Ethical issues encountered by dentists in the care of institutionalized elders

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 research in this area. A qualitative interview method was used to investigate the 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 by means of open-ended questions. Thematic analysis identified ethical problems focused on the difficulty of identifying the wishes of patients or predicting the outcome of treatment. The participants reported few difficulties in making clinical decisions in this setting. However, analysis revealed that the ethical perspectives of the dentists varied substantially. Variation was notable particularly in their preference for ideal or practical treatment and in their preference for autonomy of beneficence.