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ADA Principles and Ozar's Central Values > Principles and Central Values > Flashcards

Flashcards in Principles and Central Values Deck (97):

Ozar's Central Values

1) Patient's life and general health
2) Patient's oral health
3) Patient's autonomy
4) Dentist's preferred pattern of practice
5) Esthetic values
6) Efficiency in the use of resources


4 Doctor-Patient Relationship Models

1) Guild model
2) Agent model
3) Commercial model
4) Interactive model


• Relationship based on dentist's expertise and the patient's lack of it
• Patient does not make any contribution to dental decisions
• Dentist is the judge of the patient's needs

Guild Model


• All dental decisions made by patient
• Dentist provides service for patient choices
• Not much basis in reality

Agent Model


• Dentist has something to sell; patient may or may not want to buy it
• Standard "market place" principles apply
• Patient's need for care is not the direct determinant of the dentist's actions
• Dentist and patient on equal ground

Commercial Model


• Dentist and patient are equal partners
• Preservation and maximization of patient autonomy
• Dentist enhances patient's decision making capacity
• Dentist contributes expertise into the decision-making process

Interactive Model


5 ADA Principles of Ethics

1) Patient autonomy
2) Nonmaleficence
3) Beneficence
4) Justice
5) Veracity


3 Main Components of ADA Principles

1) Principles of Ethics
2) Code of Professional Conduct
3) Advisory Options


goals of the profession, provide guidance and offer justification

Principles of Ethics


conduct that is required or prohibited

Code of Professional Conduct


interpretations that apply the code of professional conduct to specific fact situations

Advisory Options


"self governance" ; The dentist has a duty to respect the patient's right to self-determination and confidentiality. Professionals have a duty to treat the patient according to the patient's desires, within the bounds of accepted treatment.

Patient Autonomy


"do no harm" ; Duty to refrain from harming the patient. Dentist's primary obligations include keeping knowledge and skills current, knowing one's own limitations and when to refer to a specialist or other professional, knowing when delegation of patient care to auxiliaries is appropriate.



"do good" ; Duty to promote the patients welfare. Serve the patient and public-at-large. Competent and timely delivery of dental care within the bound of clinical circumstances presented by the patient. (contract obligations do not excuse dentists from their ethical duty to put the patient's welfare first)



"fairness" ; Duty to treat people fairly. Duty to be fair in the dealings with patients, colleagues and society. Dealing with people justly and delivering dental care without prejudice.

Justice definition


"truthfulness" ; The dentist has a duty to communicate truthfully. Duty to be honest and trustworthy in their dealings with people. Obligations include respecting the position of trust inherent in the dentist-patient relationship, communicating truthfully and without deception, and maintaining intellectual integrity.



Patient involvement- patient should be informed of treatment plans

Patient Autonomy


Patient records- confidentiality of patient records. Dentists shall provide information when applicable with the law that will benefit future treatment of patient

Patient Autonomy


Furnishing copies of records- ethical obligation on request of patient or patient's doctor to furnish records (can be at a reasonable cost) and the obligation exists even if the patient's account is not paid in full.

Patient Autonomy (patient records)


Confidentiality of patient records- relevant information in the records should be released to another dental practitioner- assuming dentists requesting the information is the patient's present dentist.

Patient Autonomy (patient records)


Education- keeping their knowledge and skill current



Consultation and referral- seeking consultation. Specialists or consulting dentist should return the patient upon completion of care.



Second opinions- a dentists who has a patient referred by a third party for a second opinions should render the requested opinion. The third party dentists should not have a vested interest.

Nonmaleficence (consultation and referral)


Use of Auxiliary personnel- dentists are obliged to protect the health of their patients by only assigning to qualified auxiliaries (hygienists/ assistants) those duties which can be legally delegated



Personal impairment- unethical to practice while abusing controlled substances, alcohol, or other chemical agents which impair the ability to practice. Have a ethical responsibility to report first hand knowledge.



A dentist who contracts any disease or becomes impaired in any way that might endanger patients or staff, shall limit the activities of practices to those areas that do no endanger patients or dental staff.

Nonmaleficence (personal impairment)


exposure, bloodborne pathogens¬- dentists have an obligation to inform patient who may have been exposed to blood or other potentially infectious material in the dental office. If this happens dentist shall provide information concerning their bloodborne pathogen status.



