In the Ethical Moment feature “Ethical issues when a dentist with an active practice dies,” Dr. Jill M. Burns, referencing the ADA code of ethics, suggested that dentists are obligated to inform staff of practice debt due to the “ethical obligation to ‘provide a workplace environment that supports respectful and collaborative relationships for all those involved in oral health’” (JADA 151(4); 305-6). Since the ADA code of ethics does not explicitly address informing employees of office debt, I want to explore the issue from a Kantian perspective.
Immanuel Kant introduces the ideas of hypothetical and categorical imperatives in the Grounding for the Metaphysis of Morals. Imperatives are rational commands for action expressing an oughtand are hypothetical when the action is necessarily conditioned on a goal (I ought to do action X, if I have goal Y) and categorical when absolutely necessary (I ought to do action X). A hypothetical imperative is only prudent when an agent actually takes the specific goal in mind.
Let us assume Dr. Burns implies informing employees of office debt should be done for the purpose of respect and collaboration. While respect and collaboration are prudent goals for the survival of all dental offices, there are certainly dentists that don’t have the inclination of respecting employees and just want employees to follow orders rather than collaborate. These dentists would not recognize the need to share their finances. Most dentists, luckily, do value employees and want to hear ideas from fellow professionals. However, you can value employees and the work they do without explicitly telling them one is in debt. Obviously, blatant lies would be disrespect, but keeping quiet does not generally mean disrespect. Also, we know that acknowledging office debt might create dysfunction, such as, fear for one’s job, rather than necessitating collaboration. Dr. Burns cannot imply obligation to share office finances by means of a hypothetical imperative.
Perhaps there is a categorical imperative for a dentist to share her finances with employees. For Kant, categorical imperatives are determined by universalizing one’s maxim without contradiction (Law of Nature formulation) or more casuistically considering individuals as legislative agents (Respect for Humanity formulation). With respect to the former, we can conceive a system of nature, i.e., the rules of a dental office, where a dentist can respect and collaborate with her employees without displaying her finances (see above), but we cannot will both that employees work toward office profit and not have access to information about the health of the practice. Keeping information private to employees commits a contradiction of will. With respect to the later, employees make decisions concerning office policies, order supplies, and scheduling daily goals. Not providing them with information about how effectively they are working disregards their importance of making decisions in the office.
Through a Kantian analysis, we can identify that in fact dentists have an imperfect duty to share finances with staff regardless of respect or collaboration as ends. This duty is categorical, not merely hypothetical.
Dr. Vishnu Burla, DDS, BA Philosophy
Grounding of the Metaphysics of Morals by Immanuel Kant. Read about the foundations of the Categorical Imperative.
Intro to Dental Ethics to learn about bioethics.
This letter was sent to the Journal of American Dental Association for publication in May, 2020.