ZusammenfassungZahnärzte werden häufig mit dem Wunsch ihrer Patienten nach ästhetischen oder kosmetischen Behandlungsmaßnahmen konfrontiert. Darüber hinaus sind bereits vielen Therapieformen der Zahnmedizin ästhetische Aspekte immanent. Deren ethische Zulässigkeit im Rahmen professioneller zahnärztlicher Tätigkeit soll untersucht werden. Als ein wesentliches Kriterium, das dem Zahnarzt hilft, eine Entscheidung für oder gegen ästhetisch motivierte Behandlungswünsche zu treffen, wird die Indikation benannt. Bei der Indikation handelt es sich um die fachlich begründete Einschätzung, dass eine Behandlungsmaßnahme geeignet ist, ein angestrebtes Therapieziel zu erreichen. Die Indikation (...) muss empirisch, final und kausal begründet werden. Dazu bedarf es einer zahnärztlichen Befundung, eines zahnmedizinisch relevanten Behandlungsziels und eines ausreichenden Wirksamkeitsnachweises der Therapieform. Zusätzlich müssen individuelle Faktoren beim Patienten geprüft werden, die neben zahnmedizinischen auch allgemeinmedizinische und soziale Aspekte betreffen. Die Indikation weist als handlungsleitendes Werturteil eine Reihe von normativen Implikationen auf. Dazu zählen sozialrechtliche Konsequenzen und Folgen für das Professionsverständnis der Zahnheilkunde. Wenn für eine gewünschte zahnärztliche Maßnahme die Indikation nicht gestellt wird, ist weiter zu prüfen, ob sie im Rahmen der gesetzlich regulierten Professionsgrenzen zulässig ist. Alle Eingriffe, die darüber hinausgehen, liegen außerhalb der zahnärztlichen Profession und werden als bloße kosmetische Dienstleistung erbracht. Dies kann zu einer Erosion der normativen Grundlagen und zu einer Deprofessionalisierung der Zahnheilkunde führen. (shrink)

Personal appearance and physical beauty are becoming increasingly important in our societies and, as a consequence, enter into the realm of medicine and health care. Adequate and just health care policies call for an understanding of this trend. The core question to be addressed concerns the very idea of beauty. In the following, a conceptual clarification is given in terms of beauty's meaning, value and function (i.e. beauty that is used instrumentally, and beauty that is attained). Furthermore, some relevant distinctions (...) are drawn between physical and artistic beauty, and physical beauty in a human sense. The core idea for this is formed by a Kantian notion of the beauty concept. It is argued that beauty judgements should be understood as relative to persons and their contexts. Physical beauty should be taken seriously when it is understood in this deeper sense of being related to the shaping of a person's identity. (shrink)

In order to protect patients against medical paternalism, patients have been granted the right to respect of their autonomy. This right is operationalized first and foremost through the phenomenon of informed consent. If the patient withholds consent, medical treatment, including life-saving treatment, may not be provided. However, there is one proviso: The patient must be competent to realize his autonomy and reach a decision about his own care that reflects that autonomy. Since one of the most important patient rights hinges (...) on the patient's competence, it is crucially important that patient decision making incompetence is clearly defined and can be diagnosed with the greatest possible degree of sensitivity and, even more important, specificity. Unfortunately, the reality is quite different. There is little consensus in the scientific literature and even less among clinicians and in the law as to what competence exactly means, let alone how it can be diagnosed reliably. And yet, patients are deemed incompetent on a daily basis, losing the right to respect of their autonomy. In this article, we set out to fill that hiatus by beginning at the very beginning, the literal meaning of the term competence. We suggest a generic definition of competence and derive four necessary conditions of competence. We then transpose this definition to the health care context and discuss patient decision making competence. (shrink)

ABSTRACT The Dutch case of Brongersma presents novel challenges to the definition and evaluation of voluntary euthanasia since it involved a doctor assisting the suicide of an individual who was (merely?) ‘tired of life’. Legal officials had called on the courts to ‘set a principled boundary’, excluding such cases from the scope of permissible voluntary euthanasia, but they arguably failed. This failure is explicable, however, since the case seems justifiable by reference to the two major principles in favour of that (...) practice, respect for autonomy and beneficence. Ultimately, it will be argued that those proponents of voluntary euthanasia who are wary of its use in such circumstances may need to draw upon ‘practical’ objections, in order to erect an otherwise arbitrary perimeter. Furthermore, it will be suggested that the issues raised by the case are not peculiarly Dutch in nature and that, therefore, there are lessons here for other jurisdictions too. (shrink)

Cosmetic dentistry is a divisive discipline. Within discourses that raise questions of the purpose of the dental profession, cosmetic dentistry is frequently criticised on the basis of it being classified as a non‐therapeutic intervention. This article re‐evaluates this assertion through examination of ethics of care of the self, healthcare definitions and the social purpose of dentistry, finding the traditional position to be wanting in its conclusions. The slide of dentistry from a healthcare vocation towards being a predominantly business‐focused interaction between (...) clinician and consumer conflicts with traditional notions of dentistry as a profession. Whilst it is undeniable that cosmetic dental treatment particularly lends itself to the commercial paradigm, this is not exclusive to this area of professional practice. The cultural basis of dental appearance and the potential of the dental profession to exert coercive pressure upon the public to undergo treatment that is based upon social norms is discussed. This essay concludes that cosmetic dentistry is undeniably part of the professional purpose of 21st Century dentistry. However, the caveat that may be placed upon this, is that this status is conditional upon the professional conduct of dental practitioners remaining resilient to commercial practices not compatible with professional obligations. (shrink)