Exam 1 toipics

code of ethics

essential characteristics of a true profession professional code - binds together members of a group through the expression of goals and aspirations and in defining expected standards of behavior A code of ethics is one of the essential characteristics of a true profession. It is a guideline for members of a professional group used for self-regulation of the group. A major purpose of a professional code of ethics is to bind the members of a group together by expressing their goals and aspirations, as well as define expected standards of behavior. The code is the contract the profession makes with society outlining the standards it will adhere to and uphold. Inherent with licensure and expected by the public.

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

hierarchy of nonmaleficence

one ought not to inflict harm one ought to prevent harm one ought to remove harm one ought to do or promote good The first entry (1) refers to avoidance of harm (nonmaleficence), which takes precedence over the second, third, and fourth entries, which define beneficence, or the promotion of good. This hierarchy of nonmaleficence and beneficence provides the clinician with a guideline to follow in sorting out dilemmas in practice.Not inflicting harm takes precedence over preventing harm, and removing harm is a higher priority than promoting good. Ideally, the dental hygienist would be able to implement all four parts of this hierarchical relationship; however, when faced with constraints and conflict, prioritization would be necessary. Avoiding harm and promoting good in the practice of dental hygiene and dentistry are not always possible.

values and concepts

paternalism veracity informed consent capacity confidentiality Several values and rules support the principles of ethics and add clarity to attempts to make ethical decisions. These new terms and concepts are paternalism, veracity, informed consent, capacity, and confidentiality and are rooted in the health care principles.

Bad behavior taints the profession

patient abandonment: refusal to treat without formal dismissal Patient/provider relationships: unequal power relationship, respect and do not abuse authority beneficence: do good-promote patient welfare and quality care encourages: giving back to community-share your skills: screenings, mission of mercy, international trips, give kids a smile day add to the professional knowledge base: teaching, research, coach, scout leader, self-governance - ADA, ADHA - state, national levels report neglect and abuse maintaining professional demeanor in the work place: no throwing instruments no yelling at staff

burden of proof

patient who incurs an injury and claims inadequate consent must establish that: hygienist had a duty to disclose sufficient information about proposed treatment to obtain informed consent hygienist breached duty the breach of duty caused the injury sustained by the patient

retain or dismiss?

patients that refuse your treatment recommendations you can continue to treat the patient you can dismiss the patient from your practice due to noncompliance if you continue to treat, you risk the chance that at some point patient's condition or treatment recommendations will not be adequately documented dismissal may lead to alienation

patient responsibilities when receiving oral health care

pay a reasonable fee in a reasonable time cooperate in care and keep appointments provide accurate answers about dental or medical history and current health status follow instructions, including home care instructions

expert witness

person with specialized credentials and high level of expertise relative to the case; testifies in front of jury 1. expert - education and experience 2. expertise to testify as to standard or care for dental hygiene (ADHA code of ethics) 3. familiarity with state dental practice act 4. knowledgeable regarding all written records relating to the controversy 5. knowledge of office or institutional policy and procedure when incident occurred

DH responsibilities when delivering oral health care

possess a proper license and registration, comply with all laws, practice within the scope of practice as dictated by state law exercise reasonable skill, care and judgment in assessment, diagnosis and treatment of patients use standard drugs, materials and techniques recognized by professional groups complete treatment within a reasonable time charge reasonable feed never abandon a patient, always arrange for care during an absence refer, unusual cases to a specialist maintain patient privacy and confidentiality keep accurate records give adequate instructions to patients maintain a level or knowledge and practice within the code of ethics

practice of dental hygeine

practice of dental hygiene without a license is a crime penalty of practicing without license includes monetary fine and/or imprisonment DH license may be revoked unprofessional conduct violation of laws and regulations clinical incompetence delivery of sub-standard care unprofessional conduct, may encompass but is not limited to: acts of fraud misrepresentation deception conviction of felony aiding and abetting any person not licensed to practice sexual conduct with the patient violation of state or federal law

code of conduct is on the line

pressure to produce on new guidelines: do prophys in 30 minutes - places profit before ethics of good treatment pressure to commit fraud - patient requests date change to get insurance coverage; procedure done in december date bill january

applying principles and values

prima facie duties (duties done first) always do the act that is in accord with the stronger prima facie duty always do the act that the greatest rightness over prima facie wrongness How these principles and codes are applied to decision making is the challenge for each health care provider faced with a professional problem or dilemma. For example: In suspected abuse, the safety of the child supersedes the right of the parent.

oral cancer

primary allegation is failure to diagnose the lesion secondary is failure to refer to an oral pathologist, oral surgeon or ear, nose, and throat physician RDH is expected to identify abnormalities in the oral cavity and make dentist aware inform your patients you are performing the OCE document and refer! follow up on the recommendation (make sure the patient saw the specialist) EX: oral cancer screening neg.

personal liability insurance

some states mandate where mandated, the DH must maintain the prescribed level of insurance coverage

if you keep the refusing patient in your practice...

you have a continued duty to examine and diagnose continued duty to inform the patient heightened duty to tell the patient how the refused treatment might affect treatment and/or other structures ex: lazy perio documentation

application of nonmaleficence

unrealistic to interpret as avoidance of pain principle of double effect cannot always avoid harm some degree of harm may be beneficial For example, Patients undergo invasive testing to find disease so they can undergo treatment and be restored to health

up coding

upcoding refers to a provider's use of CPT codes to bill a health insurance payer (private, medicaid, or medicare) for providing a higher paying service than was performed upcoding is illegal. its a fraudulent practice used by providers who are trying to cheat the system so they will be paid more money than they have negotiated with those payers

ethical dilemmas

when one or more ethical principles are in conflict different from solving daily problems weighing and balancing ethical principles are the major tasks involved in ethical decision making An example of a true ethical dilemma is one in which the principle of nonmaleficence is in conflict with the principle of autonomy in a specific situation. Such a dilemma might occur, for example, when a patient who has undergone heart valve replacement within 6 months and who requires premedication tells the dental hygienist he does not want to take any antibiotics and urges the dental hygienist to go ahead with scaling and root planing. The patient is expressing his autonomy by stating he does not wish to be premedicated. The dental hygienist, however, has taken an oath to do no harm (nonmaleficence). This is a genuine ethical dilemma because two ethical principles (patient autonomy and nonmaleficence) are in conflict. Principles, values, and rules in health care will help guide decision making in the process of providing the best dental health care for the patient. Weighing and balancing ethical principles are the major tasks involved in ethical decision making.

preceptorship

where applicant for examination and license may have served atleast one year as a dental assistant and... has served for one year as a dental hygiene trainee (on the job)

the judicial system

sources of law include: 1. legislative enactments 2. judicial decisions 3. constitutional law - supreme law of the land, both state and federal laws must be consistent with the US consititution 4. statutory law - laws made by federal state and local governments

