Law and Ethics for Dental Assisting Exam Study Guide (page 4)
Practice problems for this study guide can be found at:
This article is divided into two parts. The first part deals with dental ethics and the second part deals with dental law. Generally, ethical standards are higher than legal ones. Something can be legal but unethical—for example, the slavery laws in the nineteenth century.
Concepts and Skills
Dental healthcare professionals are expected to adhere to ethical standards when dealing with patients and the general public. This chapter is divided into nine topics:
- Sources of Ethics
- Basic Ethical Principles
- Professional Code of Ethics
- Ethical Principles and Dilemmas
- State Dental Practices Act
- Dental Board
- Supervision of Duties
- Dental Team–Patient Relationship
- Reporting of Abuse and Neglect
Sources of Ethics
From an early age, we learn how to deal with and treat others. There are many ways we learn about personal ethics. These sources include parents, basic instincts, teachers, moral codes, and examples of others.
Parents are our first influences. They teach us about moral and ethical decision making. Ethical choices and decisions are made starting at very young ages, and parents are the guides.
Most of us have some level of intuition or “feeling” about whether something is right or wrong. It is important to pay attention to those feelings and always put the patient’s best interests first.
School is one of the first places where individuals encounter moral and/or ethical decisions. Teachers are the facilitators in this area of learning. They help to instill a sense of right and wrong in children.
Some individuals have a set of moral codes or religious beliefs that are followed to aid them in making ethical choices and decisions. Every religion has a moral code that members should abide by and use as guidelines when making moral and ethical decisions.
Examples of Others
Role models of those making ethical decisions or living their lives with positive morals and values are invaluable. Individuals can be influenced by watching the good choices made by someone else.
Basic Ethical Principles
Healthcare providers are always guided by ethical principles. There are six basic principles of ethical dental care. They are: veracity, justice, autonomy, nonmaleficence, beneficence, and confidentiality.
This is the act of being truthful. A dental professional should always be truthful with patients. An example of this in the dental setting is letting patients know the condition of their teeth and diagnosis.
This is being fair and honest. Justice is an ethical principle on which this country was founded, and it continues to be an important value. Patients should expect justice from their dental healthcare providers.
Most dentists operate their own business, and as such, determine how best to protect patient privacy and provide patients with appropriate treatment. Dentists must do this within the limits of practiced treatment.
This is known as the principle of “do no harm.” The dental professional has an obligation not to harm the patient. Therefore, the professional should not knowingly perform any procedure that will hurt the patient.
This is known as “doing good.” The dental professional has an obligation to promote good dental health for every patient.
Patients have the right to expect that their treatment will not be discussed with other patients or shared with anyone outside the dental office without their expressed consent. The obvious exception is if the patient is a minor; in this case, the dental team will want to discuss treatment with parents or guardians. Patients have the right to keep their child’s dental history and treatment private. The dental professional must respect this. With the adoption of the Health Insurance Portability and Accountability Act (HIPAA), more dental professionals are ensuring their practices adhere to confidentiality and patient privacy standards.
Professional Code of Ethics
Each professional organization (e.g., ADA, ADAA) formulates a professional code of ethics. This is a higher standard or ideal that is set voluntarily by the members of the organization. These standards are not laws, but serve as a way for the profession to self-regulate.
Standard of Care
This is the cornerstone of the code of ethics for dentistry. This guideline demands that each dental professional provide care at the same level as their peers in similar treatment situations.
Informed Ethical Decisions
Dental healthcare professionals are faced with ethical decisions daily. Being informed about the situation will help the professional make better choices. One way to avoid malpractice lawsuits is for the dentist to inform the patient about any risks with any dental procedure, and have the patient sign the consent form, particularly if the treatment plan will take longer than one year to complete. Parents or guardians must sign consent forms for minors.
Dental healthcare professionals are held to a code of conduct of professionalism and education. This should allow them to make sound judgments.
Ethical Principles and Dilemmas
Each day, dental healthcare professionals are faced with many ethical dilemmas. One must adhere to one’s own personal ethical principles and those of the profession to reach a sound ethical decision.
Dental law, unlike a professional code of ethics, is established statutes that serve as a minimum standard of care for the profession of dentistry.
State Dental Practice Act
Each state has its own Dental Practice Act. This act dictates what that state has decided will be law regarding dental duties, including which dental healthcare professional can perform which particular task(s).
