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Challenges Facing Virginia Dental Ethics Today

By: Dr. William Bennett

Professional conduct is a major area of discussion and concern nationally as well as here in Virginia. The subject contains numerous variables for consideration. As members of the American Dental Association we have pledged to uphold the ADA’s Principles of Ethics and Code of Professional Conduct.  It is essential to note what might be viewed as legally acceptable may not be ethical behavior. Proper ethical behavior is on an elevated level of putting patient welfare first.

What is considered ethical behavior by a healthcare professional as a whole has changed over time and locale.  However, the basic premises have remained stable:  Patient Autonomy, Beneficence, Compassion, Competence, Integrity, Professionalism, Justice, Tolerance, and Veracity. Doing no harm and not misleading a patient for personal reward is the basic foundation.

A shrinking world with different cultures, differing state laws, local norms, the economy, educational costs,  treatment advances, social media, practice management companies, promotional companies, the internet, office costs, treatment advances, family responsibilities, dental personnel, state and federal regulations, insurance company influence, corporate practice ownerships and more shape and make ethical decision making increasingly more difficult and complex. It is essential then to have and maintain a solid base of clear information on which to base our decisions. A solid foundation should be the focus of all institutions and agencies that are involved in ethical and legal professional behavior.

The ADA Code is considered the foremost reference. Many states use it as the foundation for their dental practice laws. Dental specialty organizations and other ethically based dental groups also utilize the Code in their organizational documents.  Due to the vast utilization and information available on the Code, the VDA has been suggesting increased utilization of the ADA Code by the Virginia Board of Dentistry.

The Code and many guidance documents can be found by accessing the ADA website or calling the ADA directly for information. A new ethics line has been established to assist in ethics communication.  Another excellent source on professional behavior is material obtained on the website of the American College of Dentists. Information on Virginia Dental laws can be found on the Board website.  Thus, there is available information that can be obtained regarding proper ethical and legal behavior.  Knowing the current laws and the ADA Code is a personal obligation that should not be overlooked.

It is hoped that VDA efforts to promote the ideals of the membership and our ethical standards have been noticed.  Public opinion of our profession has been decreasing from past high levels of trust.  Maintaining that trust is up to each of us and how we act as individuals and a group.  Being apathetic or not making a comment to others that are acting unethically is not a solution.  Members of the VDA ethics committee are finding that most individuals contacted do not even know what they are doing is unethical. If you are not comfortable talking to a friend or colleague ask your local ethics committee representative for assistance. Our ethics committee efforts are to first educate and not regulate. These efforts are having positive results.

The VDA has been at work with the dental school as well. For the last two years the first-year class has been engaged with faculty and VDA members in a half-day discussion on professional ethics. In the second year the White Coat Ceremony instills professionalism as they begin to treat patients. From comments these efforts are appreciated and making a difference for our collective professional futures. The challenges being faced by these new young dentists after graduation are considerable. 

The dental association has also been making attempts to present issues of concern to the Virginia Board of Dentistry. The laws that regulate dental practice should be clear and easily understood by practicing dentists and Board of Dentistry personnel. Presently guidelines are not clear or do not exist. The result is confusion when addressing legal as well as ethical decisions. Effective, clear and timely regulation is being requested of the Board.  Dentists do not have to belong to ethical professional organizations but to practice they must have a current state dental license. Few questions should exist as to what is the law and the process for resolving issues.

 A VDA petition for rulemaking has been recently filed in an attempt to obtain clarification on the Board’s position on the unprofessional activity of fee splitting. It is one of the past areas of concern that have been presented to the Board. It is hoped concerns will be taken more seriously in the future. Addressing this issue is felt to be of mutual benefit in protection of the public and maintaining patient respect for our profession.

There are ethical challenges that require resolutions. We are all a part of preserving and elevating good professional behavior. The VDA has been making increased efforts. The results are making a positive difference. You can also make a difference. 

Virginia Dental Journal - Volume 90, Number 4, October-December 2013