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PRINCIPLES OF ETHICS

• PATIENT AUTONOMY
• NON-MALEFICENCE
• BENEFICENCE
• JUSTICE
• VERACITY
PATIENT AUTONOMY
“SELF GOVERNANCE”

• RIGHT TO SELF – DETERMINATION


• RIGHT TO CONFIDENTIALITY
• PROVIDE REASONABLE
ALTERNATIVES
• FURNISHING COPIES OF RECORDS
SCENARIO
• 28 YEAR OLD PATIENT PRESENTS WITH PAIN
FROM A CARIOUS LESION ON HER RIGHT
MAXILLARY CANINE.
• YOU PRESENT HER WITH A TREATMENT
PLAN TO RESTORE THE TOOTH, BUT SHE
ADAMANTLY DENIES THE TREATMENT.
• SHE SAYS SHE WOULD RATHER HAVE IT
EXTRACTED.
WE CAN RESTORE IT!
• YOU COMPREHENSIVELY EXPLAIN THAT
THE TOOTH CAN BE RESTORED, AND
THAT THERE IS ABSOLUTELY NO NEED
FOR AN EXTRACTION.
• YOU INFORM HER OF THE
UNNECESSARY NEGATIVE
CONSEQUENCES OF THIS EXTRACTION.
“IF YOU WON’T DO IT, I’LL GO TO
SOMEONE WHO WILL!”
• MS. JUSTEX TRACT CLAIMS SHE
FULLY UNDERSTAND THE
SITUATION, AND SAYS SHE
NONETHELESS PREFERS THEM TO
BE EXTRACTED.
WHAT WOULD YOU DO?
A. CONTINUE EXPLAINING THE BENEFITS OF
RESTORATION UNTIL SHE EVENTUALLY AGREES WITH
YOU
B. REFUSE SERVICE
C. EXTRACT #6
D. REFER THE PATIENT ELSEWHERE
E. OTHER (SELECT E IF YOU WOULD DO SOMETHING
ELSE)
NON-MALEFICENCE
“DO NO HARM”
• REFRAIN FROM HARMING THE PATIENT
• KEEP SKILLS CURRENT
• KNOW WHEN TO REFER TO SPECIALISTS
• PERSONAL IMPAIRMENT
• POST EXPOSURE/BLOODBORNE
PATHOGENS
• PATIENT ABANDONMENT
• PERSONAL RELATIONSHIPS
NON-MALEFICENCE
• THE DENTIST HAS A DUTY TO REFRAIN FROM HARMING THE
PATIENT.
• PROFESSIONALS HAVE A DUTY TO PROTECT THE PATIENT FROM
HARM.
• “…OBLIGATIONS INCLUDE KEEPING KNOWLEDGE AND SKILLS
CURRENT, KNOWING ONE'S OWN LIMITATIONS AND WHEN TO REFER
TO A SPECIALIST OR OTHER PROFESSIONAL, AND KNOWING WHEN
AND UNDER WHAT CIRCUMSTANCES DELEGATION OF PATIENT CARE
TO AUXILIARIES IS APPROPRIATE.”
SCENARIO
YOUR PATIENT, TAYLOR, IS A 12 YEAR OLD GIRL WHO COMPETES
IN
BEAUTY PAGEANTS. HER MOTHER STRONGLY WANTS YOU TO DO
FULL VENEERS ON HER DAUGHTER TO COVER UP HER HEALTHY,
BUT SLIGHTLY DISCOLORED ANTERIOR TEETH. YOU KNOW THAT
THIS IS NOT A MEDICALLY NECESSARY PROCEDURE, AND COULD
ACTUALLY BE HARMFUL TO THE CHILD.
SCENARIO
YOU EXPLAIN THIS TO THE MOTHER, BUT SHE RESPONDS THAT
SHE
IS THE GUARDIAN AND GETS TO DECIDE WHAT GETS DONE TO
HER
DAUGHTER, AND THAT YOU ARE JUST THE CLINICIAN WHO IS
PAID
TO DO THE WORK.
WHAT WOULD YOU DO?
1) DO THE TREATMENT AS REQUESTED, AFTER ALL IT’S THEIR
MOUTH.
2) DO THE REQUESTED TREATMENT ONLY AFTER THE MOTHER
SIGNS A WAIVER.
3) REFUSE TO PERFORM TREATMENT ENTIRELY UNDER THESE
CONDITIONS.
WHAT WOULD YOU DO?
• WHICH ADA PRINCIPLES OF ETHICS ARE AT PLAY IN THIS
SITUATION?
1) PATIENT AUTONOMY
2) NON-MALEFICENCE
3) BENEFICENCE
4) JUSTICE
5) VERACITY
BENEFICENCE
“DO GOOD”
• PROMOTE THE PATIENT’S WELFARE
• COMPETENT DELIVERY OF DENTAL CARE
• COMMUNITY SERVICE
• GOVERNMENT OF A PROFESSION
• RESEARCH & DEVELOPMENT
• PATENTS & COPYRIGHTS
• ABUSE & NEGLECT
• PROFESSIONAL DEMEANOR IN OFFICE
BENEFICENCE
• THE DENTIST HAS A DUTY TO PROMOTE THE PATIENT'S WELFARE
• THE DENTIST'S PRIMARY OBLIGATION IS SERVICE TO THE PATIENT
AND THE PUBLIC-AT-LARGE
• MOST IMPORTANT ASPECT OF THIS OBLIGATION IS THE COMPETENT
AND TIMELY DELIVERY OF DENTAL CARE WITHIN THE BOUNDS OF
CLINICAL CIRCUMSTANCES PRESENTED BY THE PATIENT, WITH DUE
CONSIDERATION BEING GIVEN TO THE NEEDS, DESIRES AND VALUES
OF THE PATIENT
• CONTRACT OBLIGATIONS DO NOT EXCUSE DENTISTS FROM THEIR
ETHICAL DUTY TO PUT THE PATIENT'S WELFARE FIRST.
SCENARIO
KEVIN IS JUST A FEW YEARS OUT OF SCHOOL AND WORKING AS
ONE OF SIX DENTISTS IN A MEDIUM-SIZED PRIVATE GROUP
PRACTICE.
SCENARIO
RECENTLY, KEVIN LEARNED HIS PRACTICE MANAGER CHANGED
HIS
TREATMENT PLAN FOR HIS PATIENT FROM A SIMPLE
RESTORATION
TO A MORE LUCRATIVE FULL CROWN.
WHAT WOULD YOU DO?
WHAT SHOULD KEVIN DO?

