Professionalism and Ethics Midterm

The ADA Code

A written expression of the obligations arising from the implied contract between the dental profession and society

The ADA Code consists of Three Main Components

• The Principles of Ethics

• The Code of Professional Conduct

• Advisory Opinions

Ethics and the Law are

Closely related, but they are not the same

In resolving any ethical problem not explicitly covered by the ADA Code

Dentists should consider the ethical principles, the patients needs and interests, and any applicable laws

The Code of Professional Conduct

Is a product of the ADAs Legislative Body Binds members of the ADA and violations may result in disciplinary action

Advisory Opinions

Are interpretations that apply the Code to specific situations

Adopted by the ADAs Council on Ethics, Bylaws and Judicial Affairs to provide guidance

Dental Ethics are composed of Five main principles

• Patient Autonomy

• Non-Maleficence

• Beneficence

• Justice

• Veracity

Patient Autonomy (Self-Governance)

The dentist has a duty to respect the patient’s rights to self-determination and confidentiality

Patient Autonomy is a concept that

Expresses how professionals have a duty to treat the patient according to the patient’s desires, within bounds of accepted treatment (Note: One option is always no treatment)

Patient Autonomy

• Must protect patient’s confidentiality

• Must involve patients in treatment decisions in a meaningful way

• Must consider the patients needs, desires and abilities, and safeguard the patients privacy (HIPAA)

Paternalism (Parent-Child Relationship)

When a dentist overrides a patient’s decision for the patients own benefit, even if the patient is competent

Paternalism violates

A patient’s autonomy and self-determination and can be ethically wrong since it doesn’t give the patient the right to informed consent

Paternalism (Withholding Information)

A dentist may withhold information from a
patient to unduly influence them. For example, a dentist might only tell a patient about a fixed bridge or denture option to replace a missing tooth, but not mention an implant

Paternalism (Choosing a Treatment Plan)

A dentist might choose a treatment plan that
they think is easiest for the patient, even if it's not the best option. For example, a dentist might recommend extracting a painful tooth and replacing it with a bridge, instead of considering other options like endodontic treatment or an implant

Paternalism (Refusing to Extract a Tooth)

A dentist might refuse to extract a tooth, even if the patient or their parent requests it. This could be an act of justifiable paternalism, as it could make an ethical statement that might change the patient's mind.

Non-Maleficence (Do No Harm)

The concept that professionals have a duty to protect the patient from harm

A dentist’s primary obligations to avoid Non-Maleficence are

• Keeping knowledge and skills current

• Know one’s own limitations and when to refer to a specialist/other professional

• Know when and under what circumstances delegation of patient care to auxiliaries is appropriate

Beneficence (Do Good)

Professionals have a duty to act for the benefit of others (promote the patient’s welfare)

A dentist’s primary obligation in Beneficence is

Service to the patient and the public-at-large

Beneficence contains an obligation

For competent and timely delivery of dental care within the bounds of clinical circumstances presented by the patient

In beneficence, the dentist must

• Give consideration to the NEEDS, DESIRES AND VALUES of the patient

• Apply the SAME ETHICAL CONSIDERATIONS whether you are a "fee for service" dentist, "managed care" or "government contract"

• Contract obligations DO NOT excuse dentist from their ethical duty to put the patient's welfare
  first.

Abuse and Neglect

A dentist's ethical obligation to identify and report the signs of abuse and neglect is, at a minimum, to be consistent with a dentist's legal obligation in the jurisdiction where the dentist practices.

Dentists are obliged to identify, and report suspected cases to the same extent as they are legally obliged to do so in their jurisdiction

Abuse and Neglect Cont.

Dentists have a concurrent ethical obligation to respect an adult's patient's right to self- determination and confidentiality and to promote the welfare of all patients. Care should be exercised to respect the wishes of an adult patient who asks that a suspected case of abuse and/or neglect not be reported, where such a report is not mandated by law. Other possible solutions may be sought with the patient's permission.

