key: cord-0067320-hpt89ovr
authors: Dillon, Jasjit
title: Utilitarian Versus Deontological Ethics in Medicine and Dentistry
date: 2021-09-05
journal: Oral Surg Oral Med Oral Pathol Oral Radiol
DOI: 10.1016/j.oooo.2021.08.025
sha: 5340ed8f56555a79f48ab787ff87751497ba201b
doc_id: 67320
cord_uid: hpt89ovr

nan

On August 9 th , 2021, Jay Inslee Governor for the state of Washington proclaimed that any health care worker who has not been FULLY vaccinated against COVID-19 will be prohibited from working after October 18 th 2021 1 . This decision was made following considerable discussion with over 60 medical groups including the American Medical Association, the American College of Physicians, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, together with the Society for Maternal-Fetal Medicine.

His announcement has created an uproar in the dental community with the Washington State Dental Association (WSDA) asking for a modification to this rule adding the option to 'vaccinate or test'. This would be in line with the states of California and Oregon allowing those who are not vaccinated to attest to their health and get regular COVID-19 testing. Most private dental offices (irrespective of specialty) are small health care facilities who do not have the same 'luxury' as larger medical centers when there is staff depreciation. A loss of even one or two staff members can tip the balance from success to struggle. As it is, since the pandemic, there has been an extreme labor shortage in all working sectors not just medicine and dentistry.

The President of the WSDA wrote to the Governor in response that ' in failing to consider the differences among different health care settings, this mandate also fails to recognize how COVID-19 transmission varies among different settings. U.S. dentists continue to have a lower infection rate than other health professionals, such as nurses and physicians…. the cumulative infection rate for U.S. dentists is 2.6% 2 ....Comparatively, the cumulative COVID-19 prevalence rate for other U.S. health professionals ranged from 3.3% to 35.3% 3 ' 4 I have read and heard a slew of comments for and against the Governor regarding his decision. Some of them not surprisingly are quite vitriolic. Most of these comments, emails, social media postings, news reports etc. are generalizable to the country and globe. COVID-19 has brought us to our knees in more ways than one. This brings me to the crux of my editorial; What is the role of utilitarian versus deontological ethics in medicine and dentistry as related to COVID-19? The purpose of medical ethics is to deal with moral dilemmas which arise from conflicts in duty and obligation. Modern medical ethics is based on four fundamental principles: autonomy, beneficence, nonmaleficence, and justice. Take the following scenarios I made up with no one individual in mind:

 As a health care worker, do you have the 'RIGHT' to provide patient care and NOT be vaccinated knowing you may place your patient as risk of infection?

 As a patient, do you have the 'RIGHT' to seek care from a health care worker and NOT be vaccinated knowing you may place that worker and their staff at risk of infection?

 Does a patient have the 'RIGHT' to insist their health care worker be vaccinated?

 As a health care worker do we have the 'RIGHT' to refuse (elective) care to someone not vaccinated?

 Is it 'RIGHT' for a patient to seek medical care for COVID-19 after choosing NOT to be vaccinated?

At least 1 if not all the above will bring an immediate visceral response from the vast majority of readers. But which one is 'RIGHT?' Can they all be 'RIGHT?' These arguments have been in place since the beginning of health care. Utilitarianism was developed by Jeremy Bentham (1748-1832). Its concept is that of the greatest amount of GOOD (happiness) to the greatest number of people. Even if the good may be harmful to some, if the overall benefit to the majority is good then utility prevails. We know there are side effects of the COVID -19 vaccines. However, at this stage in the pandemic with millions vaccinated in the US and globally the overall side effects are minimal 5 . The data supports this. So, should the greater GOOD prevail? Utilitarianism will say yes and that it is acceptable to force, cajole, threaten, entice and even pay people to vaccinate?

Deontological ethical theory is also known as Kantism being named after its founder Immanuel Kant (1724-1804). Its premise is that the morality of an action should depend on the nature of the action. It follows universal moral laws 'don't lie, don't steal, don't cheat.' Its basis is on whether the action itself is right or wrong. i.e., harm is unacceptable irrespective of its consequences. Deontological ethics is in keeping with Scripture and natural moral law. To a deontologist, 'RIGHT' takes priority over greater GOOD. Even with demystification using evidence-based medicine, the vaccine remains as daunting and omnipotent as COVID-19 itself. It is now coming up to nearly two years since the start of the pandemic. There are multiple variants each one we are told is more deadly/infectious (pick your adjective) than the last. We

had varying levels of social isolation, masking mandates, the restriction of travel and our liberty with the possibility of more to come as the latest spike takes hold -all in the name of the greater GOOD

Irrespective of which side of the fence you are on; the only winner here is COVID-19 and that's here to stay. History will tell us who was right

COVID-19 among dentists in the United States. A 6-month longitudinal report of accumulative prevalence and incidence

Seroprevalence and Correlates of SARS-CoV-2 Antibodies in Health Care Workers in Chicago

COVID-19 Vaccine Tracker: How Many People Have Been Vaccinated In The