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UBC Theses and Dissertations

Ethical issues encountered by dentists in the care of institutionalized elders Bryant, Stephen Ross


Increasing numbers of institutionalized elders have very poor oral health. It has been suggested that ethical problems may influence dentists who attempt to provide oral care for these people, but little attention has been given to formal research in this area. A qualitative interview method was used to investigate the views and experiences of dentists working with institutionalized elders. Particular attention was given to the ethical difficulties encountered and how the dentists resolved them. Ten dentists experienced in long-term care were interviewed individually using openended questions. Verbatim transcripts were prepared from these interviews, and the dentists were interviewed again to validate a summary of their comments. An extensive thematic analysis identified that the dentists struggled primarily with practical rather than ethical problems. The ethical problems focused on the difficulty of identifying the wishes of patients or predicting the outcome of treatment. The participants reported few difficulties making clinical decisions in this setting, and it appeared that each participant had a consistent approach to resolving clinical problems. However, analysis revealed that the ethical perspectives of the dentists varied substantially. Variation was notable particularly in their preference for idealistic or realistic treatment and in their preference for autonomy or beneficence. The participants appeared to believe that the professional training of dentists promotes idealism and autonomy and that this may hinder decisions in a long-term care setting. Overall, this suggests that dentists might be better able to care for institutionalized elders if exposed to broader undergraduate instruction and experience in geriatric care.

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