Hi,
Please refer the below Link.
https://www.ada.org/~/media/ADA/Member%20Center/Ethics/ADA%20Code%20Of%20Ethics%20Book%20With%20Revised%20Advisory%20Opinions%20to%20September%202018.pdf?la=en
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Principles
of Ethics Code
of Professional Conduct &
With official advisory opinions revised to September 2018.
Patient
Autonomy
Non-
Veracity maleficence
Justice Beneficence
Dental
Ethics
Principles of Ethics
Council on Ethics, Bylaws and Judicial Affairs
I.
INTRODUCTION..............................................................................................
3
II.
PREAMBLE......................................................................................................
3
III. PRINCIPLES, CODE OF PROFESSIONAL CONDUCT AND ADVISORY OPINIONS
..... 4
The Code of Professional Conduct is organized into five sections.
Each section falls
under the Principle of Ethics that predominately applies to it.
Advisory Opinions
follow the section of the Code that they interpret.
SECTION 1– PRINCIPLE: PATIENT AUTONOMY (“self-governance”)
.......................... 4
Code of Professional Conduct
1.A. Patient Involvement
...................................................................................
4
1.B. Patient
Records..........................................................................................
4
Advisory Opinions
1.B.1. Furnishing Copies of
Records...............................................................
4
1.B.2. Confidentiality of Patient Records
....................................................... 4
SECTION 2 – PRINCIPLE: NONMALEFICENCE (“do no
harm”).................................... 5
Code of Professional Conduct
2.A.
Education..................................................................................................
5
2.B. Consultation and
Referral............................................................................
5
Advisory Opinion
2.B.1. Second
Opinions................................................................................
5
2.C. Use of Auxiliary
Personnel............................................................................
6
2.D. Personal
Impairment...................................................................................
6
Advisory Opinion
2.D.1. Ability To
Practice..............................................................................
6
2.E. Postexposure, Bloodborne
Pathogens...........................................................
6
2.F. Patient
Abandonment.................................................................................
6
2.G. Personal Relationships with
Patients.............................................................
6
SECTION 3 – PRINCIPLE: BENEFICENCE (“do good”)
............................................... 7
Code of Professional Conduct
3.A. Community
Service....................................................................................
7
3.B. Government of a
Profession.........................................................................
7
3.C. Research and
Development.........................................................................
7
3.D. Patents and
Copyrights...............................................................................
7
3.E. Abuse and
Neglect......................................................................................
7
Advisory Opinion
3.E.1. Reporting Abuse and
Neglect..............................................................
7
3.F. Professional Demeanor In The
Workplace.......................................................
8
Advisory Opinion
3.F.1. Disruptive Behavior In The
Workplace...................................................
8
SECTION 4 – PRINCIPLE: JUSTICE
(“fairness”).........................................................
8
Code of Professional Conduct
4.A. Patient
Selection........................................................................................
8
Advisory Opinion
4.A.1. Patients With Bloodborne
Pathogens...................................................
8
4.B. Emergency
Service.....................................................................................
9
4.C. Justifiable
Criticism.....................................................................................
9
Advisory Opinion
4.C.1. Meaning of
“Justifiable”......................................................................
9
CONTENTS
4.D. Expert
Testimony........................................................................................9
Advisory Opinion
4.D.1. Contingent
Fees.................................................................................9
4.E. Rebates and Split
Fees...............................................................................
10
Advisory Opinion
4.E.1. Split Fees in Advertising and Marketing
Services................................... 10
SECTION 5 – PRINCIPLE: VERACITY
(“truthfulness”)..............................................
10
Code of Professional Conduct
5.A. Representation of
Care..............................................................................
10
Advisory Opinions
5.A.1. Dental Amalgam and Other Restorative
Materials................................. 10
5.A.2. Unsubstantiated
Representations.......................................................
10
5.B. Representation of
Fees..............................................................................
11
Advisory Opinions
5.B.1. Waiver of
Copayment........................................................................
11
5.B.2.
Overbilling.......................................................................................
11
5.B.3. Fee Differential
...............................................................................
11
5.B.4. Treatment
Dates..............................................................................
11
5.B.5. Dental
Procedures............................................................................
11
5.B.6. Unnecessary
Services.......................................................................
11
5.C. Disclosure of Conflict of
Interest.................................................................
12
5.D. Devices and Therapeutic
Methods...............................................................
12
Advisory Opinions
5.D.1. Reporting Adverse
Reactions.............................................................
12
5.D.2. Marketing or Sale of Products or
Procedures....................................... 12
5.E. Professional
Announcement........................................................................
12
5.F.
Advertising...............................................................................................
12
Advisory Opinions
5.F.1. Published
Communications.................................................................
13
5.F.2. Examples of “False or
Misleading”........................................................
13
5.F.3. Unearned, Nonhealth
Degrees............................................................
13
5.F.4. Referral
Services...............................................................................
14
5.F.5. Infectious Disease Test
Results..........................................................
14
5.F.6. Websites and Search Engine
Optimization........................................... 14
5.G. Name of
Practice.......................................................................................
15
Advisory Opinion
5.G.1. Dentist Leaving
Practice....................................................................
-15
5.H. Announcement of Specialization and Limitation of
Practice............................. -15
Standards For Multiple-Specialty
Announcements......................................... -16
Advisory Opinions
5.H.1. Dual Degreed
Dentists......................................................................
-15
5.H.2. Specialist Announcement of Credentials In Non-Specialty
Interest Areas.. -16
5.I. General Practitioner Announcement of
Services............................................ -16
Advisory Opinions
5.I.1. General Practitioner Announcement of Credentials
In Interest Areas In General
Dentistry..................................................
