Ethical Decision Making in Special Care Dentistry

1. Ethical Decision Making in Special Care Dentistry Special Care Dentistry Association 25th Annual Meeting April 15-21 New Orleans, Louisiana

2. Steven Krauss, DDS, MPHNancy Dougherty, DMD, MPHVictor Badner, DMD, MPHFarah Alam, DDS

4. Principles of ethics • Patient autonomy • Nonmaleficence • Beneficence • Justice • Veracity

5. Patient Autonomy • The dentist has a duty to treat each patient according to that patient’s desires, within the accepted bounds of treatment. • The dentist must protect patient confidentiality • Treatment should be rendered with due consideration to the patient’s needs, desires and abilities

6. Autonomy- requirements • Pt. self determination • Decision making capacity • Informed consent • Competence • Freedom from coercion

7. Nonmaleficence • “Do no harm” • Doctor must act without malice • Unproven or ineffective treatments must be avoided • Harmful effects must be weighed against benefits of treatment

8. Nonmaleficence • The dentist has an obligation to protect patients from harm • Dental knowledge & skills should be kept current • The dentist must know when it is appropriate to refer • The dentist must know when it is appropriate to delegate patient care to auxiliaries.

9. Beneficience • Actions done for the benefit of others • Obligatory versus ideal actions • Interests of the patient must be put before those of the doctor or third parties (ie. caregivers or insurance providers)

10. Beneficence • The dentist’s primary obligation is service to the patient (obligatory) and the public at large (ideal). • Delivery of dental care must be competent and timely. • The dentist must be familiar with signs of abuse & neglect; is obliged to report suspected cases, consistent with state law.

11. Justice • Primary obligations of the dentist include dealing with people justly and delivering dental care without prejudice • Patients should not be denied care on the basis of race, creed, gender or national origin • Includes the concept that dentistry, as a profession, should engage in activities that will improve access to care for all

12. Justice • Benefits and burdens must be distributed equitably • Often difficult to achieve since humans are inherently unequal in requirements, health status, prognosis, etc.

13. Veracity • The dentist has a duty to be trustworthy in dealings with people • Treatment recommendations should not be presented in a false or misleading way • Dentists should not misrepresent fees for services (eg. fraudulent insurance billing practices)

14. References • American Dental Association. Principles of Ethics and code of Professional Conduct. April 2012 • American College of Dentists. Ethics Handbook for Dentists. 2012 • FDI. Dental Ethics Manual. www.fdiworldental.org