The dental board is a group of individuals (dentists, assistants, hygienists, and laypeople) appointed by the state’s governor to serve the public by interpreting and enforcing the laws set forth in the state Dental Practice Act.
Supervision of Duties
Some states have levels of supervision; for example, general and direct supervisions. General supervision allows for certain duties to be performed while the dentist is away from the office, but has left expressed consent and direction that this service be completed in his or her absence. Direct supervision refers to the performance of a dental task with the dentist present somewhere in the dental office. Refer to your state Dental Practice Act to determine if levels of supervision are listed.
Dental Team–Patient Relationship
To better understand the dental team–patient relationship, it is best to understand the following definitions and how they relate to each situation. Standard of Care This is the level of skill, knowledge, and care that is the same for other dental professionals treating patients under similar conditions. For example, it is not acceptable for a dentist to refuse treatment to a patient with HIV.
Due care is the legal term for the care that a reasonable person would exercise in similar circumstances. It is the absence of negligence.
This is the termination of the dentist–patient relationship by the dentist without a reasonable notice to the patient. For example, it is abandonment when the dentist moves to another state without informing his or her patients, or otherwise arranging for their care. In fact, if a dentist takes a vacation or closes the office for more than a day or two without emergency coverage, this is considered abandonment.
Negligence is the failure of the dental professional to exercise due care that a reasonable person would in similar circumstances. Negligence implies carelessness or inattention to one’s duties. For example, failure to correctly diagnose a condition could be considered negligence, but failure to provide a treatment plan is not.
Malpractice is professional wrongdoing resulting in injury or loss to the patient. Failure to meet a standard of conduct that is recognized by a profession becomes malpractice when a patient is injured because of error. That injury is the result of negligence, carelessness, or lack of skill of the professional healthcare worker. In a malpractice suit, dental records are legally admissible as evidence, although the dentist legally owns the clinical records and radiographs. In fact, dental assistants can be called as fact witnesses, which is someone who was present when the act was committed and tells what she or he witnessed.
Lawsuits require proof of pain and suffering (damages), negligence (lack of standard of care), cause (the negligence caused the damages), and a doctor-patient status (the individual must be a patient of record).
This is the consent given by the patient for a specific treatment once he or she has been informed of the procedure, possible complications, side-effects, and possible outcomes.
This is consent that is indicated by the patient’s actions. For example, the patient sits in the dental chair.
Dental professionals record the problem, the reason for referring the patient, and the name and type of practitioner the patient should seek for a professional opinion about treatment. Documentation of all referrals safeguards against legal action of malpractice claims.
Contributory negligence is documentation of the patient’s failure to keep, make, or follow up with appointments as recommended by the dentist. Failure to seek the attention of a specialist may also contribute to the patient’s decline in dental health.
This is the submission of information in a deceitful manner in order to gain something unlawfully. Insurance fraud is a felony and there are consequences for dental professionals filing claims that are incorrect.
Invasion of Privacy
This is the sharing of personal or private patient information with those who are not directly involved in the care of the patient. For example, posting the day’s Treatment Schedule in an area(s) where patients can view the other patients’ names is not permitted. Additionally, the selling of patient private contact information is not allowed.
In chart documentation, it is not acceptable to have a group chart for family members. Each chart entry must be made in ink, dated, and signed by both the dentist and assistant. Any errors are corrected by drawing a straight line through the mistake and beginning the entry on the next line. For example, patients’ financial ledgers are not part of their clinical record and must be kept separate.
Defamation of Character
This is the written or spoken words that cause injury to the patient’s character, name, or reputation. This is covered under tort law. Libel is false and malicious written comments, while slander is spoken false or malicious words.
This is known as the Health Insurance Portability and Accountability Act of 1996. This act is a federal regulation that ensures the privacy of the patient’s personal healthcare information.
Reporting of Abuse and Neglect
Dental healthcare providers might examine patients who have injuries to the head and neck area that stem from abuse or neglect. All dental professionals have a legal responsibility by law to report suspected cases to the authorities.
Some states legally mandate healthcare professionals to report suspected cases of abuse. Abuse is defined as any act that leads to the impairment or endangerment of another or omits normal care and treatment. Dental assistants must report suspected abuse to the proper authorities.
Dental professionals are required by law to report any types of abuse that are suspected or witnessed. Dental neglect is a form of abuse. This is a very serious matter and should be brought to the dentist’s attention. The dentist will make the decision and place the call to report the abuse.
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