16
5.I.2. Credentials In General
Dentistry.........................................................
17
NOTES...........................................................................................................
17
IV. INTERPRETATION AND
APPLICATION..............................................................
17
V.
INDEX...........................................................................................................
18
3
I. INTRODUCTION
The dental profession holds a special position of trust within
society. As a consequence,
society affords the profession certain privileges that are not
available to
members of the public-at-large. In return, the profession makes a
commitment to
society that its members will adhere to high ethical standards of
conduct. These
standards are embodied in the ADA Principles of Ethics and Code of
Professional
Conduct (ADA Code). The ADA Code is, in effect, a written
expression of the obligations
arising from the implied contract between the dental profession and
society.
Members of the ADA voluntarily agree to abide by the ADA Code as a
condition
of membership in the Association. They recognize that continued
public trust in the
dental profession is based on the commitment of individual dentists
to high ethical
standards of conduct.
The ADA Code has three main components: The Principles of Ethics,
the Code
of Professional Conduct and the Advisory Opinions.
The Principles of Ethics are the aspirational goals of the
profession. They provide
guidance and offer justification for the Code of Professional
Conduct and the Advisory
Opinions. There are five fundamental principles that form the
foundation of the ADA
Code: patient autonomy, nonmaleficence, beneficence, justice and
veracity. Principles
can overlap each other as well as compete with each other for
priority. More than one
principle can justify a given element of the Code of Professional
Conduct. Principles
may at times need to be balanced against each other, but,
otherwise, they are the
profession’s firm guideposts.
The Code of Professional Conduct is an expression of specific types
of conduct
that are either required or prohibited. The Code of Professional
Conduct is a product
of the ADA’s legislative system. All elements of the Code of
Professional Conduct
result from resolutions that are adopted by the ADA’s House of
Delegates. The Code
of Professional Conduct is binding on members of the ADA, and
violations may result
in disciplinary action.
The Advisory Opinions are interpretations that apply the Code of
Professional
Conduct to specific fact situations. They are adopted by the ADA’s
Council on Ethics,
Bylaws and Judicial Affairs to provide guidance to the membership
on how the Council
might interpret the Code of Professional Conduct in a disciplinary
proceeding.
The ADA Code is an evolving document and by its very nature cannot
be a
complete articulation of all ethical obligations. The ADA Code is
the result of an ongoing
dialogue between the dental profession and society, and as such, is
subject to
continuous review.
Although ethics and the law are closely related, they are not the
same. Ethical
obligations may– and often do –exceed legal duties. In resolving
any ethical problem
not explicitly covered by the ADA Code, dentists should consider
the ethical principles,
the patient’s needs and interests, and any applicable laws.
II. PREAMBLE
The American Dental Association calls upon dentists to follow high
ethical standards
which have the benefit of the patient as their primary goal. In
recognition of this
goal, the education and training of a dentist has resulted in
society affording to the
profession the privilege and obligation of self-government. To
fulfill this privilege,
these high ethical standards should be adopted and practiced
throughout the dental
school educational process and subsequent professional
career.
4
The Association believes that dentists should possess not only
knowledge, skill
and technical competence but also those traits of character that
foster adherence to
ethical principles. Qualities of honesty, compassion, kindness,
integrity, fairness and
charity are part of the ethical education of a dentist and practice
of dentistry and
help to define the true professional. As such, each dentist should
share in providing
advocacy to and care of the underserved. It is urged that the
dentist meet this goal,
subject to individual circumstances.
The ethical dentist strives to do that which is right and good. The
ADA Code is an
instrument to help the dentist in this quest.
III. PRINCIPLES, CODE OF PROFESSIONAL CONDUCT AND ADVISORY
OPINIONS
Section 1 PRINCIPLE: PATIENT AUTONOMY (“self-governance”). The
dentist has a
duty to respect the patient’s rights to self-determination and
confidentiality.
This principle expresses the concept that professionals have a duty
to treat the
patient according to the patient’s desires, within the bounds of
accepted treatment,
and to protect the patient’s confidentiality. Under this principle,
the dentist’s primary
obligations include involving patients in treatment decisions in a
meaningful way,
with due consideration being given to the patient’s needs, desires
and abilities, and
safeguarding the patient’s privacy.
CODE OF PROFESSIONAL CONDUCT
1.A. PATIENT INVOLVEMENT.
The dentist should inform the patient of the proposed treatment,
and any reasonable
alternatives, in a manner that allows the patient to become
involved in treatment
decisions.
1.B. PATIENT RECORDS.
Dentists are obliged to safeguard the confidentiality of patient
records. Dentists shall
maintain patient records in a manner consistent with the protection
of the welfare of
the patient. Upon request of a patient or another dental
practitioner, dentists shall
provide any information in accordance with applicable law that will
be beneficial for
the future treatment of that patient.
ADVISORY OPINIONS
1.B.1. FURNISHING COPIES OF RECORDS.
A dentist has the ethical obligation on request of either the
patient or the patient’s
new dentist to furnish in accordance with applicable law, either
gratuitously or for
nominal cost, such dental records or copies or summaries of them,
including dental
X-rays or copies of them, as will be beneficial for the future
treatment of that
patient. This obligation exists whether or not the patient’s
account is paid in full.
1.B.2. CONFIDENTIALITY OF PATIENT RECORDS.