ADHA code of ethics 3 Key concepts

Our beliefs, principles, values, and ethics are concepts reflected in the Code. They are the essential elements of our comprehensive and definitive code of ethics and are interrelated and mutually dependent.

tort law

a civil wrong or injury, other than a breach of contract, for which the plaintiff is compensated monetarily (should the plaintiff prevail) for the unreasonable harm he or she has sustained A tort is a civil wrong that results from breach of a legal duty that exists by virtue of society's expectations of performance rather than a contractual or privately created performance obligation. Torts include two types: intentional and unintentional. An intentional tort is a deliberate and purposeful act that has substantial certainty of untoward consequences from the act. Intentional torts relate to persons and to property. Insurance policies that protect health care providers against liability associated with the delivery of health care may not provide coverage for intentional tort liability. An unintentional tort includes no intent to cause harm, although harm or injury does occur

are there guarantees in dentistry?

a dentist cannot guarantee results, so a dental malpractice claim cannot be brought because the treatment you received wasn't successful ro didn't meet your expectations unanticipated outcomes: have nothing to do with error, standard of care or malpractice could be positive or negative

informed consent

a patient voluntary agreement to accept treatment based upon the patient's awareness of the nature of his/her problem, the material risks and benefits of the proposed treatment, costs associated with treatment, the alternative treatment and associated costs and risks, if any, or the consequences of no treatment at all required whenever a dental treatment is rendered based on the premise that every citizen has the basic right to be free from invasions of their body without permission is not the same as "consent" consent forms are one type of evidence that informed consent has been obtained being informed and giving consent are two different things the opportunity must exist for a discussion of the options and consequences between patient and provider duty to provide a standard of care, a dental care provider must also obtain informed consent for any treatment the patient receives treatment received must not exceed the consent given because the patient does not have a right to decide what treatment they receive

statutory provisions

abuse reporting not all laws governing the practice of dental hygiene are encompassed in state dental practice act this does not negate, dental hygienists compliance with the law dental hygienist must be familiar with personal responsibility to report abuse

intentional torts

an act must be willful, defendant must have intended to cause harm or injury, the act must have been a substantial factor in bringing about the injury battery - intentional infliction of offensive or harmful bodily contact. for example: the injection is administered. involves physical contact assault - action that places fear or bodily harm hygienist who uses physical force to control an unruly child could be charged with battery defamation - communication to a third person of an untrue statement about another person. libel-in writing; slander - verbal fraud - intentional misrepresentation Intentional Torts to Persons. The intentional tort of battery is defined as harmful, nonconsensual, or offensive contact with a person. An injury does not have to occur, only a physical invasion of a person. Intentional torts are differentiated from unintentional torts on the basis of the state of mind of the perpetrator and his or her intent to cause harm. For example, a dental hygienist who slaps a child on his buttocks with the intent to make physical contact and punish the child for difficult behavior may be guilty of battery. An assault is an action that causes apprehension in a person. No physical contact occurs in an assault, but the action may involve words and conduct. For example, a dental hygienist who raises his or her voice and threatens to harm a patient with a dental instrument, creating fear and apprehension on the part of the patient that a battery may occur, may be guilty of an assault. Dental hygienists must therefore use caution in patient management techniques to minimize the risk of being accused of battery or assault. Methods of restraint should be selected carefully, and permission should be granted before use. Other intentional torts include false imprisonment involving restraint against a victim's will, intentional infliction of emotional distress through an act of extreme and outrageous conduct, and slander or libel resulting in defamation causing damage to the reputation of another.

values and concepts: paternalism

arises from the hippocratic tradition closely related to the principles of nonmaleficence and beneficence the health care professional acts as a parent and makes decisions for the patient paternalism and autonomy are in conflict a dentist of hygienist cannot unilaterally act on behalf of the patient without denying the patients right to exercise autonomy

supper evidence for expert witness

articles in peer reviewed professional journals research findings textbooks professional organizational guidelines dental hygiene school curriculum protocols, policy & procedure manuals personal experience

4 A to alleviate moral distress

ask - ask about distress. are you seeing signs of work related distress. become aware of the problem affirm - affirm your distress and commitment to take care of yourself. affirm professional obligation to act assess - identify sources of distress and determine severity. analyze risks and benefits act - prepare personally and professionally to take action The American Association of Critical Care Nurses (AACCN) advocates a model for rising above moral distress called the "four A's." The goal in this model is to preserve the integrity and authenticity of the health care provider. Addressing moral distress requires making changes.

examples of intentional torts

assault hygienist uses harsh tone of voice and implies harm could be charged with assault dentist begins to administer local to a patient who initially refused misrepresentation doctor disregards the state practice act and allows unlicensed personnel to assume the role of the licensed hygienist

practical applications

autonomy: maintain patient records patient decides after being informed non-maleficence: "do no harm" Know: your limitations and abilities delegable duties of team members when not to work impaired-includes being too old; poor hand coordination correct handling of blood born pathogens, infection control, standard precautions CEU's - stay current with standard of care being conservative - know when to care

civil law

based on rules and regulations enforced through the court system and protects the legal rights of private persons: contract law and tort law. initiated by the individual

values and concept: informed consent

based on the patient exercising autonomy in decision making ethical and legal implications requires professional to provide relevant facts allows the patient to make decisions based on those facts Informed consent could be viewed as a process of providing appropriate information to the patient, the process of understanding and assimilating the information, and making the decision. Thus informed consent involves explaining all aspects of health and treatment and ensuring that the patient comprehends what is being explained.

what type of injuries occur due to malpractice?

cancer or periodontal disease form failed diagnosis anesthesia injuries or death from sedation injuries incurred during or after surgery on the bones/soft tissues. i.e. osteonecrosis of the jaw related to bisphosphonate therapy damage to gums or teeth resulting from failed crown and bridge protheses damage to the nerves of the mouth, lips, or jaw infection from misapplication of chemical products

learning ethical decision making

challenging often no one clearly correct answer professional, social, and economical pressures may be in conflict with values and principles ethical decision-making models helpful Ethical decision-making models provide a suggested mechanism for critical thinking and resolution of ethical dilemmas. Odom further suggested that posing ethical dilemma cases when a panel of experts is available to help students analyze and arrive at possible solutions to the hypothetical dilemmas is a means of affording those opportunities. The first dilemma, "We want her to be a Winner", in class demonstrated the process used by a panel of experts when faced with an actual ethical case. In 1989 the American Dental Education Association (ADEA) established guidelines for all dental-related educational programs that stated curriculum should provide opportunities for refining skills of ethical analysis so students are able to apply ethical principles to new and emerging problems in the profession. Moreover, students should be encouraged to develop an attitude that ethical decision making is a process involving lifelong learning and commitment. Many examples of ethical dilemma and their resolutions are posted on the ADEA website.

