also organisational prerequisites.

As part of its full integration into the curriculum, teaching in ethics and law should feature in the students' clinical experience, consistently forging links with good clinical practice. Each clinical discipline should address ethical and legal issues of particular relevance to it and its students should be subject to assessment as they would be for any other teaching in that speciality. Students should be encouraged to present problems which they have personally encountered in their course. A variety of teaching methods are consistent with achieving the preceding goals. Ideally, these will entail a mix between large and small groups, exploring issues in a case based fashion. Coverage of core material in ethics and law, however, should not falter in the face of insufficient teaching resources for small groups. Interactive work with large groups can still be effective and should always be considered rather than opting for little or no cover. The key is to make all teaching of whatever sized groups both clinically relevant and pitched to the academic background and ability of the audience taught.

Conclusion

A core curriculum for the teaching of ethics and law related to dentistry has here been outlined which parallels a similar document in medicine. Mechanisms for its successful implementation have been suggested. We believe not only that it will help to create good dentists, but that it will help them to enjoy a more fulfiling practice in a world of diverse values and beliefs. We thus commend this consensus statement to the dental schools for adoption as the basis for their teaching of ethics and law.

Teachers of ethics and law in British and Irish dental schools who have given their agreement to this consensus document: Peter Keeton, Bristol; Richard Caddick, Birmingham: Andrew Collier, Leeds; John Cunningham, Liverpool; Len Doyal, Jenny King; London SBRLSMD, David Gibbons, Malcolm Bishop, London GKT: Richard Ibbetson London, Eastman; Andrew Bridgman, Manchester; Brian Grieveson, Newcastle; Peter Rothwell, Sheffield; Derrick Chisholm, Dundee; Claudia Blakytny, Cardiff; John Kennedy, Belfast; Helen Whelton, Cork and Catherine McNamara, Dublin.