Disruptive Behavior in the Workplace

• Dentists are the leaders of the oral healthcare team

  • Must maintain an environment that supports the mutual respect, good communication and high levels of collaboration required to provide optimal care

Justice (Fairness)

The dentist has a duty to treat people fairly

Expresses the concept that professionals have a duty to be fair in their dealings with patients, colleagues, and society

Primary obligations in Justice include

• Dealing with people justly and delivering dental care WITHOUT PREJUDICE and BIAS

• Actively seek allies throughout society on specific activities that will help improve access to care for
  all

Justice Cont.

DENTISTS SHALL NOT REFUSE TO ACCEPT PATIENTS INTO THEIR PRACTICE OR DENY DENTAL SERVICE TO PATIENTS BECAUSE OF THE PATIENT'S RACE, CREED, COLOR, GENDER, SECUAL ORIENTATION, GENDER IDENTITY, NATIONAL ORIGIN OR DISABILITY!
However, they may exercise reasonable discretion in selecting patients for their practices. You also have a right to dismiss patients.

Justifiable Criticism

Ethically obligates dentists to report “gross or continual faulty treatment by other dentists.” The other prong of this obligation, however, is to be sure that patients are “informed of their present oral health status without disparaging comment about prior services.

When informing patient’s of their oral health status

The dentist should exercise care that the comments made are truthful, informed and justifiable.” Accomplishing this “should, if possible, involve consultation with the previous treating dentist(s), in accordance with applicable law, to determine under what circumstances and conditions the treatment was performed.”

Veracity (Truthfulness)

The dentist has a duty to communicate truthfully

A concept that expresses that professionals have a duty to be honest and trustworthy in their dealing with people

Primary Obligations of Veracity are

• Respecting the position of trust inherent in the dentist-patient relationship

• Communicate truthfully and without deception

• Maintain intellectual integrity

What information does Veracity cover

• Co-payments

• Overbilling

• Devices

• Marketing and advertising

• Unearned degrees

• Name of practice

• Announcement of specialization

Peer Review (Reported Unethical Acts)

Anyone who believes that a member-dentist has acted UNETHICALLY should bring the matter to the attention of the appropriate STATE or LOCAL society (if there is a peer review
board)

Note: Legal matters go to the State Board

What happened after a Peer Review?

After a fair hearing at the state level, an appeal would go to the Council on Ethics, Bylaws and Judicial Affairs.

Principle: NonMaleficence

• Education (Keep knowledge and skills current)

• Consultation and Referral (Seek consultation whenever the welfare of patients will be safeguarded utilizing those with special skills)

• Second Opinions ( Dentist rendering opinion should not have vested interest and should be in accordance with the Code of Ethics)

• Use of Auxiliary Personnel

• Personal Impairement

• Ability to Practice

• Post exposure and Bloodborne Pathogens (inform patients of exposure)

• Patient Abandonment (Should not discontinue treatment without proper notice and opportunity to obtain services elsewhere)

• Personal Relationships with Patients

Principle:Beneficence

• Community Service

• Elective and Non-Emergent Procedures During a Public Health Emergency (Ethical obligations to the public may supersede the ethical obligations to individual patients)

• Governance of Profession (Obligation of being part of a professional society and observing its rules of ethics)

• Research and Development (Share research if results/benefits are useful to the public)

• Patents and Copyrights (Cannot be used to restrict research or practice)

• Abuse and Neglect

• Disruptive Behavior in the Workplace

Principle:Justice

• Patient Selection

• Emergency Service (Make reasonable arrangements for emergency care)

• Justifiable Criticism

• Expert Testimony (Provide testimony when it is essential for a just/fair disposition of judicial/administrative action)

• Contingent Fees (Cannot agree to a fee upon favorable outcome for testifying)

• Rebates and Split Fees (Cannot use professional fees collected from patients to provide advertising/marketing services and other arrangements in order for revenue to be collected)

Principle:Veracity

• Dental Amalgam and Other Restorative Materials (Cannot remove dental restorations for alleged purposes)

• Unsubstantiated Representations (False claims in regard to techniques and treatments without scientific knowledge or research)

  Note: Extensive list on PDF file