elements of informed consetn

competency confirmed understandable language used nature of the patients condition/diagnosis risks, consequences, and anticipated result of treatment alternative treatment risks, consequences, and anticipated results of alternative treatment cost, length of treatment and provider of treatment specified consequences of accepting no treatment

Ethical code for dental hygiene

created at the inception of the ADHA; revised most recently in 1995 maintained and monitored by the ADHA revisions by committee to the house of delegates, amended by a 2/3 vote all members, as a condition of membership, agree to uphold the code used as a reference and guide The first code of ethics for dental hygienists was created at the inception of the American Dental Hygienists' Association (ADHA) in 1927. The wording of the original code reflects the tone and verbiage of the time and the fact that initially only women were dental hygienists. The code has been revised several times over the years, most significantly in 1995. For dental hygiene students, the code of ethics for dental hygienists is a vehicle for educating novices about the obligations of the profession, informing them about the basic beliefs and fundamental principles of the group, and providing guidelines regarding the expected behavior of a dental hygiene practitioner.

dental hygienist - patient relationship

critical factor in the delivery of quality of care required commitment of both parties both have certain expectations professional have obligations to comply with governance

informed refusal

date-progress notes: care plan suggest periodontal surgery. explained justification for surgery, risks and alternative of three month maintenance care with reevaluation of need for surgery; client opted for three month maintenance care. client states that she understands three month care versus surgery. client asked questions about procedure at maintenance appointment.

what is the standard of care

degree of care that a reasonable and prudent dentist would exercise under the similar or same circumstances conduct failing to conform to the standard of care constitutes a breach of duty to the patient attempts to prove the standard was not met

process in MA

dentist must notify patient in writing dentist must offer emergency treatment for 30 days dentist must provide a referral list of local dentists to the patient

contracts

implied: assumed patient is interested in making a contract i.e. patient makes an appointment expressed: orally stated or written agreements binding if: all parties are competent; specific acts are mutually agreed upon; there is a promise of something in return for something else. such as payment or service; fiduciary relationship

practice of dental hygiene

in US profession of dental hygiene is not nationally regulated and is controlled by the states it is the responsibility of the DH to be familiar with the laws and regulations of the state

top 10 most frequent causes of complaints and discipline

inadequate infection control measures failure to conduct weekly spore testing inadequate documentation lack of treatment planning lack of informed consent (general & specific consents) inadequate risk management practices lack of required continuing education no/incorrect anesthesia and sedation permits unlicensed practice - failure to renew treatment below the standard of care

principle of justice

- Concerned with providing individuals or groups with what is owed, due, or deserved - Foundation of justice is equality - Treat all people with similar needs in a similar or identical manner - In dentistry, referred to as distributive justice (allocation in large social systems) No consequentialists view justice as a duty for health care providers. Justice in dentistry, most often discussed in terms of public policy issues, is further referred to as distributive justice. Every society must address the problem of how its resources will be distributed because every society has a scarcity of resources. Policymakers must confront the issue of how society distributes its resources. Who gets what and why? This has implications for national health care policy.

application of veracity

- Lying does not respect autonomy - Benevolent deception is the withholding of information because it would do more harm - NOT SUPPORTED by most code of ethics

Summary of code of ethics

Codes of ethics are the written standards to which health care professionals agree to adhere before society, which grants certain privileges to these groups. The core values of the profession of dental hygiene are professional autonomy, confidentiality, societal trust, nonmaleficence, beneficence, justice, and veracity. Codes of ethics are the written standards to which health care professionals agree to adhere before society, which grants certain privileges to these groups. Among these privileges are societal trust and self-regulation. Once an individual has gained the necessary professional knowledge and skill and acquired a professional license, which is an acknowledgment of this achievement, he or she is accorded professional status. The responsibility that goes with this status is to uphold the core values of the profession of dental hygiene: professional autonomy, confidentiality, societal trust, nonmaleficence, beneficence, justice, and veracity

ADHA Professional responsibilities to patients

- provide oral health care using high levels of professional knowledge, judgement & SKILL - maintain a neat work ENVIRONMENT that minimizes the risk of harm - serve all patients without DISCRIMINATION and avoid action toward any individual or group that may be interpreted as discriminatory - hold professional relationships CONFIDENTIAL - communicate respectfully promote ethical behavior and high standards of care by all dental hygienists - serve as a ADVOCATE for the welfare of pt's - provide pt's will all necessary info to make INFORMED DECISIONS - REFER as needed - EDUCATE pt's about high-quality health care

values and concepts: veracity

-*Defined as:* Being honest and telling the truth -Basis of: trust between healthcare provider and pt -Two way street: Pt expected to tell the truth Veracity binds the patient and the clinician as they seek to establish mutual treatment goals. Patients are expected to be truthful about their medical history, treatment expectations, and other relevant facts. When they are not it is called "Contributory Negligence". Clinicians, for their part, must be truthful about the diagnosis, treatment options, which include the outcome of no treatment, benefits and disadvantages of each treatment option, cost of treatment, and the longevity afforded by the various treatment options. This allows patients to use their autonomy to make decisions in their own best interest.

values and concepts: capacity

-Defined as: person's ability to understand their healthcare conditions & treatment options to make own decision capacity is a prerequisite to making informed decisions implies ability to understand, appreciate, reason In the dental setting, ensuring that a patient has capacity may often require reaching out to the family, the primary care physician, or surrogate decision maker. It is not uncommon for an individual to have transient or diminished capacity, which is the ability to express his or her wishes on one day and not the next. Being aware of the issues of capacity will assist the dental hygienist in providing ethical and legal oral health treatment to populations with cognitive deficiencies.

