Ethical Decision Making in Special Care Dentistry Special Care Dentistry Association 25 th Annual Meeting April New Orleans, Louisiana

Steven Krauss, DDS, MPH Nancy Dougherty, DMD, MPH Victor Badner, DMD, MPH Farah Alam, DDS

Principles of ethics Patient autonomy Nonmaleficence Beneficence Justice Veracity

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

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

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

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.

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)

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.

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

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

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)

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