Rights of dental patients in the EU – A legal assessment
A. M. Van den Bossche, P. Ploscar
This contribution presents the legal framework for intra-European mobility of dental patients. After presenting the EU competences in respect of healthcare and a brief look into the various routes of patient mobility, the article sets out the rules for access to dental care, treatment abroad and reimbursement through social security. In addition, we focus on the impact of European Union (EU) law upon national systems in respect of professional insurance, complaints procedures and information mechanisms. In conclusion, we reflect on the development in EU law of an independent set of rights to cross – border dental care and its consequences for financing and reimbursement of care, as well as for national practices in respect of professional liability and insurance
(J Forensic Odontostomatol 2012;30 (sup. 1):4-11)
Personal responsibility in oral health: ethical considerations
A. Albertsen
Personal responsibility is a powerful idea supported by many values central to West European thought. On the conceptual level personal responsibility is a complex notion. It is important to separate the concept of being responsible for a given state of affairs from the concept of holding people responsible by introducing measures that decrease their share of available resources. Introducing personal responsibility in oral health also has limitations of a more practical nature. Knowledge, social status and other diseases affect the degree to which people can be said to be responsible for their poor oral health. These factors affect people’s oral health and their ability to take care of it. Both the conceptual and practical issues at stake are not reasons to abandon the idea of personal responsibility in oral health, but they do affect what the notion means and when it is reasonable to hold people responsible. They also commit people who support the idea of personal responsibility in oral health to supporting the idea of societal responsibility for mitigating the effects of factors that diminish people’s responsibility and increase the available information and knowledge in the population
(J Forensic Odontostomatol 2012;30 (sup. 1):12-20)
L. Mark, N. Adler, H. Blom-Reukers, J. H. Elhorst, A. Kraaijenhagen-Oostinga, J. Vanobbergen
This study evaluates several ethical dilemmas of by dental practitioners treating persons with mental disabilities (PMD) by dentists in the Netherlands and Belgium. Ethical dental care for PMD is a hot topic. Worldwide different treatment strategies are used in the dental treatment of this patient group. In addition, cultural aspect seems to play an important role in the choices made. The latter can explain the difficulty in creating European and worldwide guidelines on this issue. A questionnaire was sent to dental practitioners interested in treating PMD persons both in the Netherlands and in Belgium including questions on the use of behaviour management techniques, use and attitude towards sedation and physical fixation and the cooperation with other health care personal. Behaviour management techniques and sedation are frequently used. Dentist of the Netherlands and Belgium in general reject the restraint of PMD persons. However, limited use of manual restraint in accordance with the carers and the close surrounding of the patient seems to be accepted. Dental practitioners are sometimes confronted with an emotional dilemma in treating PMD and the majority feels that it is a continuous challenge to obtain optimal result of the dental treatment
(J Forensic Odontostomatol 2012;30 (sup. 1):21-28)
Expert witnesses in dentistry:a comparison between Italy and Croatia
E. Nuzzolese, I. Čuković-Bagić
A dentist is frequently required to translate dental trauma into monetary value, for example after car accidents and/or work-related injuries. When called to act in this capacity a dentist should combine his/her biological and technical knowledge with a quality medico-legal knowledge. Calculation of economic (pecuniary) damages and non-economic (non-pecuniary) damages requires specific training in medico-legal matters and awareness of the inherent pitfalls. Expert Witnesses registered in Court are usually asked to perform this duty. Nevertheless, European countries have differences regarding dental damage evaluations as well as significant differences in the conditions required for registration as an Expert Witness in Court. A dental Expert Witness has precise responsibilities and is subject to civil or criminal proceedings (depending on the judicial system) if found wanting. In forensic/legal dentistry a medico-legal doctor should not work in isolation from a dentist in dental cases nor is it wise for a dentist to work in the courts without having had specific training regarding judicial disciplines relating to dental damages. In this preliminary work the authors investigate the principal differences in the judicial systems regarding the appointment of Expert Witnesses in both Italian and Croatian courts. The next step will expand this investigation through to European countries in order to marshal knowledge towards harmonization, best practice and a common ground for dental evaluation and claim compensations (in accordance with the Council of Europe Resolution 75 – 7 Compensation for physical injury or death)
(J Forensic Odontostomatol 2012;30 (sup. 1):29-39)
The dentist’s responsibilities with respect to a nofault motor accident compensation scheme
P. J. Craig, J. G. Clement
The State of Victoria, Australia operates a no-fault accident compensation scheme for the treatment and rehabilitation of those injured on the roads. The administration of the scheme by the Transport Accident Commission includes an in-house clinical panel of clinicians in many disciplines including dentistry who liaise with treating practitioners with the aim of optimizing the outcome for the injured claimants
(J Forensic Odontostomatol 2012;30 (sup. 1):40-46)
Missing people, migrants, identification and human rights
E. Nuzzolese