ethical decision making checkpoints

-Evaluate the circumstances. -Determine what moral values and ethical principles are at risk. -Ascertain what principles need to be expressed and defended. -Consider the possible adverse consequences/risks associated with taking action. -Assess whether or not the adversity can be endured. -Avoid stumbling blocks. -Continue to develop moral courage. Murray provided a listing of seven critical checkpoints to use in ethical decision making. His guiding checkpoints start with evaluating the need for moral courage and end with avoiding things that might restrain moral courage. In a clinical setting, whether it is a small or large group of practitioners, there can be an unwillingness to face the challenge of addressing unethical behaviors. Those who have the courage to stand up and speak out need the support of their peers. Do not go through the process if you are unwilling to take action. Checkpoints to apply in ethical decision making: Evaluate the circumstances to establish whether moral courage is needed in the situation. Determine what moral values and ethical principles are at risk or in question of being compromised. Ascertain what principles need to be expressed and defended in the situation—focus on one or two of the more critical values. Consider the possible adverse consequences/risks associated with taking action. Assess whether or not the adversity can be endured—determine what support/resources are available. Avoid stumbling blocks that might restrain moral courage, such as apprehension or other reflection leading to reasoning oneself out of being morally courageous in the situation. Continue to develop moral courage through education, networking, advanced training, and practice. The model provided in this chapter is a simple six-step approach derived from the decision-making literature as interpreted by Atchison and Beemsterboer and used in the early 1990s with dental and dental hygiene students in a combined ethics course. It is a reasoned approach based on theory and principle. The model has been diagrammed as a circle to emphasize the use of past information and experiences on current and future decision making.

application of paternalism

-Historical role of dental professional when patients lacked access to updated health knowledge -Should never be applied to benefit the professional at the expense of the patient In years past, however, paternalism (now commonly called parentalism) was a common practice partly because the health care provider had superior knowledge and skills and partly because patients expected the health care provider to make decisions in their best interests. Patients often had no knowledge that alternative care options were available.

application of justice

-Just allocation of health care services is difficult -No legal mandate for care to all -Access to care granted by the ability to pay, not on need (mostly) The question of who should provide dental care when an economically impoverished individual is in need of treatment is difficult to answer. Many dental hygienists and dentists provide charitable services on a regular basis, either in a private practice office or through participation in a community-based service clinic, because of their recognition of their obligation to serve society. Unfortunately, although this is a lauded practice, it does not come close to meeting the needs of those who cannot access dental care. Many dental public health practitioners and leaders consistently call for the profession to make oral health a much higher priority for federal and state decision makers.

application of informed consent

-Patient has the right to informed consent AND informed refusal -Applies to caregivers of children, those with diminished mental abilities -Use of a translator mandatory Dentists and hygienists must recognize that the patient has a right to informed consent as well as a right to make an informed refusal. Respecting the autonomy of individuals as self-determining agents recognizes their right to make their own choices and determine their own destiny. This includes the right for a patient to assess all the information provided by the professional yet still make a choice that is not the one most valued by the professional. This is known as informed refusal. The media frequently provide details of medical dilemmas when a "wrong" or questionable decision is made for another person.

structure of a lawsuit

1. injured party determines that he/she has a cause of action against another individual. based on facts of the situation and the rights and duties of each party 2. the court must have jurisdiction over the subject matter 3. notice - summons orders the defendant to appear in court 4. venue - determined by the plaintiff, if defendant may request a change 5. pleadings - complaint by the plaintiff and the defendants answer 6. discovery - permits both parties to know as many facts relating to the dispute. devices include: oral examination and written questions 7. deposition - testimony that results from oral examination of a witness under oath out of court 8. pretrial conference - just before trial, attorneys for each party meet with the judge to decide what issues remain for trial and whether a settlement prior to trial is possible 9. trial - cases are tried before a jury if a jury trial is requested by either party. some cases are tried before a judge or judges only

states court systems

1. state district court 2. state supreme court 3. state superior court *if a law suit is filed in a state court against a dental health care provider, the action would be initiated in the state district court. if damages claimed are in excess of the state's limit, the action would be initiated in the state superior court

federal court system

1. united states supreme court 2. united states courts of appeals 3. united states district courts 4. united states bankruptcy courts and united states tax courts

professional codes shape behavior in three ways:

1.Applicants for admission are screened for integrity and character. Admissions committees aim to select candidates who are the best qualified academically as well as candidates of good character. Virtue is a character trait; the assumption is that if a person is virtuous he or she will act virtuously. Thus part of the selection process often focuses on identifying virtue in the character of applicants. 2. Until proven otherwise, each entering student must be assumed to have the character traits needed to be a true professional. Educational institutions actively seek to indoctrinate students to the goals of the profession and expected professional behaviors. Learning what is expected of that professional person reinforces character traits in the developing professional. This often is accomplished by introducing students to the institution's code of conduct, by familiarizing them with the profession's code of ethics and professional conduct, by faculty serving as positive role models, and by enforcing adherence to expected professional behaviors when professional codes have been violated. 3. Upon entering professional practice, it becomes the obligation of those professionals to help regulate their profession. When violations occur, members of the profession who become aware of these violations have a duty to intervene in a substantive way. This is a serious step and must be carefully considered; the reputation of the profession and the well-being of the public ultimately rest on a willingness to engage in meaningful self-policing of the profession. This is the role of the Board of Registration in Dentistry in Massachusetts. This board is appointed by the Governor and exists to protect the public.

statue of limitations

3 years from the date of discovery of possible malpractice in no case more than 7 years from the date of treatment

ADHA code of ethics 1 preamble

As dental hygienists, we are a community of professionals devoted to the prevention of disease and the promotion and improvement of the public's health. We are preventive oral health professionals who provide educational, clinical, and therapeutic services to the public. We strive to live meaningful, productive, satisfying lives that simultaneously serve us, our profession, our society, and the world. Our actions, behaviors, and attitudes are consistent with our commitment to public service. We endorse and incorporate the Code into our daily lives

categories of ethical awareness moral sensitivity

How the dental hygienist responds to ethical issues that arise in practice depends on the ethical awareness of the individual (moral sensitivity). A situation or problem can be perceived by one individual as having an ethical component but not by another. Campbell and Rogers8 categorized the kind of moral problems encountered in life and dental practice (Table 6-1). Their first category deals with problems of moral weakness, in which moral responsibilities point in one direction and personal inclinations in another. The dental hygienist who forgoes providing a patient with needed dental health education because he or she wants to get to lunch early is lacking in professional responsibility. Another category is moral uncertainty, which is defined as the question of whether a moral obligation exists and its scope. For a dental hygienist, dealing with a noncompliant periodontal patient could raise issues of uncertainty. How far should the dental hygienist go to attain a level of health when the patient is unwilling or uninterested in following good dental health advice and guidance? The third category is composed of problems that are moral dilemmas. A moral dilemma exists when obligations or responsibilities are in conflict. Moral Distress follows on the next slide.

classifications of law

Society provides for retribution to harmed citizens through civil and criminal litigation (civil action or criminal action). A civil offense is a wrongful act against a person that violates his or her person (body), privacy, or property or contractual rights. A dental hygienist whose failure to provide appropriate periodontal therapy results in a condition of increased severity may have committed a civil offense. An office manager who breaches confidentiality by discussing a patient's medical condition with an unauthorized person without the patient's consent may have committed a civil offense. A violation of criminal law is a violation of a societal rule outlined by statutory law. Physically harming someone with a weapon is a criminal offense, as is practicing dental hygiene without a license. Although civil offenses are most commonly litigated, both civil and criminal offenses can be committed in the practice of dental hygiene. certain violations of law may be considered both criminal and civil for example, if a patient loses his or her life resulting from gross negligence of a hygienist, the hygienist could suffer loss of professional licensure, the estate of the deceased person could bring civil charges such as wrongful death against the hygienist and the state may bring criminal action such as manslaughter against the hygienist

ADHA code of ethics for dental hygienists

The Dental Hygiene Code of Ethics is meant to influence us throughout our careers. It stimulates our continuing study of ethical issues and challenges us to explore our ethical responsibilities. The Code establishes concise standards of behavior to guide the public's expectations of our profession and supports dental hygiene practice, laws and regulations. By holding ourselves accountable to meeting the standards stated in the Code, we enhance the public's trust on which our professional privilege and status are founded.

