ethical decision making

Question 1

Define ethics; give an example of a code

what does a code of ethics recognize

Answer 1

1. ethics is a branch of philospophy that deals with thinking about morality, moral problems, and moral judgments; American Dental Hygienists Association Code of Ethics
2. professional and clients; professional and professional; professional and society

Question 2

define accountability

how to maintain it between: self (4), client (4), profession (3), employment situation (2), society (2)

Answer 2

1. the ability to answer for ones actions
2. Self: report any conduct that endangers patients, seek lifelong learning opportunities, make judgements and evaluate based on evidence, maintain current licensure and CE
   Client: provide clients with thorough and accurate info, ensure client safety and well being, encourage respectful communication, be knowledgeable of state and federal laws
   Profession: maintain ethical standards, encourage colleagues to do the same, report colleagues with unethical behavior
   Employment: remain current on state rules and regulations, follow the employment setting policy and procedures
   Society: maintain ethical conduct in the care of all clients in all settings, integrate sensitivity to diversity and cultural competency in pt care

Question 3

FUNDAMENTAL ETHICAL PRINCIPLES OF HEALTHCARE: define the following

autonomy, beneficence, nonmaleficence, justice, veracity, fidelity, societal trust, confidentiality

Answer 3

autonomy: individual right to self determination; involving client in decision making and obtaining informed consent

beneficence: benefit, or promoting good; taking only necessary rads, maintaining equipment, volunteering

nonmaleficence: above all, do no harm

justice: fairness and equality

veracity: truth telling or integrity

fidelity: obligation to keep implied or explicit promises

societal trust: value pts trust and understand that public trust in our profession is based on our actions and behavior

confidentiality: we respect the confidentiality of pt info (HIPPA)

Question 4

ADHA code of ethics: assists _______ in achieving high levels of _______, decision making, and practice

the code contains categories of ________________

Answer 4

• The ADHA Code of Ethics assists
  dental hygienists in achieving
  high levels of ethical consciousness, decision making, and practice
• the Code contains categories of Standards of Professional Responsibilities

Question 5

4 specific objectives of the code of ethics

Answer 5

• 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

Question 6

what 7 basic beliefs guide our practice and provide context for our ethics

Answer 6

• 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.
• We are obliged to be inclusive, diverse and to promote equity for access to our services and career opportunities.

Question 7

list and define the 5 fundamental principles

Answer 7

Universality: 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: 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: 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: 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: central to our ethics; 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.

Question 8

what are the 7 core values

Answer 8

Individual autonomy and respect for human beings: treat ppl with respect, give informed consent prior to treatment, give full disclosure with relevant info for them to make informed decisions

Confidentiality: respect the confidentiality of pt info, our obligation to justify any violation of confidence

Societal Trust: value client trust and understand that public trust in our profession is based on our actions
and behavior.

Non-maleficence: provide services in a manner that protects all clients
and minimizes harm to them

Beneficence: promoting the well-being of individuals and the public by engaging in health promotion/disease prevention activities.

Justice and Fairness: fair and equitable distribution of health care resources; all people should have access to high-quality, affordable oral healthcare.

Veracity: 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

Question 9

what is an ethical dilemma

Answer 9

a situation in which two ethical principles are in conflict, regardless of the decision, one will be violated

Question 10

areas in which ethical dilemmas occur:

public health:
administration:
research:
DH-DDS-client relationships:
DH-DH relationships:
employer-employee relationship:

Answer 10

– Public health hygienists: Allocating limited resources and maximizing benefits for a large population

– Administration: Maintaining balance between client and employee (or student clinician in educational settings) needs and rights

– Research: Surveys, compiling data, evaluating products or drugs
(bias, falsifying data, misuse of funds)

– Dental hygienist–dentist-client relationships: Disagreements about
oral care (most difficult & common)

– Dental hygienist–dental hygienist relationships: Colleagues
compromising client care

– Employer-employee relationships: Misuse of power or corruption

Question 11

what is the ethical decision making framework (7 steps)

Answer 11

define the problem/conflict by ones sense of professionalism/moral code

identify ethical issues

gather info including all relevant subjective and objective info including research

identify ethical alternatives and their implications

establish an ethical position which may just be the least negative

select, justify, and defend alternatives after reviewing to make sure decisions are supported and consider the client, DDS, DH, and coworkers

act on the ethical choice (implement the alternative)

Question 12

EX of ethical conflict:

– Client refuses to be premedicated with an antibiotic before an
appointment

– If the dental hygienist honors the client’s request, the ethical principle of autonomy is followed
– Ethically, the dental hygienist who treats a client without appropriate premedication would potentially harm the client, violating the ethical principles of nonmaleficence.