The increasing volume and complexities of migratory flow has led to a range of problems such as human rights issues, public health, disease and border control, and also the regulatory processes. As result of war or internal conflicts missing person cases and management have to be regarded as a worldwide issue. On the other hand, even in peace, the issue of a missing person is still relevant. In 2007 the Italian Ministry of Interior nominated an extraordinary commissar in order to analyse and assess the total number of unidentified recovered bodies and verify the extent of the phenomena of missing persons, reported as 24,912 people in Italy (updated 31 December 2011). Of these 15,632 persons are of foreigner nationalities and are still missing. The census of the unidentified bodies revealed a total of 832 cases recovered in Italy since the year 1974. These bodies/human remains received a regular autopsy and were buried as ‘corpse without name”. In Italy judicial autopsy is performed to establish cause of death and identity, but odontology and dental radiology is rarely employed in identification cases. Nevertheless, odontologists can substantiate the identification through the ‘biological profile’ providing further information that can narrow the search to a smaller number of missing individuals even when no ante mortem dental data are available. The forensic dental community should put greater emphasis on the role of the forensic odontology as a tool for humanitarian action of unidentified individuals and best practise in human identification
(J Forensic Odontostomatol 2012;30 (sup. 1):47-59)
P. Sahelangi ,M. Novita
Indonesia is the largest archipelago in the world, consisting of five main islands and 17,500 smaller islands, spread across three seismic belts that run throughout the country. Indonesia is extremely prone to disasters, both natural and manmade. With a total population of nearly 250 million people, Indonesia’s Muslim community exceeds 180 million – the largest Muslim population in the world. On December 26, 2004 an earthquake and tsunami hit Aceh resulting in an estimated 165,00 deaths (mostly Muslims) and half a million people displaced. The members of the Disaster Victim Identification (DVI) operations faced unique obstacles. Speed was required because families wished to bury their relatives within 24 hours (before the next prayer time) and the hot tropical climate caused rapid decomposition of bodies. At the same time, survivors needed medical help; there was total destruction of facilities; minimal equipment; ante mortem data destroyed by the flood; and no electricity, transportation, water or food. DVI was of necessity basic so that the team of 33 could process tens of thousands of victims. Lessons were learnt including the need to involve religions leaders immediately; revise the DVI protocols that were designed for manmade (and smaller) mass disasters; provision of individual cameras, laptops and portable x-ray devices; and attention to more efficient use of mass graves
(J Forensic Odontostomatol 2012;30 (sup. 1):60-71)
Professionalism: challenges for dentistry in the future
D.T. Ozar
While countries varies significantly in the financing of dental care, they are much more alike in the delivery of dentistry. Dental care is principally provided in dental offices and clinics that are independent business entities whose business leaders are most often the dentists themselves. However society expects from dentists a level of professionalism (i.e. habitually acting ethically, both in terms of competence and conduct) in contrast to the methods and motivations of the marketplace. This is why the single most important challenge of dental professional ethics continues to be giving proper priority to patients’ well being and building ethically correct decision-making relationships with patients while, at the same time, trying to maintain a successful business operation. If we look into dentistry’s future, the centrality of this aspect of professional ethics is not likely to change, although the ways in which dentists might violate this trust will probably multiple as funding mechanisms become increasingly complex. It is important that dentists reflect with fresh eyes on their ethical commitments. One challenge is the increased availability of oral health information to the public and the fact that so many people are uncritical of the accuracy of information in the media and on the web. A second is the increase in the amount of health care advertising in many societies. A third is the growth of aesthetic dentistry that differs from standard oral health care in important and ethically significant ways. The fourth is insurance that frequently complicates the explanation of a patient’s treatment alternatives and often brings a third party into the treatment decision relationship. The ethical challenges of each of these factors will be considered and ultimately tying it to the central theme of dental professionalism
(J Forensic Odontostomatol 2012;30 (sup. 1):72-84)
Ethics in age estimation of unaccompanied minors
P. W.Thevissen , S.I. Kvaal ,K. Dierickx , G. Willems
Children absconding from countries of conflict and war are often not able to document their age. When an age is given, it is frequently untraceable or poorly documented and therefore questioned by immigration authorities. Consequently many countries perform age estimations on these children. Provision of ethical practice during the age estimation investigation of unaccompanied minors is considered from different angles: (1) The UN convention on children’s rights, formulating specific rights, protection, support, healthcare and education for unaccompanied minors. (2) Since most age estimation investigations are based on medical examination, the four basic principles of biomedical ethics, namely autonomy, beneficence, non-malevolence, justice. (3) The use of medicine for non treatment purposes. (4) How age estimates with highest accuracy in age prediction can be obtained. Ethical practice in age estimation of unaccompanied minors is achieved when different but related aspects are searched, evaluated, weighted in importance and subsequently combined. However this is not always feasible and unanswered questions remain