Ethics

July, 2010 edition

The Core Values of Confidentiality  and Justice and Fairness

   
By Cynthia Carlson, RDH, BS; Winnie Furnari, RDH, MS, FAADH;  Lisa K. Higbee, RDH, BS; and Jennifer Lamb, RDH, MPH

Core Value: Confidentiality

Definition: Condition under which one party entrusts another with private or secret matters, told in secret. Trust is a critical aspect of confidentiality.

Application to Dental Hygiene: Confidentiality and trust between a patient and clinician are critical to an honest exchange of personal information. In order to understand a patient’s needs, choose correct methods of care and properly treat a patient, we must establish an open communication based on confidentiality. Society recognizes that health care providers are not only governed by the legal system but also by virtue of their education and special skills; health care providers are held to a higher standard than can be mandated exclusively by statutes.[1] Society expects and demands certain professional traits from a health care provider. One of these traits is confidentiality. Patients, after sharing their information, have the right to privacy of that information. This includes how information is gathered, dealt with, stored and shared. Yet confidentiality is not an absolute obligation. Situations may arise where the harm in maintaining confidentiality is greater than the harm brought about by disclosing confidential information.

Ethical Dilemma: Ethical problems arise for the dental hygienist in professional practice who is caught between two conflicting obligations.

Example: You have a recall patient whom you have known since he was 7 years old. He is now 20, and his mother brought him in today. You have known the family in the practice for 20 years and are aware that there is a family problem with alcoholism. At today’s prophylaxis appointment, you smell alcohol on the patient, and his demeanor is very different than you have known previously. In performing the oral cancer exam, you notice that the tissues are very red and inflamed, and you notice a moderate amount of recession on the facial aspects of the anterior teeth. You have him demonstrate his brushing techniques, and he states he really wants white clean teeth so he is extra aggressive. He is brushing super aggressively and incorrectly. You try to discuss proper techniques, but he cannot grasp the concept due to his impaired state. He admits to you that he had a “few shots before coming in and probably drinks too much,” but he doesn’t want anyone to know.

Is there an ethical dilemma here? The patient is a legal adult but not of legal drinking age and has confided in you about his drinking habits. You are concerned about the permanent damage he is doing to his tissues, as well as the larger drinking concerns.

What would you do?

Reference

1. Beemsterboer P. Ethics and law in dental hygiene, 2nd ed. St. Louis: Saunders; 2010.

Core Value: 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.

Definition: Equitable application of rules or conditions, or reasonableness, especially in the way people are treated or decisions are made.

Application to Dental Hygiene: All patients deserve excellent clinical treatment. Race, color, religion or age should not affect the quality of treatment provided, nor should social, economic or educational status. Differences in the specific nature of treatment should be based solely on the patient characteristics that will affect treatment outcome. Fair and just treatment requires that patients know all of their options for clinical treatment.

Ethical Dilemma: Do we prejudge our patients and recommend the treatment to which we think the patient will agree, rather than the ideal treatment to address patient need? Are we guilty of an injustice? Are we being fair to our patients?

Example: Marge, one of your elderly recall patients, presents with a broken tooth. A patient of record for many years, Marge has had a considerable amount of dental work done in the past. She usually complains of the fees and is slow to pay on her account. She has expressed in the past that she doesn’t want to put any more money into her teeth. Marge is recently widowed and has had to move into an assisted living center. Clinically, it is obvious to you that the tooth is indicated for a crown, and you have discussed this possibility with Marge. (The last time she was told she needed a crown, she left the office angry and did not reschedule for treatment.) The dentist checked the tooth, smoothed the sharp edge and dismissed her. You later ask the dentist why he didn’t diagnose the need for a crown or give Marge other options for treatment. He admitted he didn’t want to upset her. He also said she probably couldn’t afford it and wouldn’t pay for treatment anyway.

Is there an ethical dilemma here? Should you call Marge and tell her she needs a crown? Was it fair to assume that Marge cannot afford a crown? Was it fair for the dentist to disregard your professional opinion? Are we not ethically obligated to inform our patients of conditions, needed treatment, options and consequences of nontreatment? You be the judge.

Resource

American Dental Hygienists’ Association: ADHA Code of Ethics for Dental Hygienists, 1995. Available at www.adha.org/aboutadha/index.html.

The ADHA Ethics Committee does not offer legal or ethical advice. The column will address our values and offer perceived challenges to practicing by our code. Readers are encouraged to ponder the issues presented and are welcome to submit their opinions for publication as letters to the editor. Email Communications@adha.net.

Cynthia Carlson, RDH, BS, is past president and delegate of the Nebraska Dental Hygienists’ Association. A recipient of Nebraska’s Hygienist of the Year Award and member of the Medical Reserve Corps, she has practiced clinically over 30 years and presents oral health education as a volunteer.

Winnie Furnari, RDH, MS, FAADH, is past president of the New Jersey and New York Dental Hygienists’ Associations. Recipient of numerous awards, she is assistant professor at New York University, serving on the Ethics and Professionalism Council and as ADHA student chapter co-advisor. She lectures and works extensively in forensic odontology.

Lisa K. Higbee, RDH, BS, has practiced in Pocatello, Idaho for over 21 years and is Idaho’s delegate chair, serving on the Practice and Regulations Committee. Recipient of Breath RX Dental Hygienist of the Year, RDH/Sunstar Award of Distinction and ISU Distinguished Alumni Award, she delivers various continuing education presentations.

Jennifer Lamb, RDH, MPH, is currently president-elect of the Arkansas State Dental Hygienists’ Association. She has served seven years as Arkansas’ delegate for ADHA. She currently works in private practice for Richardson and Monroe, DDS, PA.