The dominant theme in Code Section l.B is the protection of the
confidentiality
of a patient’s records. The statement in this section that relevant
information in
the records should be released to another dental practitioner
assumes that the
dentist requesting the information is the patient’s present
dentist. There may
be circumstances where the former dentist has an ethical obligation
to inform
the present dentist of certain facts. Code Section 1.B assumes that
the dentist
releasing relevant information is acting in accordance with
applicable law. Dentists
5
should be aware that the laws of the various jurisdictions in the
United States
are not uniform and some confidentiality laws appear to prohibit
the transfer of
pertinent information, such as HIV seropositivity. Absent certain
knowledge that
the laws of the dentist’s jurisdiction permit the forwarding of
this information, a
dentist should obtain the patient’s written permission before
forwarding health
records which contain information of a sensitive nature, such as
HIV seropositivity,
chemical dependency or sexual preference. If it is necessary for a
treating dentist
to consult with another dentist or physician with respect to the
patient, and
the circumstances do not permit the patient to remain anonymous,
the treating
dentist should seek the permission of the patient prior to the
release of data
from the patient’s records to the consulting practitioner. If the
patient refuses,
the treating dentist should then contemplate obtaining legal advice
regarding the
termination of the dentist-patient relationship.
Section 2 PRINCIPLE: NONMALEFICENCE (“do no harm”). The dentist has
a duty to
refrain from harming the patient.
This principle expresses the concept that professionals have a duty
to protect the
patient from harm. Under this principle, the dentist’s primary
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.
CODE OF PROFESSIONAL CONDUCT
2.A. EDUCATION.
The privilege of dentists to be accorded professional status rests
primarily in the
knowledge, skill and experience with which they serve their
patients and society. All
dentists, therefore, have the obligation of keeping their knowledge
and skill current.
2.B. CONSULTATION AND REFERRAL.
Dentists shall be obliged to seek consultation, if possible,
whenever the welfare of
patients will be safeguarded or advanced by utilizing those who
have special skills,
knowledge, and experience. When patients visit or are referred to
specialists or
consulting dentists for consultation:
1. The specialists or consulting dentists upon completion of their
care shall return the
patient, unless the patient expressly reveals a different
preference, to the referring
dentist, or, if none, to the dentist of record for future
care.
2. The specialists shall be obliged when there is no referring
dentist and upon a
completion of their treatment to inform patients when there is a
need for further
dental care.
ADVISORY OPINION
2.B.1. SECOND OPINIONS.
A dentist who has a patient referred by a third party1 for a
“second opinion”
regarding a diagnosis or treatment plan recommended by the
patient’s treating
dentist should render the requested second opinion in accordance
with this Code
of Ethics. In the interest of the patient being afforded quality
care, the dentist
rendering the second opinion should not have a vested interest in
the ensuing
recommendation.
6
2.C. USE OF AUXILIARY PERSONNEL.
Dentists shall be obliged to protect the health of their patients
by only assigning to
qualified auxiliaries those duties which can be legally delegated.
Dentists shall be
further obliged to prescribe and supervise the patient care
provided by all auxiliary
personnel working under their direction.
2.D. PERSONAL IMPAIRMENT.
It is unethical for a dentist to practice while abusing controlled
substances, alcohol
or other chemical agents which impair the ability to practice. All
dentists have an
ethical obligation to urge chemically impaired colleagues to seek
treatment. Dentists
with first-hand knowledge that a colleague is practicing dentistry
when so impaired
have an ethical responsibility to report such evidence to the
professional assistance
committee of a dental society.
ADVISORY OPINION
2.D.1. ABILITY TO PRACTICE.
A dentist who contracts any disease or becomes impaired in any way
that might
endanger patients or dental staff shall, with consultation and
advice from a
qualified physician or other authority, limit the activities of
practice to those areas
that do not endanger patients or dental staff. A dentist who has
been advised
to limit the activities of his or her practice should monitor the
aforementioned
disease or impairment and make additional limitations to the
activities of the
dentist’s practice, as indicated.
2.E. POSTEXPOSURE, BLOODBORNE PATHOGENS.
All dentists, regardless of their bloodborne pathogen status, have
an ethical obligation
to immediately inform any patient who may have been exposed to
blood or other
potentially infectious material in the dental office of the need
for postexposure
evaluation and follow-up and to immediately refer the patient to a
qualified health
care practitioner who can provide postexposure services. The
dentist’s ethical
obligation in the event of an exposure incident extends to
providing information
concerning the dentist’s own bloodborne pathogen status to the
evaluating health
care practitioner, if the dentist is the source individual, and to
submitting to testing
that will assist in the evaluation of the patient. If a staff
member or other third person
is the source individual, the dentist should encourage that person
to cooperate as
needed for the patient’s evaluation.
2.F. PATIENT ABANDONMENT.
Once a dentist has undertaken a course of treatment, the dentist
should not
discontinue that treatment without giving the patient adequate
notice and the
opportunity to obtain the services of another dentist. Care should
be taken that
the patient’s oral health is not jeopardized in the process.
2.G. PERSONAL RELATIONSHIPS WITH PATIENTS.
Dentists should avoid interpersonal relationships that could impair
their professional
judgment or risk the possibility of exploiting the confidence
placed in them by a
patient.
7
Section 3 PRINCIPLE: BENEFICENCE (“do good”). The dentist has a
duty to promote
the patient’s welfare.
This principle expresses the concept that professionals have a duty
to act for the
benefit of others. Under this principle, the dentist’s primary
obligation is service to
the patient and the public-at-large. The 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. The same ethical
considerations apply
whether the dentist engages in fee-for-service, managed care or
some other practice
arrangement. Dentists may choose to enter into contracts governing
the provision of
care to a group of patients; however, contract obligations do not
excuse dentists from
their ethical duty to put the patient’s welfare first.
