Dental care is the “product of a dialogue between the dental profession and the larger community”** and is thereby a social enterprise.
“Broad social structures distribute society’s resources and govern their exchange.”** Are these structures ethically sound and just?
The term “social justice” is used here to define the interplay among us, our patients, and these social structures, and is vital to a just distribution of dental care in our society. There are, of course, a number of theories and interpretations of what constitutes a fair and ethical distribution of dental care in our society.
One theory bases its approach to the problem on equality; that is, equal access to care based on need. But what is needed or essential care? Typically, basic needed care is not only that which is needed to end or limit oral pain and restore oral function to properly eat and speak, but also preemptive intervention to prevent the above pain and loss of function through preventive dental care and basic restorative services. This theory contends that need is the criteria for care distribution. With enough resources, society should then provide for those in need. If with those resources society does not distribute care accordingly, it is an unjust system.
A second theory bases its approach on distribution according to an individual’s contribution to society — i.e., what you put in you take out. The problems here are first, how do we measure the value of any single person’s contributions; second, what about those who are unable to contribute — i.e., the young and the disabled; and third, many of our actual contributions may be made by chance or created by elements that are beyond our control and thus not a product of effort or hard work.
A third theory, of course, is the free market theory, based on the principle that distribution of dental services is ethical and just as long as both parties involved have a freedom to choose. We all know, of course, that under this theory many would go without basic dental care because of their limited ability to choose. We also know that forced redistribution of resources from “haves” to “have-nots” may be a violation of freedoms and therefore unjust to some.
Basic dental care is essential to any person’s participation in other areas of human life. The only way for a purely free market system to secure basic dental care for everyone would be for dentists to provide vast amounts of free or underpaid care. However, a dentist’s obligation to sacrifice for his or her patients is limited.
People are, I believe, innately good. They want what is best. I am writing this article on the Fourth of July, this great country’s birthday. I believe a free market system is a part of what has made America great. However, the need for distribution of dental services is simply too large to rely on our people’s goodness. Some system of distributive justice must be sought to address this need without interfering either with dentists’ livelihoods or their professional commitments.
By now we have all been made aware of the proposal to create a “mid-level oral practitioner”. This is Minnesota’s latest effort at distributive justice. Without commenting one way or the other about this proposal, I must say one thing: This is more than an issue of safety, of licensure, of money, or of fairness. This is a moral issue.
As author C. S. Lewis has stated, “moral rules are directions for running the human machine.”*** Morality can be divided into three parts: one, “fair play and harmony between individuals”;*** two, “tidying up or harmonizing the things inside each individual”;*** and three, “the general purpose of human life as a whole, what man was made for.”*** Three parts – the trifecta. Let’s use the analogy of a fleet of sailing ships. Each ship must be seaworthy, its rigging in order, its crew alert. Likewise, each of us must be lifeworthy. Within ourselves we must nurture a respect for ourselves, a respect for others, and a love for our God. An inner motor to help and serve must drive us.
These sailing ships must sail together without colliding with each other. Their crews must communicate with one another so as not to inadvertently rob the others’ wind. Similarly, we in dentistry must work and communicate with one another for the common good and at the same time not steal wind from another’s sails.
Lastly, this fleet must have a common destination. Each ship must be sailing with the same map. Without such, these sailing vessels would no longer be a fleet. They would be asea, floating every which way without a course or a cause. We too must have a common cause, a single destination guided by a moral compass.
Whether this new oral practitioner be mid-level or medieval, its creation must be guided not by the immediacy of politics or money. This issue must be dealt with by something that lasts beyond the next political term or the next financial biennium. It must be dealt with by the moral rules that run the human machine. These rules cannot be changed or amended by the opposing party. They are steadfast. Let them be our Star of the North in guiding us to a better grasp of the issues and a consensus on how to serve all in need.
*Dr. Churchill is Chair of the Minnesota Dental Association’s Committee on Ethics, Bylaws, and Constitution. He is a general dentist in private practice in Minneapolis, Minnesota.
**Quoted from Dental Ethics at Chairside: Professional Principles and Practical Applications by David T. Ozar, Ph.D. and David J. Sokol, D.D.S., J.D., F.A.G.D., Georgetown University Press., Washington, D.C.
*** Quoted from Mere Christianity by C. S. Lewis, HarperSanFrancisco.