ADHA code fo ethics

The code, developed in three sections that list the duties of the profession to patients, reads as follows: Section 1: The dental hygienist should be ever ready to respond to the wants of her patrons, and should fully recognize the obligations involved in the discharge of her duties toward them. As she is in most cases unable to correctly estimate the character of her operations, her own sense of right must guarantee faithfulness in their performance. Her manner should be firm, yet kind and sympathizing so as to gain the respect and confidence of her patients, and even the simplest case committed to her care should receive that attention which is due to operations performed on living, sensitive tissue. Section 2: It is not to be expected that the patient will possess a very extended or very accurate knowledge of professional matters. The dental hygienist should make due allowance for this, patiently explaining many things which seem quite clear to herself, thus endeavoring to educate the public mind so that it will properly appreciate the beneficent efforts of our profession. She should encourage no false hopes by promising success when in the nature of the case there is uncertainty. Section 3: The dental hygienist should be temperate in all things, keeping both mind and body in the best possible health, that her patients may have the benefit of the clearness of judgment and skill which is their right.

development of ethical codes

The first ethical code dates back to the time of the Greek physician Hippocrates, and the influence of the Hippocratic oath is still reflected today in modern versions of ethical codes (Box 5-1). Traditional medical codes of ethics emphasize the physician's (1) duties in the individual patient-physician relationship, including the obligation of confidentiality; (2) authority and duty of beneficence (i.e., acting for the patient's good); and (3) obligation to each other. In return for the power and prestige granted to the professions, a code of ethics is the promise to society to uphold certain values and standards in the practice of the profession. .

ADHA code of ethics 2 purpose

The purpose of a professional code of ethics is to achieve high levels of ethical consciousness, decision making, and practice by the members of the profession. Specific objectives of the Dental Hygiene Code of Ethics are: to increase our professional and ethical consciousness and sense of ethical responsibility to lead us to recognize ethical issues and choices and to guide us in making more informed ethical decisions to establish a standard for professional judgment and conduct to provide a statement of the ethical behavior the public can expect from us

ADHA code of ethics 5 fundamental principles

These fundamental principles, universal concepts, and general laws of conduct provide the foundation for our ethics. Universality - The principle of universality expects that, if one individual judges an action to be right or wrong in a given situation, other people considering the same action in the same situation would make the same judgment. Complementarity - The principle of complementarity recognizes the existence of an obligation to justice and basic human rights. In all relationships, it requires considering the values and perspectives of others before making decisions or taking actions affecting them. Ethics - are the general standards of right and wrong that guide behavior within society. As generally accepted actions, they can be judged by determining the extent to which they promote good and minimize harm. Ethics compel us to engage in health promotion/disease prevention activities. Community - This principle expresses our concern for the bond between individuals, the community, and society in general. It leads us to preserve natural resources and inspires us to show concern for the global environment. Responsibility - is central to our ethics. We recognize that there are guidelines for making ethical choices and accept responsibility for knowing and applying them. We accept the consequences of our actions or the failure to act and are willing to make ethical choices and publicly affirm them.

ADHA code of ethics 6 core values

We acknowledge these values as general for our choices and actions. Individual Autonomy and Respect for Human Beings - People have the right to be treated with respect. They have the right to informed consent prior to treatment, and they have the right to full disclosure of all relevant information so that they can make informed choices about their care. Confidentiality - We respect the confidentiality of client information and relationships as a demonstration of the value we place on individual autonomy. We acknowledge our obligation to justify any violation of a confidence. Societal Trust - We value client trust and understand that public trust in our profession is based on our actions and behavior. Nonmaleficence - We accept our fundamental obligation to provide services in a manner that protects all clients and minimizes harm to them and others involved in their treatment. Beneficence - We have a primary role in promoting the well-being of individuals and the public by engaging in health promotion/disease prevention activities. Justice and Fairness - We value justice and support the fair and equitable distribution of health care resources. We believe all people should have access to high-quality, affordable oral health care. Veracity - We accept our obligation to tell the truth and expect that others will do the same. We value self-knowledge and seek truth and honesty in all relationships.