CODE OF PROFESSIONAL CONDUCT
3.A. COMMUNITY SERVICE.
Since dentists have an obligation to use their skills, knowledge
and experience for the
improvement of the dental health of the public and are encouraged
to be leaders in
their community, dentists in such service shall conduct themselves
in such a manner
as to maintain or elevate the esteem of the profession.
3.B. GOVERNMENT OF A PROFESSION.
Every profession owes society the responsibility to regulate
itself. Such regulation
is achieved largely through the influence of the professional
societies. All dentists,
therefore, have the dual obligation of making themselves a part of
a professional
society and of observing its rules of ethics.
3.C. RESEARCH AND DEVELOPMENT.
Dentists have the obligation of making the results and benefits of
their investigative
efforts available to all when they are useful in safeguarding or
promoting the health
of the public.
3.D. PATENTS AND COPYRIGHTS.
Patents and copyrights may be secured by dentists provided that
such patents and
copyrights shall not be used to restrict research or
practice.
3.E. ABUSE AND NEGLECT.
Dentists shall be obliged to become familiar with the signs of
abuse and neglect and
to report suspected cases to the proper authorities, consistent
with state laws.
ADVISORY OPINION
3.E.1. REPORTING ABUSE AND NEGLECT.
The public and the profession are best served by dentists who are
familiar
with identifying the signs of abuse and neglect and knowledgeable
about the
appropriate intervention resources for all populations.
A dentist’s ethical obligation to identify and report the signs of
abuse and
neglect is, at a minimum, to be consistent with a dentist’s legal
obligation in
the jurisdiction where the dentist practices. Dentists, therefore,
are ethically
obliged to identify and report suspected cases of abuse and neglect
to the same
extent as they are legally obliged to do so in the jurisdiction
where they practice.
Dentists have a concurrent ethical obligation to respect an adult
patient’s right to
8
self-determination and confidentiality and to promote the welfare
of all patients.
Care should be exercised to respect the wishes of an adult patient
who asks that
a suspected case of abuse and/or neglect not be reported, where
such a report is
not mandated by law. With the patient’s permission, other possible
solutions may
be sought.
Dentists should be aware that jurisdictional laws vary in their
definitions
of abuse and neglect, in their reporting requirements and the
extent to which
immunity is granted to good faith reporters. The variances may
raise potential legal
and other risks that should be considered, while keeping in mind
the duty to put
the welfare of the patient first. Therefore a dentist’s ethical
obligation to identify
and report suspected cases of abuse and neglect can vary from one
jurisdiction to
another.
Dentists are ethically obligated to keep current their knowledge of
both identifying
abuse and neglect and reporting it in the jurisdiction(s) where
they practice.
3.F. PROFESSIONAL DEMEANOR IN THE WORKPLACE.
Dentists have the obligation to provide a workplace environment
that supports
respectful and collaborative relationships for all those involved
in oral health care.
ADVISORY OPINION
3.F.1. DISRUPTIVE BEHAVIOR IN THE WORKPLACE.
Dentists are the leaders of the oral healthcare team. As such,
their behavior in
the workplace is instrumental in establishing and maintaining a
practice environment
that supports the mutual respect, good communication, and high
levels of
collaboration among team members required to optimize the quality
of patient
care provided. Dentists who engage in disruptive behavior in the
workplace risk
undermining professional relationships among team members,
decreasing the
quality of patient care provided, and undermining the public’s
trust and confidence
in the profession.
Section 4 PRINCIPLE: 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 improve access to care for all.
CODE OF PROFESSIONAL CONDUCT
4.A. PATIENT SELECTION.
While dentist, in serving the public, may exercise reasonable
discretion in selecting
patients for their practices, dentists shall not refuse to accept
patients into their
practice or deny dental service to patients because of the
patient’s race, creed, color,
gender, sexual orientation or gender identity or national
origin.
ADVISORY OPINION
4.A.1. PATIENTS WITH BLOODBORNE PATHOGENS.
A dentist has the general obligation to provide care to those in
need. A decision not
to provide treatment to an individual because the individual is
infected with Human
9
Immunodeficiency Virus, Hepatitis B Virus, Hepatitis C Virus or
another bloodborne
pathogen, based solely on that fact, is unethical. Decisions with
regard to the type
of dental treatment provided or referrals made or suggested should
be made on
the same basis as they are made with other patients. As is the case
with all patients,
the individual dentist should determine if he or she has the need
of another’s skills,
knowledge, equipment or experience. The dentist should also
determine, after
consultation with the patient’s physician, if appropriate, if the
patient’s health
status would be significantly compromised by the provision of
dental treatment.
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.
4.C. JUSTIFIABLE CRITICISM.
Dentists shall be obliged to report to the appropriate reviewing
agency as determined
by the local component or constituent society instances of gross or
continual faulty
treatment by other dentists. Patients should be informed of their
present oral health
status without disparaging comment about prior services. Dentists
issuing a public
statement with respect to the profession shall have a reasonable
basis to believe that
the comments made are true.
ADVISORY OPINION
4.C.1. MEANING OF “JUSTIFIABLE.”