Answer 12

EEK!

Question 13

Jurisprudence: ________

– Oral health professionals are governed by _______ laws enacted by legislators, ________ laws (regulations) disseminated by regulatory boards, and
_______ law or ____ law determined by judicial decisions in court cases.

– A dental hygienist must be aware of the rules and regulations governing the practice of dental hygiene in the _______ where licensing is maintained.

Answer 13

jurisprudence: Oral Health
Professionals at Risk

– Oral health professionals are governed by statutory laws enacted by legislators, administrative laws (regulations) disseminated by regulatory boards, and common law or case law determined by judicial decisions in court cases.

– A dental hygienist must be aware of the rules and regulations governing the practice of dental hygiene in the jurisdiction where licensing is maintained.

Question 14

what is the difference between civil and criminal law

Answer 14

Civil law: offenses for violating private or contractual rights; a breach of legal duty against a person; requires less strict level of proof, called a preponderance of evidence

Criminal law: established for preventing harm against society and describes a criminal act as well as the appropriate punishment; level of proof required is that beyond a reasonable doubt

Question 15

what 6 governing bodies affect the practice of DH

Answer 15

• federal laws
• state or provincial statues
• regulatory boards
• state/provincial public health and safety codes
• case law from medical and dental malpractice lawsuits
• local/regional laws and codes

Question 16

– Each governing body affects the ____ of dental hygiene

– The professional is presumed to be ______ of all the rules and regulations influencing practice and can’t claim ______ of the law

– ________ for violations exist, and a practitioner who violates a particular rule may be judged under _______ governing bodies

Answer 16

– Each governing body affects the practice of dental hygiene

– The professional is presumed to be aware of all the rules and regulations influencing practice and can’t claim ignorance of the law

– Sanctions for violations exist, and a practitioner who violates a particular rule may be judged under multiple governing bodies

Question 17

legal vulnerability in dental practice can be ____ or ____

civil can be _____ or _______

tort can be _______ or _______

if tort is unintentional, that is ______

if tort is intentional what 4 laws could be broken

Answer 17

legal vulnerability in dental practice can be criminal or civil

civil can be contract or tort

tort can be intentional or unintentional

if tort is unintentional, that is negligence (professional or malpractice)

if tort is intentional what 4 laws could be broken: assault and battery, misrepresentation/deceit, defamation/slander, breach of confidentiality

Question 18

malpractice lawsuits are ____ in nature

Answer 18

civil

Question 19

BREACH OF CONTRACT

– Failure to perform a ____

A legal definition states that a contract is:
– Agreement between ___ or more ______ and _______ parties
– To do or not to do a ____ ____ for which there is sufficient consideration
– Consideration is an exchange of something of _____, such as money, between two people

Answer 19

– Failure to perform a promise

A legal definition states that a contract is:
– Agreement between two or more consenting and competent parties
– To do or not to do a legal act for which there is sufficient consideration
– Consideration is an exchange of something of value, such as money, between two people

Question 20

define:
implied contract
express contract
duty

Answer 20

Implied contract: no written document of the agreement, a contractual relationship just exists

Express contract: One in which the terms are expressed and includes either a verbal or a written agreement

Duty: Obligatory conduct or service, or conducting oneself in a particular manner

Question 21

what are the client contractual duties (4)

if a breach in a contract occurs, what can the client do

Answer 21

Cooperating in care, providing accurate information, paying fees, and keeping appointments

client can use the contract
concept to remedy the situation and obtain damages

Question 22

what are the contractual duties of the oral healthcare provider (18)

Answer 22

Be licensed and registered legally

Use reasonable care in providing services

Never exceed scope of practice

Not use experimental procedures or medications

Complete care in a reasonable time

Never abruptly stop care

Obtain informed consent

Arrange for care when absent or in emergencies

Make referrals and request consultations when necessary

Maintain privacy and confidentiality

Maintain up-to-date knowledge in field

Inform clients of treatment progress

Inform client of unanticipated occurrences

Keep accurate records

Comply with all laws

Practice within code of ethics

Charge a reasonable fee based on community standards

Never attempt a procedure for which practitioner is unqualified

Question 23

the relationship between a professional and client may end without charges of abandonment IF the following conditions are met: (6)

Answer 23

• both parties agree to end it
• death of the client or DH occurs
• the client ends the relationship by act or statement
• the client is cured/treatment is complete, as with a specialist
• the practitioner unilaterally decides to terminate care
• the client refuses necessary oral radiographs or premed for preventing infective endocarditis

Question 24

if the PRACTITIONER seeks to terminate care, what steps must be taken? (6)

The law states that a practitioner may refuse to treat an individual for any reason except for: (5)

Answer 24

notify the client by WRITTEN communication; include reason for termination; state termination date and emergency care procedure; suggest the client seek another DH; offer to provide copies of the client record; send the letter by certified or registered mail

race, creed, color, national origin, or a certain condition, such as a disability

Question 25

does the DH rely on the dentist for DH care

Answer 25

NO, Dental hygienists are accountable for dental hygiene care and do not rely on others to assume this responsibility.