ADHA code of ethics 7 standards of professional responsibility

We are obligated to practice our profession in a manner that supports our purpose, beliefs, and values in accordance with the fundamental principles that support our ethics To Ourselves as Individuals . . . •Avoid self-deception and continually strive for knowledge and personal growth. •Establish and maintain a lifestyle that supports optimal health. •Create a safe work environment. •Assert our own interests in ways that are fair and equitable. •Seek the advice and counsel of others when challenged with ethical dilemmas. •Have realistic expectations of ourselves and recognize our limitations. To Ourselves as Professionals . . . •Enhance professional competencies through continuous learning in order to practice according to high standards of care. •Support dental hygiene peer-review systems and quality-assurance measures. •Develop collaborative professional relationships and exchange knowledge to enhance our own lifelong professional development. To Family and Friends . . . •Support the efforts of others to establish and maintain healthy lifestyles and respect the rights of friends and family. To Clients . . . •Provide oral health care utilizing high levels of professional knowledge, judgment, and skill. •Maintain a work environment that minimizes the risk of harm. •Serve all clients without discrimination and avoid action toward any individual or group that may be interpreted as discriminatory. •Hold professional client relationships confidential. •Communicate with clients in a respectful manner. •Promote ethical behavior and high standards of care by all dental hygienists. •Serve as an advocate for the welfare of clients. •Provide clients with the information necessary to make informed decisions about their oral health and encourage their full participation in treatment decisions and goals. •Refer clients to other health care providers when their needs are beyond our ability or scope of practice. •Educate clients about high-quality oral health care. To Colleagues . . . •Conduct professional activities and programs, and develop relationships in ways that are honest, responsible, and appropriately open and candid. •Encourage a work environment that promotes individual professional growth and development. •Collaborate with others to create a work environment that minimizes risk to the personal health and safety of our colleagues. •Manage conflicts constructively. •Support the efforts of other dental hygienists to communicate the dental hygiene philosophy and preventive oral care. •Inform other health care professionals about the relationship between general and oral health. •Promote human relationships that are mutually beneficial, including those with other health care professionals. To Employees and Employers . . . •Conduct professional activities and programs and develop relationships in ways that are honest, responsible, open, and candid. •Manage conflicts constructively. •Support the right of our employees and employers to work in an environment that promotes wellness. •Respect the employment rights of our employers and employees. To the Dental Hygiene Profession . . . •Participate in the development and advancement of our profession. •Avoid conflicts of interest and declare them when they occur. •Seek opportunities to increase public awareness and understanding of oral health practices. •Act in ways that bring credit to our profession while demonstrating appropriate respect for colleagues in other professions. •Contribute time, talent, and financial resources to support and promote our profession. •Promote a positive image for our profession. •Promote a framework for professional education that develops dental hygiene competencies to meet the oral and overall health needs of the public. To the Community and Society . . . •Recognize and uphold the laws and regulations governing our profession. •Document and report inappropriate, inadequate, or substandard care and/or illegal activities by a health care provider to the responsible authorities. •Use peer review as a mechanism for identifying inappropriate, inadequate, or substandard care provided by dental hygienists. •Comply with local, state, and federal statutes that promote public health and safety. •Develop support systems and quality-assurance programs in the workplace to assist dental hygienists in providing the appropriate standard of care. •Promote access to dental hygiene services for all, supporting justice and fairness in the distribution of health care resources. •Act consistently with the ethics of the global scientific community of which our profession is a part. •Create a healthful workplace ecosystem to support a healthy environment. •Recognize and uphold our obligation to provide pro bono service. To Scientific Investigation . . . •We accept responsibility for conducting research according to the fundamental principles underlying our ethical beliefs in compliance with universal codes, governmental standards, and professional guidelines for the care and management of experimental subjects. We acknowledge our ethical obligations to the scientific community: •Conduct research that contributes knowledge that is valid and useful to our clients and society. •Use research methods that meet accepted scientific standards. •Use research resources appropriately. •Systematically review and justify research in progress to insure the most favorable benefit-to-risk ratio to research subjects. •Submit all proposals involving human subjects to an appropriate human subject review committee. •Secure appropriate institutional committee approval for the conduct of research involving animals. •Obtain informed consent from human subjects participating in research that is based on specification published in Title 21 Code of Federal Regulations Part 46. •Respect the confidentiality and privacy of data. •Seek opportunities to advance dental hygiene knowledge through research by providing financial, human, and technical resources whenever possible. •Report research results in a timely manner. •Report research findings completely and honestly, drawing only those conclusions that are supported by the data presented. •Report the names of investigators fairly and accurately. •Interpret the research and the research of others accurately and objectively, drawing conclusions that are supported by the data presented and seeking clarity when uncertain. •Critically evaluate research methods and results before applying new theory and technology in practice. •Be knowledgeable concerning currently accepted preventive and therapeutic methods, products, and technology and their application to our practice.

ADHA code of ethics 4 basic beliefs

We recognize the importance of the following beliefs that guide our practice and provide context for our ethics: The services we provide contribute to the health and well-being of society. Our education and licensure qualify us to serve the public by preventing and treating oral disease and helping individuals achieve and maintain optimal health. Individuals have intrinsic worth, are responsible for their own health, and are entitled to make choices regarding their health. Dental hygiene care is an essential component of overall health care, and we function interdependently with other health care providers. All people should have access to health care, including oral health care. We are individually responsible for our actions and the quality of care we provide.

principles

ethical - guide the conduct of health care providers by helping to identify, clarify, and justify moral choices normative - provide a cognitive framework for analyzing moral questions and problems In health care, the main normative principles are nonmaleficence, beneficence, autonomy, and justice. These principles are associated with expectations for behaviour, and they provide guidelines in dealing with right and wrong actions. These principles provide direction about what should and should not be done in specific situations. These principles and values have already been discussed in your Health care Ethics class as has Ethical Theory and Philosophy.

professional codes in healthcare

ethical codes address personal integrity, dedication, and principled behavior effectively shape professional behavior by: screening candidates for integrity and good character professional behavior expected at entrance competent graduates regulate the profession

function of the board may include:

examination for dental hygiene licensure investigation of disciplinary charges adoption of rules and regulations regarding practice of DH

moral distress

experienced when an individual cannot do what is right because of system issue, resistance or a powerful person, or a restraint in the situation The term moral distress has been added to this listing to acknowledge situations in which the health care provider is frustrated from feelings of powerlessness when a perceived wrong is occurring but he or she is unable to act. It is the feeling experienced when an individual cannot do what he or she believes ought to be done because of a system issue, resistance of a powerful person, or a restraint in the situation. The use of this term came from the nursing profession to describe situations in which the nurse feels powerless to act ethically.

application of beneficence

for a dental hygienist, promoting good is a daily purpose and goal biomedical research, public health policies and programs, and preventive medicines are the formalized aspects community based activities attempt to meet the needs of the public problem: when "good" hold different definitions The promotion of good becomes difficult, however, when good is defined according to differing values and belief systems. The teaching of careful oral hygiene self-care to maintain health and function is an example of promotion of good to many people. However, the removal of all carious teeth to eliminate pain and suffering may be considered promoting good to other individuals. In public health programs, the appropriation of limited resources to meet the medical and dental needs of a given population can be a challenging and frustrating exercise but also part of being a health care professional who advocates for the betterment of society.

application of autonomy

founded in deontology and based on respect for persons dilemma occurs when patient and professional do not agree on what is best for the patient professional, in exercising autonomy, may decide to not provide a patient-requested service if it is conflict with a standard of care The deontologist holds that the health care provider has a duty to allow patients to make decisions about actions that will affect their bodies. The health care provider also has a duty to provide patients with all the unbiased information they would need to make a decision about treatment options. This is an area where potential for conflict exists between what the dentist and/or hygienist believes is in the best interest of the patient and what the patient believes is in his or her best interest. As long as the patient selects from treatment options that are consistent with accepted standards of care, the professional may ethically act on the patient's choice. However, the professional practitioner also has the autonomy to not provide a service requested by the patient if that service is in conflict with the standards of patient care.

principle of nonmaleficence

founding principle of all health professions first obligation: do no harm evolved to also include preventing and removing harm Patients place themselves in the care of another person and, at a minimum, should expect that no additional harm will result from that act. The patient grants another person the privilege of access to a portion of his or her body for an explicit purpose, a privilege founded in trust. Fundamental to that trust is that the health care provider will do no harm to the patient. Although nonmaleficence primarily is concerned with doing no harm, over time it has evolved to include preventing and removing harm. Prevention of harm clearly is a domain of dental hygienists. Hygienists are concerned with preventing harm when universal precautions are observed, when scaling and root planing are performed to preserve teeth and periodontal tissues, and when educating patients in home health care. Similarly, dental hygienists remove harm when they treat patients who have active periodontal disease.

