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KUDOS FROM THE FRONT
L E T T E R S
LETTERS ADA welcomes letters from readers on topics of current interest in dentistry. The Journal reserves the right to edit all communications and requires that all letters be signed. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated.
J
KUDOS FROM THE FRONT
We would like to commend JADA, and Mr. Craig Palmer in particular, for a nicely written feature article in March JADA on military dentists serving in Afghanistan and Iraq, “Voices From the Front: Dentists Share Their Stories of War.” We appreciate that a dental journal as widely read and respected as JADA would dedicate journal space to honoring those on the front lines. We read with much interest what our comrades had to say. This article helped highlight some of the sacrifices that military dentists make to help serve our great country. As dentists serving in the Army in Iraq, we are well aware of the honor in serving our country abroad, and in taking care of the troops who put their lives on the line every day as they pound the pavement searching for insurgents. This has been an incredible experience, far beyond our imagination, as we committed to the Army during our dental school years, but one for which we are thankful. We also are appreciative of the many dentists in the Reserves and National Guard who have left behind much to join us in this 720
JADA, Vol. 136
duty. As we reach the relative end of our commitment to the Army and begin to contemplate our future civilian dental careers, we encourage any dentist or dental student considering a commitment to the military to speak to those many great dentists who have made a career in the military, as well as to those who have served and decided to get out. This is not for everyone, and it is important to hear the full story. We thank JADA and Mr. Palmer for beginning to tell our stories. So, JADA and Mr. Palmer, thank you. Philip Livingood, D.D.S., M.P.H. U.S. Army Baghdad, Iraq
Timothy J. Houlihan, Jr., D.M.D. U.S. Army Forward Operating Base E, Iraq
Hal Rider, D.D.S. U.S. Army Camp Bucca, Iraq
ETHICAL QUESTIONS
Dr. Kenneth Jones’s response in March JADA’s “Ethical Moment: Extreme Makeovers” seems to embrace the idea that, as long as patients have been informed of all risks, it is ethically permissible to give them anything they desire. This could not be further from accepted ethical practice. The duty to do no harm (nonmaleficence) does not mean that we merely have to fully inform the patient, it specifically demands that when we have determined that the risks and costs of a procedure outweigh the benefits, we have a moral duty to say no. This is not a choice at the dis-
cretion of the dentist. It is a duty, and it is the very thing that makes dentistry a profession and not just a business. Weighing risks, costs and benefits is, admittedly, not a science, and it often involves conflicts between the values of the patient and those of the dentist. Nonetheless, a conscientious estimation of risks, costs and benefits, with the values and preferences of the patient well in mind, is every dentist’s duty. And when he or she has determined that the benefits are outweighed by other factors, he or she should decline to treat. We should be proud that we are part of a profession that still has concerns about the patient’s right to dictate “treatment” that we know or suspect will cause them harm. Larry Jenson, D.D.S., M.A. Secretary-Treasurer American Society for Dental Ethics (formerly PEDNET) San Francisco
Author’s response: Dr Jenson, you and I definitely agree—sometimes we should just say no. However, neither of us has the right to make that statement as a blanket policy for every dentist and every patient. Each case must be considered individually. And, more importantly, to make those decisions while ignoring our patients’ views is the epitome of arrogance. Treatment decisions and communication are two-way streets, and, as I indicated, communication is the key. It is our responsibility not only to communicate with, but also to educate, our patients. (And sometimes we must even communicate with ourselves and be open to their educating us.) Some patients actually may
www.ada.org/goto/jada June 2005 Copyright ©2005 American Dental Association. All rights reserved.
LETTERS ADA welcomes letters from readers on topics of current interest in dentistry. The Journal reserves the right to edit all communications and requires that all letters be signed. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated.
J
KUDOS FROM THE FRONT
We would like to commend JADA, and Mr. Craig Palmer in particular, for a nicely written feature article in March JADA on military dentists serving in Afghanistan and Iraq, “Voices From the Front: Dentists Share Their Stories of War.” We appreciate that a dental journal as widely read and respected as JADA would dedicate journal space to honoring those on the front lines. We read with much interest what our comrades had to say. This article helped highlight some of the sacrifices that military dentists make to help serve our great country. As dentists serving in the Army in Iraq, we are well aware of the honor in serving our country abroad, and in taking care of the troops who put their lives on the line every day as they pound the pavement searching for insurgents. This has been an incredible experience, far beyond our imagination, as we committed to the Army during our dental school years, but one for which we are thankful. We also are appreciative of the many dentists in the Reserves and National Guard who have left behind much to join us in this 720
JADA, Vol. 136
duty. As we reach the relative end of our commitment to the Army and begin to contemplate our future civilian dental careers, we encourage any dentist or dental student considering a commitment to the military to speak to those many great dentists who have made a career in the military, as well as to those who have served and decided to get out. This is not for everyone, and it is important to hear the full story. We thank JADA and Mr. Palmer for beginning to tell our stories. So, JADA and Mr. Palmer, thank you. Philip Livingood, D.D.S., M.P.H. U.S. Army Baghdad, Iraq
Timothy J. Houlihan, Jr., D.M.D. U.S. Army Forward Operating Base E, Iraq
Hal Rider, D.D.S. U.S. Army Camp Bucca, Iraq
ETHICAL QUESTIONS
Dr. Kenneth Jones’s response in March JADA’s “Ethical Moment: Extreme Makeovers” seems to embrace the idea that, as long as patients have been informed of all risks, it is ethically permissible to give them anything they desire. This could not be further from accepted ethical practice. The duty to do no harm (nonmaleficence) does not mean that we merely have to fully inform the patient, it specifically demands that when we have determined that the risks and costs of a procedure outweigh the benefits, we have a moral duty to say no. This is not a choice at the dis-
cretion of the dentist. It is a duty, and it is the very thing that makes dentistry a profession and not just a business. Weighing risks, costs and benefits is, admittedly, not a science, and it often involves conflicts between the values of the patient and those of the dentist. Nonetheless, a conscientious estimation of risks, costs and benefits, with the values and preferences of the patient well in mind, is every dentist’s duty. And when he or she has determined that the benefits are outweighed by other factors, he or she should decline to treat. We should be proud that we are part of a profession that still has concerns about the patient’s right to dictate “treatment” that we know or suspect will cause them harm. Larry Jenson, D.D.S., M.A. Secretary-Treasurer American Society for Dental Ethics (formerly PEDNET) San Francisco
Author’s response: Dr Jenson, you and I definitely agree—sometimes we should just say no. However, neither of us has the right to make that statement as a blanket policy for every dentist and every patient. Each case must be considered individually. And, more importantly, to make those decisions while ignoring our patients’ views is the epitome of arrogance. Treatment decisions and communication are two-way streets, and, as I indicated, communication is the key. It is our responsibility not only to communicate with, but also to educate, our patients. (And sometimes we must even communicate with ourselves and be open to their educating us.) Some patients actually may
www.ada.org/goto/jada June 2005 Copyright ©2005 American Dental Association. All rights reserved.