Patients are dependent on the expertise of dentists to know their
oral health
status. Therefore, when informing a patient of the status of his or
her oral health,
the dentist should exercise care that the comments made are
truthful, informed
and justifiable. This should, if possible, involve consultation
with the previous
treating dentist(s), in accordance with applicable law, to
determine under what
circumstances and conditions the treatment was performed. A
difference of
opinion as to preferred treatment should not be communicated to the
patient in a
manner which would unjustly imply mistreatment. There will
necessarily be cases
where it will be difficult to determine whether the comments made
are justifiable.
Therefore, this section is phrased to address the discretion of
dentists and advises
against unknowing or unjustifiable disparaging statements against
another dentist.
However, it should be noted that, where comments are made which are
not
supportable and therefore unjustified, such comments can be the
basis for the
institution of a disciplinary proceeding against the dentist making
such statements.
4.D. EXPERT TESTIMONY.
Dentists may provide expert testimony when that testimony is
essential to a just and
fair disposition of a judicial or administrative action.
ADVISORY OPINION
4.D.1. CONTINGENT FEES.
It is unethical for a dentist to agree to a fee contingent upon the
favorable
outcome of the litigation in exchange for testifying as a dental
expert.
10
4.E. REBATES AND SPLIT FEES.
Dentists shall not accept or tender “rebates” or “split
fees.”
ADVISORY OPINION
4.E.1. SPLIT FEES IN ADVERTISING AND MARKETING SERVICES.
The prohibition against a dentist’s accepting or tendering rebates
or split fees
applies to business dealings between dentists and any third party,
not just other
dentists. Thus, a dentist who pays for advertising or marketing
services by
sharing a specified portion of the professional fees collected from
prospective or
actual patients with the vendor providing the advertising or
marketing services
is engaged in fee splitting. The prohibition against fee splitting
is also applicable
to the marketing of dental treatments or procedures via “social
coupons” if
the business arrangement between the dentist and the concern
providing the
marketing services for that treatment or those procedures allows
the issuing
company to collect the fee from the prospective patient, retain a
defined
percentage or portion of the revenue collected as payment for the
coupon
marketing service provided to the dentist and remit to the dentist
the remainder
of the amount collected.
Dentists should also be aware that the laws or regulations in their
jurisdictions
may contain provisions that impact the division of revenue
collected from
prospective patients between a dentist and a third party to pay for
advertising
or marketing services.
Section 5 PRINCIPLE: VERACITY (“truthfulness”). The dentist has a
duty to
communicate truthfully.
This principle expresses the concept that professionals have a duty
to be honest and
trustworthy in their dealings with people. Under this principle,
the dentist’s primary
obligations include respecting the position of trust inherent in
the dentist-patient
relationship, communicating truthfully and without deception, and
maintaining
intellectual integrity.
CODE OF PROFESSIONAL CONDUCT
5.A. REPRESENTATION OF CARE.
Dentists shall not represent the care being rendered to their
patients in a false or
misleading manner.
ADVISORY OPINIONS
5.A.1. DENTAL AMALGAM AND OTHER RESTORATIVE MATERIALS.
Based on current scientific data, the ADA has determined that the
removal of
amalgam restorations from the non-allergic patient for the alleged
purpose of
removing toxic substances from the body, when such treatment is
performed
solely at the recommendation of the dentist, is improper and
unethical. The
same principle of veracity applies to the dentist’s recommendation
concerning
the removal of any dental restorative material.
5.A.2. UNSUBSTANTIATED REPRESENTATIONS.
A dentist who represents that dental treatment or diagnostic
techniques
11
recommended or performed by the dentist has the capacity to
diagnose, cure or
alleviate diseases, infections or other conditions, when such
representations are
not based upon accepted scientific knowledge or research, is acting
unethically.
5.B. REPRESENTATION OF FEES.
Dentists shall not represent the fees being charged for providing
care in a false or
misleading manner.
ADVISORY OPINIONS
5.B.1. WAIVER OF COPAYMENT.
A dentist who accepts a third party1 payment under a copayment plan
as payment
in full without disclosing to the third party1 that the patient’s
payment portion will
not be collected, is engaged in overbilling. The essence of this
ethical impropriety
is deception and misrepresentation; an overbilling dentist makes it
appear to the
third party1 that the charge to the patient for services rendered
is higher than it
actually is.
5.B.2. OVERBILLING.
It is unethical for a dentist to increase a fee to a patient solely
because the patient
is covered under a dental benefits plan.
5.B.3. FEE DIFFERENTIAL.
The fee for a patient without dental benefits shall be considered a
dentist’s full
fee.2 This is the fee that should be represented to all benefit
carriers regardless
of any negotiated fee discount. Payments accepted by a dentist
under a
governmentally funded program, a component or constituent dental
societysponsored
access program, or a participating agreement entered into under
a
program with a third party shall not be considered or construed as
evidence
of overbilling in determining whether a charge to a patient, or to
another third
party1 in behalf of a patient not covered under any of the
aforecited programs
constitutes overbilling under this section of the Code.
5.B.4. TREATMENT DATES.
A dentist who submits a claim form to a third party1 reporting
incorrect treatment
dates for the purpose of assisting a patient in obtaining benefits
under a dental
plan, which benefits would otherwise be disallowed, is engaged in
making an
unethical, false or misleading representation to such third
party.1
5.B.5. DENTAL PROCEDURES.
A dentist who incorrectly describes on a third party1 claim form a
dental
procedure in order to receive a greater payment or reimbursement or
incorrectly
makes a non-covered procedure appear to be a covered procedure on
such a
claim form is engaged in making an unethical, false or misleading
representation
to such third party.1
5.B.6. UNNECESSARY SERVICES.
