The mother might want to learn more about oral health in general, which would encourage her to monitor Jason's habits and scrutinize his behavior to the point where she might notice if he had been smoking. If Jason's oral health deteriorated over time, the hygienist might need to make more overt statements to the mother such as, "Jason assured me that he is not using tobacco, but I am concerned about the lesions in his mouth." The hygienist also needs to confide in the presiding dentist. 3. Which of the ethical principles apply to this situation? Explain your response from both the dental hygienist's perspective and the patient's perspective.

The dental hygienist is experiencing an ethical dilemma. On the one hand, the hygienist is obligated by the tenets of the profession to promote public health. Promoting public health entails warning patients of the effects of their lifestyle choices. The hygienist should be concerned not just for Jason's health alone, but also that of the entire community.

Focusing on oral health, the hygienist will want to do everything possible to educate and advise patients. The hygienist cannot assume that patients will have had access to oral health-related information, or will be aware of what impact their lifestyle choices have on their oral health. Patients like Jason might not be aware of how harmful tobacco use is: including non-smoking tobacco. In fact, smoking tobacco receives considerably more press than smokeless tobacco products. Jason might not believe that chewing tobacco is harmful because of the lack of smoke. Principles like community and responsibility guide the hygienist's decisions beyond the basic ethical guidelines of the profession.

The hygienist is also dealing with core ethical values like individual autonomy and freedom. After...

She is obligated to inform, but cannot control his actions. The hygienist is ethically and legally obliged to keep patient confidentiality. Confidentiality is a matter of societal trust: as soon as the confidentiality agreement is broken, patients do not feel safe divulging their secrets. However, beneficence is also a core value of the profession. The hygienist might need to consult with the presiding dentist to encourage direct intervention with Jason, especially if Jason's tobacco use is costing the office money: such is a standard of professional responsibility.
From Jason's perspective, autonomy and confidentiality are the most important concerns. He needs to trust the hygienist. Ethical principles like universality and complementarity ensure that Jason seeks mainly to be treated with respect at all times. Of course, Jason also deserves access to as much information as possible. The principle of veracity applies: Jason needs to trust that what the hygienist tells him is true and substantiated by science. The principle of fairness also applies, because Jason and his mother might both be unaware of the oral health effects of smokeless tobacco. The hygienist cannot assume that all patients have equal access to all information.

The hygienist needs to balance ethical principles like respect for autonomy, confidentiality, veracity, and responsibility. Informing patients of the effects of their lifestyle choices can be accomplished without interfering with their independence, and without compromising confidentiality. Even if Jason is underage, he still has a right to confidentiality. In fact, breaching confidentiality would thoroughly erode his trust in the medical system.