Ariane Camoin1, Lionel Dany2, Corinne Tardieu3, Michel Ruquet3, Pierre Le Coz4. 1. UMR 7268 ADÉS/Aix Marseille Université - EFS-CNRS, Faculté de Médecine Nord, 51, Boulevard Pierre Dramard, 13916 Marseille Cedex 20, France; Faculté d'Odontologie, Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France. Electronic address: ariane.camoin@gmail.com. 2. UMR 7268 ADÉS/Aix Marseille Université - EFS-CNRS, Faculté de Médecine Nord, 51, Boulevard Pierre Dramard, 13916 Marseille Cedex 20, France; Aix Marseille Univ, LPS, Aix-en-Provence, France; APHM, Timone, Service d'Oncologie Médicale, Marseille, France. 3. UMR 7268 ADÉS/Aix Marseille Université - EFS-CNRS, Faculté de Médecine Nord, 51, Boulevard Pierre Dramard, 13916 Marseille Cedex 20, France; Faculté d'Odontologie, Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France. 4. UMR 7268 ADÉS/Aix Marseille Université - EFS-CNRS, Faculté de Médecine Nord, 51, Boulevard Pierre Dramard, 13916 Marseille Cedex 20, France; Faculté de Médecine, Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France.
Abstract
BACKGROUND: The provision of dental care for children with intellectual disability raises many ethical questions. OBJECTIVE: The aim of this qualitative study was to explore approaches to dental treatment in an anxious child with intellectual disability and the ethical dilemmas that ensue. METHODS: Semi-structured interviews were conducted between February and May 2012. A clinical scenario was used to establish a starting point for a discussion of the clinical approach and lead to an ethical reflection. Four topics were discussed: first contact with the patient, information, attitude towards the patient and outcome from the practitioner's viewpoint. The coding procedure used thematic content analysis. RESULTS: Most practitioners fetched the patient from the waiting room personally, greeted them, gave them special attention, and either began the consultation at once, or used distraction to relax the patient. Verbal language and tell-show-do were most often used to provide information. Anxiety and pain were evaluated using parental assessment and standardized scales. A reassuring attitude was adopted. An ethical dilemma arose if the patient refused care or had to be restrained. Practitioners reported sacrificing ethical values (patient autonomy, beneficence and non-maleficence) when making a clinical decision. CONCLUSIONS: There is a wide range of practices but no consensus. This study shed some light on the different perspectives of dentists, most of whom adopted a utilitarianist viewpoint. In this context, ethical reflection is necessary to avoid a detached attitude or, worse, abuse. Further study would enrich this reflection.
BACKGROUND: The provision of dental care for children with intellectual disability raises many ethical questions. OBJECTIVE: The aim of this qualitative study was to explore approaches to dental treatment in an anxious child with intellectual disability and the ethical dilemmas that ensue. METHODS: Semi-structured interviews were conducted between February and May 2012. A clinical scenario was used to establish a starting point for a discussion of the clinical approach and lead to an ethical reflection. Four topics were discussed: first contact with the patient, information, attitude towards the patient and outcome from the practitioner's viewpoint. The coding procedure used thematic content analysis. RESULTS: Most practitioners fetched the patient from the waiting room personally, greeted them, gave them special attention, and either began the consultation at once, or used distraction to relax the patient. Verbal language and tell-show-do were most often used to provide information. Anxiety and pain were evaluated using parental assessment and standardized scales. A reassuring attitude was adopted. An ethical dilemma arose if the patient refused care or had to be restrained. Practitioners reported sacrificing ethical values (patient autonomy, beneficence and non-maleficence) when making a clinical decision. CONCLUSIONS: There is a wide range of practices but no consensus. This study shed some light on the different perspectives of dentists, most of whom adopted a utilitarianist viewpoint. In this context, ethical reflection is necessary to avoid a detached attitude or, worse, abuse. Further study would enrich this reflection.