Question 26

what is a tort intentional tort: unintentional tort: negligence: > what 4 things must occur

Answer 26

tort: interference with another persons right to enjoy person, property, or privacy intentional tort: committed with intent on the part of the person unintentional tort: not intended by the person accused of committing tort > Negligence: failure of one owing a duty to another to do what a reasonable and prudent person would ordinarily have done under the circumstances (falls under unintentional tort) > A duty or standard exists; a breach or failure to exercise necessary care occurs; a harm results; and the harm is directly caused by the breach of duty

Question 27

STANDARD OF CARE – Degree of ____ a reasonably prudent professional would exercise under the _____ or ______ circumstances – Is determined by members of the ______, not the ______ – Failure to meet standard of care can include: – An act of _______ (not doing something) – An act of ________ (performing act inappropriately) – Although the ______ is ultimately responsible for the actions of the dental hygienist, the dental hygienist still may be found _______ in a court of law if a required duty is not met

Answer 27

– Degree of CARE a reasonably prudent professional would exercise under the same or similar circumstances – Is determined by members of the profession, not the courts – Failure to meet standard of care can include: – An act of omission (not doing something) – An act of commission (performing act inappropriately) – Although the dentist is ultimately responsible for the actions of the dental hygienist, the dental hygienist still may be found negligent in a court of law if a required duty is not met

Question 28

INFORMED CONSENT – Informed consent is a person’s _____ to allow something to happen based on full ______ of facts required to make an intelligent decision – Consent is the individual’s right to __________ – Patient must be informed of _______ – what is a material risk – The _____ has the final say in his or her care, the client must be of _____ mind when giving consent, and the consent must be ______ to be valid

Answer 28

– Informed consent is a person’s agreement to allow something to happen based on full disclosure of facts required to make an intelligent decision – Consent is the individual’s right to self-determination – Patient must be informed of material risk – A material risk is one that a “reasonable person” would consider in determining whether to proceed with the proposed treatment – The client has the final say in his or her care, the client must be of sound mind when giving consent, and the consent must be informed to be valid

Question 29

INFORMED CONSENT what 8 things must be included in the informed consent

Answer 29

1. diagnosis of the condition 2. recommended procedure 3. nature and reasons for procedure 4. benefits AND material risks of procedure 5. prognosis if procedure is preformed or not performed 6. alternative procedures 7. risks and benefits to alternatives 8. potential consequences if not completed

Question 30

INFORMED CONSENT – In lawsuits that focus on informed consent, clients often claim: (2) – DH should explain any ______ terms and make sure that the client ______ the information – Consent must be obtained for minors from _________ – It is suggested that the office policy be developed so that informed consent is obtained in a _______ manner from all clients

Answer 30

– In lawsuits that focus on informed consent, clients claim: a lack of understanding of the risks involved, and that alternatives to treatment were not presented – DH should explain any technical terms and make sure that the client comprehends the information – Consent must be obtained for minors from parents or guardians – It is suggested that office policy be developed so that informed consent is obtained in a consistent manner from all clients

Question 31

INFORMED REFUSAL Risk of a lawsuit occurs when the client ________ to follow the advice of the treating dentist or dental hygienist when the patient has injury or consequences as a result of ________ Always inform the client of: (3) There must be discussion about the refusal and the _____, as well as an opportunity to discuss the _______

Answer 31

Risk of a lawsuit occurs when the client refuses to follow the advice of the treating dentist or dental hygienist; if patient has injury or consequences as a result of refusing the treatment Always inform the client of recommendation, reasons for recommendation, possible consequences of refusal= informed refusal There must be discussion about the refusal and the effects, as well as an opportunity to discuss the recommendation

Question 32

the informed refusal should include: (4) if the client refuses to sign the informed refusal, this should be _____ and the form signed by the _____ and the _______ a copy of the form should be given to the _____ and another copy kept in their _____

Answer 32

recommendation, list of consequences of refusal, documentation that the client understood the risk of refusal, and the date and signature of the dentist, client, and witness if the client refuses to sign the informed refusal, this should be noted and the form signed by the provider and the witness a copy of the form should be given to the client and another copy kept in the chart

