With access to care at dangerously low levels for low-income and other disadvantaged populations, dentists are encouraged to participate in free screenings and clinics whenever and wherever they can. But this participation can lead to some tricky ethical questions.
That’s why the ADA Council on Ethics, Bylaws and Judicial Affairs (CEBJA) has published “The Ethics of Temporary Charitable Events.” This free, online white paper provides guidance on ethical issues based on the ADA’s Principles of Ethics and Code of Professional Conduct.
“We’re hoping it eliminates problems before they occur,” said Dr. Elizabeth Reynolds, one of the authors of the paper. Its topics include:
- Access to, maintenance of, and confidentiality of patient records;
- The elements necessary for informed consent;
- Patient abandonment;
- Honestly educating patients about treatment options and the limitations of a temporary charitable event;
- The temporary nature of these events precluding development of an ongoing relationship with patients.
For example, event sponsors typically keep patient records, not the dentists. Problems with treatment could arise later, so patients should be clearly informed about how to obtain those records and how to schedule follow-up care. The paper suggests simply ensuring patients get the phone numbers of the organization or person in charge of the records along with the emergency contact responsible for postoperative care.
Also, providers must ensure patients understand available treatment options along with their risks and benefits. For instance, patients may opt for a root canal to save an abscessed tooth without realizing they will need a crown to protect it. Perhaps the crown seemed too expensive or unnecessary. The unprotected tooth could break later, though, requiring emergency surgery. These patients would benefit from a better awareness of options and consequences before selecting treatment.
The paper addresses personnel as well. It says that volunteers must be properly trained, credentialed, supervised, and legally authorized to perform their assigned duties for their subsequent treatment and advice to be considered appropriate. Dental and auxiliary students who provide direct care must be versed in the treatment they are administering. And, coordinators must continually monitor and supervise the event to ensure these principles are upheld while also meeting any local requirements.
The authors note that charity events often produce unintended consequences and conclude the paper with a list of questions that volunteers should ask before participating. For example, if these events are too successful, could patients use them as dental homes? Are dollars and cents the best way to define the success of these projects? Is anyone watching to be sure that these projects don’t become a platform for heroics by providers who may not be proficient in a specific area?
Finally, the paper includes a pair of checklists to ask during the event—one for patients and one for dentists. Questions for patients include if they understand that the treatment is being rendered in a less than ideal environment, if they are aware of alternative sites for care, and if they are forthcoming about all medical conditions. Among other queries, dentists should ask if the treatment they are providing is necessary and appropriate, what their supervisory responsibilities may be, and if their specialty precludes them from performing the procedure.
For more information, contact Nanette Elster of the CEBJA at elstern@ada.org.
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