A dentist who recommends or performs unnecessary dental services or
procedures
is engaged in unethical conduct. The dentist’s ethical obligation
in this matter
applies regardless of the type of practice arrangement or
contractual obligations
in which he or she provides patient care.
12
5.C. DISCLOSURE OF CONFLICT OF INTEREST.
A dentist who presents educational or scientific information in an
article, seminar or
other program shall disclose to the readers or participants any
monetary or other
special interest the dentist may have with a company whose products
are promoted
or endorsed in the presentation. Disclosure shall be made in any
promotional material
and in the presentation itself.
5.D. DEVICES AND THERAPEUTIC METHODS.
Except for formal investigative studies, dentists shall be obliged
to prescribe, dispense,
or promote only those devices, drugs and other agents whose
complete formulae are
available to the dental profession. Dentists shall have the further
obligation of not
holding out as exclusive any device, agent, method or technique if
that representation
would be false or misleading in any material respect.
ADVISORY OPINIONS
5.D.1. REPORTING ADVERSE REACTIONS.
A dentist who suspects the occurrence of an adverse reaction to a
drug or dental
device has an obligation to communicate that information to the
broader medical
and dental community, including, in the case of a serious adverse
event, the Food
and Drug Administration (FDA).
5.D.2. MARKETING OR SALE OF PRODUCTS OR PROCEDURES.
Dentists who, in the regular conduct of their practices, engage in
or employ
auxiliaries in the marketing or sale of products or procedures to
their patients
must take care not to exploit the trust inherent in the
dentist-patient relationship
for their own financial gain. Dentists should not induce their
patients to purchase
products or undergo procedures by misrepresenting the product’s
value, the
necessity of the procedure or the dentist’s professional expertise
in recommending
the product or procedure.
In the case of a health-related product, it is not enough for the
dentist to
rely on the manufacturer’s or distributor’s representations about
the product’s
safety and efficacy. The dentist has an independent obligation to
inquire into the
truth and accuracy of such claims and verify that they are founded
on accepted
scientific knowledge or research.
Dentists should disclose to their patients all relevant information
the patient
needs to make an informed purchase decision, including whether the
product is
available elsewhere and whether there are any financial incentives
for the dentist
to recommend the product that would not be evident to the
patient.
5.E. PROFESSIONAL ANNOUNCEMENT.
In order to properly serve the public, dentists should represent
themselves in a
manner that contributes to the esteem of the profession. Dentists
should not
misrepresent their training and competence in any way that would be
false or
misleading in any material respect.3
5.F. ADVERTISING.
Although any dentist may advertise, no dentist shall advertise or
solicit patients in
any form of communication in a manner that is false or misleading
in any material
respect.3
13
ADVISORY OPINIONS
5.F.1. PUBLISHED COMMUNICATIONS.
If a dental health article, message or newsletter is published in
print or electronic
media under a dentist’s byline to the public without making
truthful disclosure of
the source and authorship or is designed to give rise to
questionable expectations
for the purpose of inducing the public to utilize the services of
the sponsoring
dentist, the dentist is engaged in making a false or misleading
representation to
the public in a material respect.3
5.F.2. EXAMPLES OF “FALSE OR MISLEADING.”
The following examples are set forth to provide insight into the
meaning of the
term “false or misleading in a material respect.”3 These examples
are not meant to
be all-inclusive. Rather, by restating the concept in alternative
language and giving
general examples, it is hoped that the membership will gain a
better understanding
of the term. With this in mind, statements shall be avoided which
would:
a) contain a material misrepresentation of fact, b) omit a fact
necessary to make
the statement considered as a whole not materially misleading, c)
be intended or
be likely to create an unjustified expectation about results the
dentist can achieve,
and d) contain a material, objective representation, whether
express or implied,
that the advertised services are superior in quality to those of
other dentists, if
that representation is not subject to reasonable
substantiation.
Subjective statements about the quality of dental services can also
raise ethical
concerns. In particular, statements of opinion may be misleading if
they are not
honestly held, if they misrepresent the qualifications of the
holder, or the basis of
the opinion, or if the patient reasonably interprets them as
implied statements of
fact. Such statements will be evaluated on a case by case basis,
considering how
patients are likely to respond to the impression made by the
advertisement as a
whole. The fundamental issue is whether the advertisement, taken as
a whole, is
false or misleading in a material respect.3
5.F.3. UNEARNED, NONHEALTH DEGREES.
A dentist may use the title Doctor or Dentist, D.D.S., D.M.D. or
any additional
earned, advanced academic degrees in health service areas in an
announcement to
the public. The announcement of an unearned academic degree may be
misleading
because of the likelihood that it will indicate to the public the
attainment of
specialty or diplomate status.
For purposes of this advisory opinion, an unearned academic degree
is one
which is awarded by an educational institution not accredited by a
generally
recognized accrediting body or is an honorary degree.
The use of a nonhealth degree in an announcement to the public may
be a
representation which is misleading because the public is likely to
assume that any
degree announced is related to the qualifications of the dentist as
a practitioner.
Some organizations grant dentists fellowship status as a token of
membership
in the organization or some other form of voluntary association.
The use of such
fellowships in advertising to the general public may be misleading
because of the
likelihood that it will indicate to the public attainment of
education or skill in the
field of dentistry.
Generally, unearned or nonhealth degrees and fellowships that
designate
association, rather than attainment, should be limited to
scientific papers and
14
curriculum vitae. In all instances, state law should be consulted.
In any review by the
council of the use of designations in advertising to the public,
the council will apply
the standard of whether the use of such is false or misleading in a
material respect.3
5.F.4. REFERRAL SERVICES.