Question 33

STATUTE OF LIMITATIONS – Length of time an ______ person has to enter ______ against another for an alleged injury – Starts either at the _________ occurs or at the __________ or reasonably should have discovered the injury – Ability to ___ when an injury is discovered _____ the length of time in which someone can file a lawsuit – Practitioners must be aware of the __________ and rules within their state to assist in planning for record keeping and record storage

Answer 33

– Length of time an aggrieved person has to enter lawsuits against another for an alleged injury – Starts either at the time an injury occurs or at the time the plaintiff discovers the injury or reasonably should have discovered the injury – Ability to sue when an injury is discovered expands the length of time in which someone can file a lawsuit – Practitioners must be aware of the statute of limitations and rules within their state to assist in planning for record keeping and record storage

Question 34

VA statute of limitations (yrs in jail) assault and battery contract in writing contract w/o writing false imprisonment fraud legal malpractice libel medical malpractice personal injury product liability property damage slander trespassing wrongful death

Answer 34

2yrs 5yrs 3yrs 2yrs 2yrs 2-5yrs 1yr 2yrs 2yrs 2yrs 5yrs 1yr 5yrs 2yrs

Question 35

DH and client relationship define confidentiality - maintain confidentiality in all _____ - a person can waive confidentiality through _____ or _____

Answer 35

- information about a clients care is not to be shared without a clients permission - maintain confidentiality in all settings - a person can waive confidentiality through words or actions

Question 36

how can confidentiality be waived? (2)

Answer 36

- referral to a specialist - by action of law, such as a requirement to report specific communicable diseases or the suspicion of child abuse to the state or provincial agency

Question 37

define defamation define libel define slander – If an individual’s _____ is not harmed by the defamatory comment, there is no ___ or ____ – In certain defamation cases, _____ (intent to inflict an injury) must be shown

Answer 37

a communication that injures an individual's reputation; must be FALSE written defamation verbal defamation – If an individual’s reputation is not harmed by the defamatory comment, there is no libel or slander – In certain defamation cases, malice (intent to inflict an injury) must be shown

Question 38

DH AND DENTIST RELATIONSHIP – Individual is protected against unlawful _________ in employment; Includes discrimination based on: (3) – Americans with Disabilities Act (ADA): If an individual satisfies the position requirements, the employer is required to provide reasonable accommodations such as modifying: (4) – Equal ___ Act – _____ harassment – Termination of employment: “__ ___” : termination for little or no ___

Answer 38

– Individual is protected against unlawful discrimination in employment; Includes discrimination based on pregnancy, childbirth and related medical conditions – Americans with Disabilities Act (ADA): If an individual satisfies the position requirements, the employer is required to provide reasonable accommodations such as modifying equipment, facilities, schedules, or job routine – Equal Pay Act – Sexual harassment – Termination of employment: “At will” : termination for little or no reason

Question 39

SEXUAL HARASSMENT sexual harassment is sexual _______ because it forces a person to work under ____ ______ ______ what is quid pro quo what is hostile environment

Answer 39

– Sexual discrimination because it forces a person to work under adverse employment conditions – Quid pro quo: involves a superior-subordinate relationship in which the offender has control over the working conditions of the victim – Hostile environment includes unwelcome, demeaning verbal or physical conduct of a sexual nature that creates a hostile, intimidating, or offensive work environment

Question 40

what are the steps to take when facing sexual harassment (6)

Answer 40

1. directly inform the harasser that the conduct in unwelcome and to stop 2. review office policies and protocols 3. notify a supervisor or superior 4. talk to co workers to determine if it has happened before 5. inform: if refusal of advances may affect the job, inform a coowner of the practice or other supervisory pannel 6. document precisely the content, date, time, and witnesses

Question 41

what can an employer not ask you about during an interview (11)

Answer 41

- maiden name /birth name - birth place - religion - color of skin - disability status - photograph - height/weight - marital status/children - arrest record - national origin/ancestry/descent - society/club memberships or affiliations

Question 42

Between the employer and the employee, the DH rarely has a ________. The lack of _______ may leave the DH in a risky situation. the __ should assist an employer with developing a ____ in most jurisdictions the DH works as an employee of the _______ Independent contractors (2)

Answer 42

Between the employer and the employee, the DH rarely has a written employment contract. The lack of a written agreement may leave the DH in a risky situation. the DH should assist an employer with developing a contract in most jurisdictions the DH works as an employee of the dentist Independent contractors: increased liability and total responsibility for income and social security taxes

