Virtue versus ethical obligations: working for system-wide change.

Clinical ethics issues most often focus on the individual encounter or relationship between a specific doctor and patient. This is an appropriate focus, since this dynamic defines the normal course of health care delivery and it is within this relationship that most ethical dilemmas arise. Once a provider has discharged his or her ethical duties to a particular patient, further efforts toward assisting that patient or toward social policy affecting health care in general are virtuous but are not ethical mandates. Issues of distributive justice in health care allocation and reimbursement are examples of policy issues that impact persons who may not be patients in one's practice but who may benefit from the actions of the dental profession. Many times, as in the case presented, the dentist's awareness of such issues of distributive injustice may arise from an individual patient encounter. In the process of attempting to secure justice for a particular patient, the dentist may become aware of the broader social context of the problem. This awareness calls upon dentists, just as it calls upon other health care providers, to become involved via their professional organization and to work for distributive justice. While individual values may mediate the duty to advocate for many social issues, professional values that are oriented toward improving the health and well-being of all in a society require organized health care professions to advance these causes.