A principle

general normative standard of conduct a particular decision of action is true or good for all people in all times and all places derived from common morality provides comprehensive norms in biomedical ethical framework analysis

Licensure by endorsement or reciprocity

graduates of a CODA accredited DH program whose license in in good standing in similar or higher requirements of licensure who have practiced dental hygiene for a minimum prescribed period may have examination requirements waived

licensure provision

graduation from dental hygiene program accredited by commission on dental accreditation successful completion of national, regional, and/or state licensure examination

at what point in the treatment should informed consent be given?

informed consent should be given before the treatment is begun. if during the course of treatment, the treatment plan changes then the nature of the changes should be explained and additional consent required i.e. need to use general anesthesia, change drugs, when treatment takes longer than 1 year to complete

state statutory law

licensure requirement licensure examination requirements licensure eligibility requirements licensure by endorsement approval of educational program examination and disciplinary authority scope of practice supervision requirements continuing education requirements

unsupervised practice

limited number of cities including colorado, connecticut, new mexico, minnesota, maine permit some form of unsupervised practice

potential liability for DH

not protecting privacy/divulging protected patient information practicing outside the scope of legal duties not adhering to the standard of care failure to ask if the patient is pre-medicated failure to record thorough documentation failure to identify or take precautions with a medically compromised patient soliciting patients upon change of employment venue up coding or incorrectly coding procedures

dental malpractice

malpractice for an injury due to negligent dental work, failure to diagnose or treat possible precarious oral conditions, delayed diagnosis or treatment of oral disease or other precarious oral conditions, as well as any malevolent or otherwise intentional misconduct on the dental professional's part occurs when improper treatment on the part of the dentist results in the injury of a patient. if a patient is injured, and that injury is a result of the dentists negligence, a qualified attorney could mount a malpractice suit. in addition, a dentist may be liable for failing to get proper patient consent or for failing to maintain proper credentials

issues that may regulated by state law but are not part of dental practice act

malpractices or actions resulting from health care injuries mandatory malpractice insurance patient confidentiality and heightened protection public health reporting requirements false health care claim liability for volunteer services

unintentional torts

negligence and malpractice professional negligence - failure to act as a reasonable person would under similar circumstances (standard of care) standard of care - degree of care that a reasonable prudent professional should exercise malpractice - a form of negligence, wrongful acts of professional persons

what damages can be sought

nominal - actual costs compensatory - nominal plus extra costs: lost wages, cost of correcting the problem, pain and suffering punitive: goes beyond compensating victim. intent is to punish individual who caused the harm

development of ethical codes (cont)

principal functions: provides an enforceable standard of minimally decent conduct indicates some ethical considerations for determining appropriate conduct limitations: cannot address every situation A code of ethics also is a set of commandments and, as such, has two principal functions. First, it provides an enforceable standard of minimally decent conduct for those who fall below that standard. Second, it indicates in general terms some of the ethical considerations a professional must consider when deciding on conduct. The code of ethics can and does serve as a tool in the function of self-regulation. The use of professional codes in health care has some limitations. Not every situation can be addressed in an ethical code or fully explained in an accompanying interpretation. Some philosophers have noted that most codes stress the obligations of health care professionals rather than describe the rights of those receiving health care services. 5 The current use of a patient's bill of rights in health care settings is an attempt to address this discrepancy

maintenance of patient records

professionally prudent may be mandated statutorily some sates have included it in state dental practice acts others have enacted separate laws MA: must retain record and radiographs for min. 7 years since date of last treatment

criminal law

related to acts considered offensive to society as a whole, initiated by the government *criminal law seeks to punish the offender while civil law seeks to compensate the victim

values and conflicts: confidentiality

related to respect for persons and involves the patient exercising his or her autonomy in providing information to the professional evident in all codes of ethics health information can be shared with patient permission A patient has a right to privacy concerning his or her medical and dental history, examination findings, discussion of treatment options and treatment choices, and all records pertaining to dental and dental hygiene care. This privacy extends to the way in which information is gathered, stored, and communicated to other health care professionals. Discussion about a patient's history or treatment is not to be shared with spouses, family, or friends; to do so is a violation of confidentiality

principle of beneficence

required that existing harm be removed focuses on "doing good" for the patient often linked with nonmaleficence found in all health care codes Doing good requires taking all appropriate actions to restore patients to good health. Health care providers, based on their knowledge and skill, use all reasonable means to benefit the patient. Beneficence and nonmaleficence often are linked because they are both founded in the Hippocratic tradition, which requires the physician to do what will best benefit the patient. This is a consequentialist approach. This means that the hygienist's actions, behaviors, and attitudes must be consistent with a commitment to public service, which is a commitment to benefit others. This commitment to help and benefit others morally defines the healing professions and sets them apart from other occupations, such as architecture or engineering.

breach of contract

rights are violated services are not performed services are delayed

law

rules and regulation that govern society reflects society's attitudes, mores and needs, therefore, law is constantly changing to meet the needs and expectations of society statues - laws enacted by legislation in the US congress and state or local legislatures

scope of practice

scope of practice varies among states the practice of DH includes: assessment treatment planning implementation evaluation education/prevention other therapeutic and expanded services scope of function that can be legally performed is defined by state of law example of routinely performed functions: removal of deposits and accretions from supragingival and subgingival surfaces by scaling, root plaining and polishing pit and fissure sealants fluoride application topical therapeutic and preventive solutions dental hygiene examination and charting of oral conditions exposing, developing, oral radiographs administration of local anesthesia general preclusions (you are not licensed to do this is MA) includes: diagnosis of dental procedures cutting or removal of hard tissue prescription of drugs

justice

see to emergency needs of our patients. emergency coverage includes patient not of records provide expert testimony in legal/peer issues do not participate in fee splitting "buying patients" coupons are ok as long as the vendor does not control number of referrals and how much you paid avoid disparaging comments/being hypercritical of others do not make ungrounded statements of the profession

principle of autonomy

self-determination and the ability to be self-governing and self-directing permitting individuals to make decisions about their own health potential dilemma An autonomous person chooses thoughts and actions relevant to his or her needs, independent of the will of all health care providers, who must respect the autonomy of patients and properly inform them about all aspects of the diagnosis, prognosis, and the care being provided. Because dental hygienists have a wide range of knowledge and skills, they must fully and adequately explain the parameters of the services that can be performed as well as the consequences of performing or not performing those services.

