The following was a question submitted by a student at Northern Michigan University. Please use the “contact us” page to make a submission of articles or questions that will be posted on this blog website.
Question: If a person has a dental procedure (extraction and bone graft) by an “out of town” surgeon, returns home and has a bleed or other emergency, is their local oral surgeon obliged to help them?
This question has been traditionally answered as “yes” by the American Dental Association (ADA). Dentists are obligated to treated emergencies because they have the special knowledge to treat dental conditions in society. By this social contract we may see why dentists are relevant (they hold the special rights and knowledge in society) but not necessarily why its “obligatory.” The ADA code of ethics says outlines a dentist’s duty to be beneficent (to help those in need). [see Intro to Dental Ethics for information about dental bioethics] However, this is an “imperfect” duty. This means that while a dentist has an obligation to help others, it is, as Imanuel Kant says, up to the individuals judgement when to do so (see Metaphysics of Morals). So we are left with a somewhat ambiguous answer: there is a general obligation to help others but is there a particular obligation for a dentist to help non-patients-of-record?
If we want a more particular answer we might apply the principle of justice which means “treat people fairly” (don’t differentiate patients between yours or theres, treat them equally). The issue with justice however has always been the vagueness of the idea of fairness and equality and exactly in what way are people supposed to be just. So how are we supposed to answer this particular question when all these different standards of morality?
I propose we apply the categorical imperative to the situation. A categorical imperative is tautologically categorical and a command is an command for action with the conception of a moral “ought.” Categorical means that a command is not just suggestive but that it must be obeyed, i.e. it is necessary and universal to all. We want to find out if there is a categorical imperative for a dentist’s seeing non-record patients since we want to understand “obligation” (am I obligated and must I do it?). An obligation depends on it being universalize to as a law (a necessary rule) of nature as one formulation of the categorical imperative.
Let us look at a rational agents maxim “I ought not to see a patient that has seen another dentist but I cannot see for their emergency.” We must apply the two contraction tests, illustrated by Kant in the Grounding of the Metaphysics of Morals. (1) can I will my maxim universally and (2) can I will my maxim as a system of laws in nature. This maxim fails the first test because the agent makes an exception to the general will that dentists should see their patients, namely, that they do not have to see patients. This maxim fails the second test because in a system where dentists didn’t see non-record patients for dental treatment when those patients couldn’t find their dentist we would be eliminating the concept of dental emergencies. No patients could seek emergency treatment at all (since no one would see them), so the maxim would “destroy” itself (we cannot conceive of the practice of dentistry if dentists did not see non-record patients as emergencies). We see that therefore there are practical contradictions in not helping patients of non-record. Instead, there actually is a categorical imperative to help dental patients irregardless of who they saw first.
You see, obligation is recognized when a command (a maxim) apples to the agent (universality) and when an agent must do it (necessity). This was a long winded answer but I hope I gave you some tools or at least some reasons for figuring out when something is an obligation or not.