1) ACCEPT THE REASSIGNMENT AND CONTINUE WORK.


2) CONFRONT THE PRACTICE-MANAGER ABOUT THE CHANGE
IN TREATMENT PLAN
3) IGNORE THE CHANGE AND CONTINUE WITH HIS ORIGINAL
TREATMENT.
WHAT WOULD YOU DO?
KEVIN DECIDES TO CONFRONT THE PRACTICE-MANAGER AND IS
TOLD TO NOT WORRY ABOUT IT AND THAT THE PATIENT’S
INSURANCE WILL COVER THE CROWN COMPLETELY. IN ADDITION,
HE IS TOLD TO CONCENTRATE ON KEEPING HIS PRODUCTION UP
AND NOT DISCUSS THE CASE FURTHER.
WHAT WOULD YOU DO?
WHO IS ETHICALLY RESPONSIBLE FOR PATIENT CARE AND
PATIENT
TREATMENT PLANS?
1) KEVIN – HE IS THE PRACTICING DENTIST.
2) THE OWNER-DENTIST – KEVIN IS SIMPLY AN EMPLOYEE.
3) PATIENTS MUST BE RESPONSIBLE FOR THE TYPE OF
HEALTHCARE THEY RECEIVE.
JUSTICE
“FAIRNESS”