There are two basic types of referral services for dental care:
not-for-profit and
the commercial. The not-for-profit is commonly organized by dental
societies or
community services. It is open to all qualified practitioners in
the area served. A fee
is sometimes charged the practitioner to be listed with the
service. A fee for such
referral services is for the purpose of covering the expenses of
the service and
has no relation to the number of patients referred. In contrast,
some commercial
referral services restrict access to the referral service to a
limited number of
dentists in a particular geographic area. Prospective patients
calling the service may
be referred to a single subscribing dentist in the geographic area
and the respective
dentist billed for each patient referred. Commercial referral
services often advertise
to the public stressing that there is no charge for use of the
service and the patient
may not be informed of the referral fee paid by the dentist. There
is a connotation
to such advertisements that the referral that is being made is in
the nature of a
public service. A dentist is allowed to pay for any advertising
permitted by the
Code, but is generally not permitted to make payments to another
person or entity
for the referral of a patient for professional services. While the
particular facts and
circumstances relating to an individual commercial referral service
will vary, the
council believes that the aspects outlined above for commercial
referral services
violate the Code in that it constitutes advertising which is false
or misleading in a
material respect and violates the prohibitions in the Code against
fee splitting.3
5.F.5. INFECTIOUS DISEASE TEST RESULTS.
An advertisement or other communication intended to solicit
patients which
omits a material fact or facts necessary to put the information
conveyed in the
advertisement in a proper context can be misleading in a material
respect. A dental
practice should not seek to attract patients on the basis of
partial truths which
create a false impression.3
For example, an advertisement to the public of HIV negative test
results,
without conveying additional information that will clarify the
scientific significance
of this fact contains a misleading omission. A dentist could
satisfy his or her
obligation under this advisory opinion to convey additional
information by clearly
stating in the advertisement or other communication: “This negative
HIV test
cannot guarantee that I am currently free of HIV.”
5.F.6. WEBSITES AND SEARCH ENGINE OPTIMIZATION.
Many dentists employ an Internet web site to announce their
practices, introduce
viewers to the professionals and staff in the office, describe
practice philosophies
and impart oral health care information to the public. Dentists may
use services
to increase the visibility of their web sites when consumers
perform searches
for dentally-related content. This technique is generally known as
“search engine
optimization” or “SEO.” Dentists have an ethical obligation to
ensure that their web
sites, like their other professional announcements, are truthful
and do not present
information in a manner that is false and misleading in a material
respect.3 Also, any
SEO techniques used in connection with a dentist’s web site should
comport with
the ADA Principles of Ethics and Code of Professional
Conduct.
15
5.G. NAME OF PRACTICE.
Since the name under which a dentist conducts his or her practice
may be a factor
in the selection process of the patient, the use of a trade name or
an assumed name
that is false or misleading in any material respect is unethical.
Use of the name of a
dentist no longer actively associated with the practice may be
continued for a period
not to exceed one year.3
ADVISORY OPINION
5.G.1. DENTIST LEAVING PRACTICE.
Dentists leaving a practice who authorize continued use of their
names should
receive competent advice on the legal implications of this action.
With permission
of a departing dentist, his or her name may be used for more than
one year, if,
after the one year grace period has expired, prominent notice is
provided to the
public through such mediums as a sign at the office and a short
statement on
stationery and business cards that the departing dentist has
retired from the
practice.
5.H. ANNOUNCEMENT OF SPECIALIZATION AND LIMITATION OF
PRACTICE.
A dentist may ethically announce as a specialist to the public in
any of the dental
specialties recognized by the American Dental Association including
dental public
health, endodontics, oral and maxillofacial pathology, oral and
maxillofacial radiology,
oral and maxillofacial surgery, orthodontics and dentofacial
orthopedics, pediatric
dentistry, periodontics, and prosthodontics, and in any other areas
of dentistry
for which specialty recognition has been granted under the
standards required
or recognized in the practitioner’s jurisdiction, provided the
dentist meets the
educational requirements required for recognition as a specialist
adopted by the
American Dental Association or accepted in the jurisdiction in
which they practice.*
Dentists who choose to announce specialization should use
“specialist in” and shall
devote a sufficient portion of their practice to the announced
specialty or specialties
to maintain expertise in that specialty or those specialties,
Dentists whose practice
is devoted exclusively to an announced specialty or specialties may
announce that
their practice “is limited to” that specialty or those specialties.
Dentists who use their
eligibility to announce as specialists to make the public believe
that specialty services
rendered in the dental office are being rendered by qualified
specialists when such
is not the case are engaged in unethical conduct. The burden of
responsibility is on
specialists to avoid any inference that general practitioners who
are associated with
specialists are qualified to announce themselves as
specialists.
ADVISORY OPINIONS
5.H.1. DUAL DEGREED DENTISTS.
Nothing in Section 5.H shall be interpreted to prohibit a dual
degreed dentist who
practices medicine or osteopathy under a valid state license from
announcing to
the public as a dental specialist provided the dentist meets the
educational, experience
and other standards set forth in the Code for specialty
announcement and
further providing that the announcement is truthful and not
materially misleading.
* In the case of the ADA, the educational requirements include
successful completion of an advanced
educational program accredited by the Commission on Dental
Accreditation, two or more years in
length, as specified by the Council on Dental Education and
Licensure, or being a diplomate of an
American Dental Association recognized certifying board for each
specialty announced.
16
5.H.2. SPECIALIST ANNOUNCEMENT OF CREDENTIALS IN
NON-SPECIALTY
INTEREST AREAS.