Question 43

a _______ program is recommended to identify risks in the ____________

Answer 43

a risk management program is recommended to identify risks in the delivery of oral care

Question 44

how can communication be a risk managment tool (3)

Answer 44

- open communication between the DH and client minimizes misunderstandings - educate employers about potential liabilities for DH and their prevention - best resources for the development of a risk managment philosophy are the personnel within the employment setting

Question 45

what should the client record include? (7) *this is the providers best defense or worst enemy in a malpractice action

Answer 45

-health and dental status at the time of initial exam - treatment provided - legal documentation for corpse identification or insurance claims or fraud - legal documentation for defense of litigious claims - record required as part of state regulatory practice - tool for quality assessment and assurance - communication tool among health professionals for the clients care

Question 46

what is a dependent practitioner

Answer 46

dependent as a result of the licensing and regulation laws of the state; however, the individual is not dependent on the employer to assume legal responsibility for his or her own actions

Question 47

a DH may be charged with _____ if a breach of duty occurs and ____ results EX: not assessing a clients BP, not performing and recording a perio assessment

Answer 47

a DH may be charged with negligence if a breach of duty occurs and harm results

Question 48

what is an independent practitioner – Also is an ____ and is responsible for knowledge of labor and employment laws, _____ issues, tax laws, and related business obligations – Protecting ________, as well as keeping personal and professional ______ separate, is essential

Answer 48

a DH is responsible for all the legal principles that influence client care – Also is an employer and is responsible for knowledge of labor and employment laws, discrimination issues, tax laws, and related business obligations – Protecting personal assets, as well as keeping personal and professional expenses separate, is essential

Question 49

legal issues with an independent contractor: – The _________ is contracting to provide services: – Dental hygienist assumes that the contracting party will pay a ____ and provide certain facilities and support staff – Must approach practice with a strong __________ philosophy – During the interview process, should evaluate the employer in terms of potentially _____ activities, ________ philosophies, _____ control, and _____ keeping, to name a few considerations – Requires careful scrutiny of ___ laws and definitions of the _______ ___________ ______

Answer 49

– The dental hygienist is contracting to provide services: – Dental hygienist assumes that the contracting party will pay a salary and provide certain facilities and support staff – Must approach practice with a strong risk management philosophy – During the interview process, should evaluate the employer in terms of potentially negligent activities, referral philosophies, infection control, and record keeping, to name a few considerations – Requires careful scrutiny of tax laws and definitions of the independent contracting status

Question 50

legal issues with the EDUCATOR: - Contract with both ______ and _____ - _______ is one aspect of the relationships developed in an educational setting - _______ may also be an issue - the educator who serves as a clinical _______ must recognize that the legal principles apply to clinical _______ - may be involved in supervision of clerical and clinical staff or work with administrators

Answer 50

- Contract with both colleagues and students - confidentiality is one aspect of the relationships developed in an educational setting - discrimination may also be an issue - the educator who serves as a clinical instructor must recognize that the legal principles apply to clinical education - may be involved in supervision of clerical and clinical staff or work with administrators

Question 51

Administrator or Manager: Legal Issues - Involved in _____, _____, and possibly _______ students, colleagues, or employees - All parties involved require a clear understanding of the ___ and ______ delineated in the contract - May be responsible for ensuring the ____ of an employee from wrongful acts of another - ____ laws and related legal concepts may dictate what _______ is important and also appropriate

Answer 51

- Involved in hiring, evaluating, and possibly dismissing students, colleagues, or employees - All parties involved require a clear understanding of the rights and responsibilities delineated in the contract - May be responsible for ensuring the safety of an employee from wrongful acts of another - Labor laws and related legal concepts may dictate what documentation is important and also appropriate

Question 52

Consumer Advocate: Legal Issues – The consumer rights advocate should be aware of legislation on: (5) – Focus on areas that best meet personal needs and the needs of the population group(s) they represent

Answer 52

– The consumer rights advocate should be aware of legislation on legal issues, civil rights, healthcare, labor issues in employment of the disabled, geriatrics, and issues regarding children and adolescents – Focus on areas that best meet personal needs and the needs of the population group(s) they represent

Question 53

legal issues for a researcher – Be familiar with issues such as _________, ________, rights of human and ______ subjects, informed consent, record keeping, data management, and abandonment – Must also consider legal issue such as product liability, fund management, and tax issues

Answer 53

– Be familiar with issues such as institutional review boards, confidentiality, rights of human and animal subjects, informed consent, record keeping, data management, and abandonment – Must also consider legal issue such as product liability, fund management, and tax issues