Page 5 - Bulletin Vol 28 No 2 - May - Aug. 2023 FINAL

Message from the Editor

Moral Injury

Moral injury is an increasingly recognized medical condition. Mostly affecting
physicians and nurses, moral injury results when healthcare providers are
caught between the desire to treat and care for patients and the financial
demands of what can be described as the medical industrial complex. Profits
over care often place doctors in difficult positions and too many now struggle
with the morality of their choices when treating patients.
The question arises, has moral injury begun to infect dentists as well? With
the rapid changes taking place in the delivery of dental care in this country;

the rise of DSOs, private equity acquisitions, the decline of the sole proprietor and small partnership, will
dentists soon experience moral injury? Is moral injury even an appropriate description for such a
condition?
According to the Oxford dictionary, there is a distinction between ethical and moral behavior. Ethical
behavior implies conformity with a code of fair and honest behavior, particularly in business or in a
profession, while moral behavior refers to generally accepted standards of goodness and rightness in
character and conduct – especially sexual conduct. Perhaps, moral injury is an inaccurate description, a
more accurate description would be ethical injury. Does this then bring into conflict the ADA’s code of
ethics? Whatever terminology one uses to define the condition, it does describe a dentist in conflict with
our code.

Are some modalities of delivery of dental care too focused on profits and, therefore, put practitioners in
jeopardy? Are dentists working under such arrangements prone to moral/ethical injury? Dentistry has
always been a business. We care for our patients, and ultimately, we treat to earn a living. Who among
us can honestly say he or she became a dentist to cure the world of dental disease. Truly altruistic physi-
cians, called to medicine to help and heal, are most at risk for moral/ethical injury, but what about the
dentist under an unrealistic production quota?
Dentists do need to make a living and production numbers do matter, but if treatment choices are solely
driven by the bottom line, patients and their providers inevitably suffer. Are young dentists, and senior
dentists working in a corporate model already suffering from dental moral/ethical injury? If remaking a
twenty-year old, adequately fitting crown with a small ceramic chip becomes the treatment of choice
over clear areas of caries, dental moral/ethical injury can and does exist.
Over treatment is nothing new. In my 30 years as a dental consultant, I have unfortunately seen
countless instances of aggressive overtreatment. The most severe and repeat offenders are likely not
ADA members, are unlikely to read this, have little concern for our code of ethics, and do not suffer any
of the moral/ethical dilemmas described here.
As ADA members we are held to a higher standard, as we should be. It separates us from nonmembers
and the public is better served by those who adhere to our code of ethics.

Don

Editor-in-Chief

Nassau County Dental Society ⬧ (516) 227-1112 | 5