A dentist who is qualified to announce specialization under this
section may not
announce to the public that he or she is certified or a diplomate
or otherwise
similarly credentialed in an area of dentistry not recognized as a
specialty area
by the American Dental Association unless:
1. The organization granting the credential grants certification or
diplomate
status based on the following: a) the dentist’s successful
completion of a formal,
full-time advanced education program (graduate or postgraduate
level) of at least
12 months’ duration; and b) the dentist’s training and experience;
and c) successful
completion of an oral and written examination based on psychometric
principles;
and
2. The announcement includes the following language: [Name of
announced area
of dental practice] is not recognized as a specialty area by the
American Dental
Association.
Nothing in this advisory opinion affects the right of a properly
qualified dentist
to announce specialization in an ADA-recognized specialty area(s)
as provided
for under Section 5.H of this Code or the responsibility of such
dentist to limit
his or her practice exclusively to the special area(s) of dental
practice announced.
Specialists shall not announce their credentials in a manner that
implies specialization
in a non-specialty interest area.
5.I. GENERAL PRACTITIONER ANNOUNCEMENT OF SERVICES.
General dentists who wish to announce the services available in
their practices are
permitted to announce the availability of those services so long as
they avoid any
communications that express or imply specialization. General
dentists shall also state
that the services are being provided by general dentists. No
dentist shall announce
available services in any way that would be false or misleading in
any material respect.3
ADVISORY OPINIONS
5.I.1. GENERAL PRACTITIONER ANNOUNCEMENT OF CREDENTIALS
IN INTEREST AREAS IN GENERAL DENTISTRY.
A general dentist may not announce to the public that he or she is
certified or a
diplomate or otherwise similarly credentialed in an area of
dentistry not recognized
as a specialty area by the American Dental Association
unless:
1. The organization granting the credential grants certification or
diplomate
status based on the following: a) the dentist’s successful
completion of a formal,
full-time advanced education program (graduate or postgraduate
level) of at least
12 months duration; and b) the dentist’s training and experience;
and c) successful
completion of an oral and written examination based on psychometric
principles;
2. The dentist discloses that he or she is a general dentist;
and
3. The announcement includes the following language: [Name of
announced area
of dental practice] is not recognized as a specialty area by the
American Dental
Association.
17
5.I.2. CREDENTIALS IN GENERAL DENTISTRY.
General dentists may announce fellowships or other credentials
earned in the
area of general dentistry so long as they avoid any communications
that express
or imply specialization and the announcement includes the
disclaimer that the
dentist is a general dentist. The use of abbreviations to designate
credentials shall
be avoided when such use would lead the reasonable person to
believe that the
designation represents an academic degree, when such is not the
case.
NOTES:
1. A third party is any party to a dental prepayment contract that
may collect premiums, assume financial
risks, pay claims, and/or provide administrative services.
2. A full fee is the fee for a service that is set by the dentist,
which reflects the costs of providing the
procedure and the value of the dentist’s professional
judgment.
3. Advertising, solicitation of patients or business or other
promotional activities by dentists or dental
care delivery organizations shall not be considered unethical or
improper, except for those promotional
activities which are false or misleading in any material respect.
Notwithstanding any ADA Principles of
Ethics and Code of Professional Conduct or other standards of
dentist conduct which may be differently
worded, this shall be the sole standard for determining the ethical
propriety of such promotional activities.
Any provision of an ADA constituent or component society’s code of
ethics or other standard of dentist
conduct relating to dentists’ or dental care delivery
organizations’ advertising, solicitation, or other
promotional activities which is worded differently from the above
standard shall be deemed to be in
conflict with the ADA Principles of Ethics and Code of Professional
Conduct.
4. Completion of three years of advanced training in oral and
maxillofacial surgery or two years
of advanced training in one of the other recognized dental
specialties prior to 1967.
IV. INTERPRETATION AND APPLICATION OF PRINCIPLES OF ETHICS AND
CODE
OF PROFESSIONAL CONDUCT.
The foregoing ADA Principles of Ethics and Code of Professional
Conduct set forth
the ethical duties that are binding on members of the American
Dental Association.
The component and constituent societies may adopt additional
requirements or
interpretations not in conflict with the ADA Code.
Anyone who believes that a member-dentist has acted unethically
should bring the
matter to the attention of the appropriate constituent (state) or
component (local)
dental society. Whenever possible, problems involving questions of
ethics should be
resolved at the state or local level. If a satisfactory resolution
cannot be reached, the
dental society may decide, after proper investigation, that the
matter warrants issuing
formal charges and conducting a disciplinary hearing pursuant to
the procedures set
forth in Chapter XI of the ADA Bylaws and Governance and
Organizational Manual of
the American Dental Association (“Governance Manual”). PRINCIPLES
OF ETHICS AND
CODE OF PROFESSIONAL CONDUCT, MEMBER CONDUCT POLICY AND
JUDICIAL
PROCEDURES. The Council on Ethics, Bylaws and Judicial Affairs
reminds constituent
and component societies that before a dentist can be found to have
breached any
ethical obligation the dentist is entitled to a fair hearing.
A member who is found guilty of unethical conduct proscribed by the
ADA Code
or code of ethics of the constituent or component society, may be
placed under
a sentence of censure or suspension or may be expelled from
membership in the
Association. A member under a sentence of censure, suspension or
expulsion has the
right to appeal the decision to his or her constituent society and
the ADA Council on
Ethics, Bylaws and Judicial Affairs, as provided in Chapter XI of
the ADA Bylaws and
Governance Manual.
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