Ethical Principles and the Delivery of Children's Oral Health Care

Fundamental ethical principles provide a framework for evaluating children's oral health care and current policies. Principles of justice reveal fundamental inequities in the delivery of children's oral health care. The dental care delivery system rations services by ability to pay and personal choice and places at a disadvantage children who are in the poorest age group, who do not make their own decisions, and who depend upon adults for access to health care. All major theories of justice are consistent with a societal obligation to provide basic health care for children, including oral health care. Beneficence requires physicians and dentists to help the individual child-patient but also obligates others and the society to advocate for children in view of their vulnerability and the importance of oral health to their well-being and future opportunities. Respect for autonomy requires that decisions about children's health care be made in the best interests of the child and in conjunction with families. Such decisions will be grounded in the context of the child's development and his social, family, cultural, and environmental circumstances. Advocacy for a just distribution of resources to children is morally required of physicians and dentists in view of the professions' implicit contract to serve society, public funding of professional education, and the professionals' special knowledge of children's health needs. Pediatricians in particular have an important role to play but often lack the knowledge to promote or effectively advocate for children's oral health. Conversely, dentists may not fully understand critical contextual issues in children's lives.

KEY WORDS:  access , children , dental care , disparities , ethics , justice