• PATIENT SELECTION
• EMERGENCY SERVICES
• JUSTIFIABLE CRITICISM
• EXPERT TESTIMONY
• REBATES & SPLIT FEES
SCENARIO
Mother brings in her 8 year old son, Sami, to your office after he
chipped the mesial of #9 from chewing on ice. Sami has no
pain, no swelling in the region, but has mild sensitivity. Sami
seems to be fine, otherwise.
SCENARIO
The mother is concerned about her son, so you do a patient
exam. During the exam you notice a chip mainly in enamel with
some dentin exposure.
SCENARIO
Sami is not a patient of record and visits a different general
dentist regularly. His mother is requesting immediate treatment.
WHAT WOULD YOU DO?
A) Treat Sami and refer him to his general dentist for follow-up
care
B) Treat Sami and schedule 3 month follow-up appointment at
your office
C) Offer no immediate treatment and recommend follow-up
appointment with Sami’s general dentist
D) No immediate treatment is required and schedule 3 month
follow-up appointment at your office
ADA CODE OF ETHICS
4.B. Emergency Service. Dentists shall be obliged to make
reasonable arrangements for the emergency care of their
patients of record. Dentists shall be obliged when consulted in
an emergency by patients not of record to make reasonable
arrangements for emergency care. If treatment is provided, the
dentist, upon completion of treatment, is obliged to return the
patient to his or her regular dentist unless the patient expressly
reveals a different preference.
JUSTICE
“FAIRNESS”
The dentist has a duty to treat people fairly.
This principle expresses the concept that professionals have a
duty to be fair in their dealings with patients, colleagues and
society. Under this principle, the dentist's primary obligations
include dealing with people justly and delivering dental care
without prejudice. In its broadest sense,this principle expresses
the concept that the dental profession should actively seek
allies throughout society on specific activities that will help.
JUSTICE
“FAIRNESS”
4.A. PATIENT SELECTION.
4.A.1. PATIENTS WITH BLOODBORNE PATHOGENS.
4.B. EMERGENCY SERVICE.
4.C. JUSTIFIABLE CRITICISM.
4.C.1. MEANING OF "JUSTIFIABLE."
4.D. EXPERT TESTIMONY.
4.D.1. CONTINGENT FEES.
4.E. REBATES AND SPLIT FEES.
4.E.1. SPLIT FEES IN ADVERTISING AND MARKETING SERVICES
VERACITY
“TRUTHFULNESS”
• DUTY TO BE HONEST & TRUSTWORTHY
WHEN DEALING WITH PEOPLE
• RESPECTING THE POSITION OF TRUST
INHERENT IN THE DENTIST-PATIENT
RELATIONSHIP
• COMMUNICATE TRUTHFULLY AND WITHOUT
DECEPTION
• MAINTAINING INTELLECTUAL INTEGRITY
“TRUTHINESS”
“IF YOU LIKE
YOUR PLAN YOU
CAN KEEP IT”
SCENARIO
The fee for a patient without dental benefits shall be considered a dentist's full fee.
This is the fee that should be represented to all benefit carries. (ADA)

A 35 yo female comes to your office because she has noticed she has a cavity. Upon
inspection you determine that #30 is severely broken down and can only be restored
with a full coverage crown. Upon hearing this, she becomes very emotional and
begins sobbing as she explains that her husband recently lost his job, they are falling
behind on their bills already, and she can’t afford to do a crown. Your normal fee for a
crown is $1,000 (which is what you bill to the insurance companies as well). Because
you have a good relationship with their family and feel bad because of their situation,
you tell your pt. that you will do the crown for only $600 to help her out.
SCENARIO
Is the principle of Veracity violated if you are reporting to insurance
companies that your crown fee is $1,000 but you lessen that fee for
certain patients?
A: Yes
B: No
What if this patient had insurance that covered 50% of the procedure,
leaving her a $500 co-pay. Would the principle of veracity be violated if
you told the patient you would only collect $100 of their co-pay?
A: Yes
B: No
OTHER EXAMPLES
• ACCEPTED SCIENTIFIC KNOWLEDGE
• WAIVER OF COPAYMENT
• OVERBILLING/ FEE DIFFERENTIAL
• TREATMENT DATES
• DENTAL PROCEDURES
• UNNECESSARY SERVICES
• MARKETING