self-referral kickbacks

state and federal statues have beeb enacted to avoid conflict of interest at state and federal level there is a prohibition of kickbacks, remunerations, or payment as an incentive or inducement to refer

dental law

state boards of dentistry are created by the state legislatures a legislature delegates the authority of a board through its licensing stature boards primary responsibility is to maintain high quality health care by disciplining incompetent health care providers before and/or after patients are injured a health practitioner may be found guilty in a criminal or civil matter and remain licensed in his/her profession

ethical decision making model

step 1: identify the ethical dilemma Step 1 is the most critical step in the process. Many situations are simply never perceived to be ethical problems or dilemmas. Once the problem has been recognized, the decision maker must clearly and succinctly state the ethical question, considering all pertinent aspects of the problem. If the ethical question does not place principles in conflict, it is a simple matter of right and wrong and no process of ethical decision making is required. Proceeding to step 2 is not necessary if a clear determination of right or wrong has been made. step 2: collect information This is when you do you investigation to gather information that will help you make an informed decision. Factual information may come from more than one source. Information regarding the values of the parties involved is required. step 3: state the options After gathering all the necessary information, one may proceed to the third step, which involves brainstorming to identify as many alternatives or options as possible. Often the best decision is not the first one that comes to mind. Also, a tendency exists to think that a question has only one answer. This step forces us to stop and view the situation from all angles to identify what other people might see as alternative answers to the problem. An enlightened and open mind is required to recognize often more than one answer to a problem exists. step 4: apply ethical principles to the options Focus on the ethical principles (autonomy, beneficence, nonmaleficence, and justice) and ethical values and concepts (paternalism, confidentiality, and informed consent). In general, one or more of these will be involved in any ethical decision. State how each alternative will affect the ethical principle or rule by developing a list of pros and cons. In the pro column, show alternatives that protect or hold inviolate each principle or value. In the con column, state how an alternative could violate the principle or value. Do this for each option. This process will enable you to see which ethical principles are in conflict in this situation. Refer to the ADHA Code of Ethics for Dental Hygienists for guidance. step 5: make the decision When each alternative has been clearly outlined in terms of pros and cons, a reasonable framework is apparent for making a decision. Each option must then be considered in turn, with attention to how many pros and cons would attend each decision. The seriousness of the cons must then be weighed by the dental hygienist, remembering that, as a professional, he or she is obliged to put the patient's interests first. Simply by examining the options in a careful way, the best solution to an ethical dilemma frequently becomes obvious. Before implementing the decision, the practitioner should replay each principle against the decision to see if the decision holds up to this evaluation. step 6: implement the decision The final step involves acting on the decision that has been made. The decision process will have been futile if no action is taken. Many appropriate decisions are never implemented because this step is omitted. Remember that no action represents tacit approval of a situation.

Most common ethical dilemmas faced by dental hygienists

substandard care over-treatment scope of practice fraud confidentiality breaches impaired professional sexual harassment abuse Any type of an ethical dilemma or problem can arise in the practice of dental hygiene. Major advances in technology and the changes in delivery and payment systems in dentistry will further alter the scope and depth of ethical challenges facing dental hygienists and dentists. Dental hygienists also are increasingly finding employment in areas besides private practice, such as research, public health, and corporate fields. These arenas will pose different ethical dilemmas for these individuals. Categories of Ethical Dilemmas Most Commonly Encountered by Dental Hygienists Substandard Care Situations in which there is failure to diagnose, failure to refer, or lack of proper infection control or in which dental or dental hygiene services are provided that do not meet the accepted standard of care. Overtreatment Situations in which excessive services or services that are unnecessary for a particular case are provided. This category includes unduly influencing a patient's care decision as a result of one's position of greater knowledge. Scope of Practice Instances in which the legally assigned scope of practice is exceeded by a dental hygienist, dentist, or other member of the dental team. Know the dental laws in your state. Fraud Situations in which an insurance claim or other reimbursement mechanism is adjusted to favor the dental office or the patient's financial situation. Other types of false charting or other cost-containment efforts may be included in this category. Confidentiality Breaches Situations in which patient and/or child-parent confidentiality is jeopardized or the need and requirement for informed consent is not met. Impaired Professional Situations in which the dental hygienist or other dental team member cannot or should not perform appropriate dental care because of a dependence on alcohol, drugs, or other substances (impaired professional). Sexual Harassment Includes a wide range of behaviors that a dental team member may observe or be subjected to that can be classified as harassment. Abuse Situations in which abuse of a child, elder, or spouse is observed or suspected. Such situations have legal requirements as well as ethical considerations in most states.

general supervision

supervision of dental procedures based on instructions given by a licensed dentist but not requiring the physical presence of the dentist during the performance of those procedures

direct supervision

supervision of dental procedures based on instructions given by a licensed dentist who remains in the facility while the procedures are performed by the auxillary

immediate supervision

supervision of dental procedures by a licensed dentist who remains in the facility, personally diagnoses the condition to be treated, personally authorized the procedures, and before dismissal of the patient, evaluates the performance of the auxillary

veracity

telling the truth - risk benefits alternatives to the patient i.e. replacing fillings based on patients fears that amalgam causes systemic disease doing procedures not grounded in science - need to educate patients in the science and risk of elective procedures causing more treatment communicate to the patient when things did not go well. it is difficult to tell the patient the instrument broke or the restoration failed early tell the truth and be accountable for it and offer to make it right

abandonment

termination of treatment or refusal to see a patient unless certain criteria are met

lay witness

testifies as to facts for judge and jury

strict liability

the defendants behavior is not intentional or negligent, the basis of liability is the nature of the activity for example: the manufacturer of a defective product would be liable for damages to an individual who is injured as a result of that defect

rules and regulations

the executive branch is responsible for implementing statutory law and providing more specific guidance: executive branches include: 1. department of health 2. department of professional regulations 3. department of consumer and industry services 4. secretary of state regulation of the practice of dental hygiene is facilitated by: board of examiners board of dentistry state dental board state dental commission dental quality assurances commission board of dental health care

values and concepts: application of confidentiality

the patients right to confidentiality often must be balances against the rights of other individuals fidelity - belief that it is right to keep promises and fulfill commitments For the health care provider, it includes the duty to fulfill all portions of implied or expressed promises made to the patient in addition to holding to contractual agreements, not abandoning the patient before the completion of treatment, and keeping confidentiality.

legal frameworj

the professional relationship is legally binding based of societal beliefs of protective rights retribution for harm via civil and criminal litigation civil offense - wrongful act against a person criminal offense - violation of a societal rule