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 services at another dentist.



Personal relationships with patients- should avoid sexual/ interpersonal relationships.



Community service- obligation to use their skills, knowledge and experience for the improvement of the dental health of the public, be leader in their community and maintain or elevate the esteem of the profession.



Government of a profession- (regulate itself) obligation to make themselves a part of a professional society and of observing its rules of ethics. SELF REGULATION



Research and development- make the results and benefits of their 'results' available to all when they are useful in safeguard or promoting the health to the public.



Patents and copyrights- can be obtained as long as they are not used to restrict research or practice.



Abuse and neglect- become familiar with signs of abuse and neglect and report suspected cases to authorities



Reporting abuse and neglect- ethically obligated to identify and report suspected cases of abuse and neglect to the same extent as they are legally obliged to do so in the jurisdiction where they practice. Respect the wishes of an adult patient who asks that a suspected cause of abuse/neglect not be reported.

Beneficence (abuse and neglect)


Professional demeanor in the workplace- provide a workplace environment that supports respectful and collaborative relationships for all those involved in oral health care.



Disruptive behavior in the workplace- dentists are leaders and their behavior in the workplace is important for establishing and maintaining a practice environment that supports mutual respect, good communication, and high levels of collaboration.

Beneficence (professional demeanor in workplace)


Patient Selection- reasonable discretion in selecting patients for their practices, dentists shall not accept/deny patients based on: race, creed, color, sex, or national origin



Patients with bloodborne pathogens- provide care for those in need. It is unethical to not provide treatment because they are infected with HIV, Hep B, Hep C or other bloodborne pathogens.

Justice (patient selection)


Emergency service-make reasonable arrangements for the emergency care of their patients of record. Obligated when consulted in an emergency by nonpatients to make reasonable arrangements.



Justifiable Criticism- report gross or continual faulty treatment by other dentists. Patients should be informed of their present oral health status without disparaging comment about prior service.



Meaning of "justifiable"- when informing patients of their oral health status, dentists should make sure comments made are truthful, informed and justifiable.

Justice (justifiable criticism)


Expert testimony¬- dentists may provide expert testimony when that testimony is essential to a just and fair disposition of a judicial or administrative action.



Contingent fees- unethical to get paid (charge a fee) upon favorable outcome of the litigation in exchange for testifying as a dental expert.

Justice (expert testimony)


Rebates and split fees- rebates or split fees should not be accepted or tendered



Split fees in advertising and marketing services- a dentists who pays for advertising or marketing services by sharing a specified portion of the professional fees collected from prospective or actual patients with the vendor providing the advertising or marketing services is engaged in fee splitting. Allow the issuing company to collect a fee from the prospective patient, retain a defined percentage or portion of the revenue collected as payment.

Justice (rebates and split fees)


Representation of care- dentists shall not represent the care being rendered to their patients in a false or misleading manner.



Dental amalgam and other restorative materials- the removal of amalgam restorations from the non-allergic patients for the alleged purpose of removing toxic substances from the body solely from the recommendation of the dentist is improper and unethical. Also applies to removal of any dental restorative materials.

Veracity (representation of care)


Unsubstantiated representations- unethical to represent treatment or diagnostic techniques that promote to cure or alleviate disease, infection or other conditions when there is no accepted scientific knowledge.

Veracity (representation of care)


Representation of fees- cannot represent fees being charged for providing care in a false or misleading manner



Waiver of copayment- accepts third party plans that lead to overbilling. Dentists makes it seem to the third party that the charge to the patient for services rendered is higher than it actually is.

Veracity (representation of fees)


Overbilling- unethical to increase a fee to a patient solely because the patients has dental benefits plan

Veracity (representation of fees)


Fee differential- fee for a patient without dental benefits shall be considered a dentist's full fee.

Veracity (representation of fees)


Treatment dates- submitting claims to a third party with incorrect treatment dates for the purpose of assisting a patient in obtaining benefits under a dental plan (otherwise disallowed) is unethical, and misleading to the third party.

Veracity (representation of fees)


Dental procedures- dentist who incorrectly describes a treatment to a third party claim to receive greater payment or reimbursement (non-covered procedure as a covered procedure) is unethical and misleading

Veracity (representation of fees)


Dental procedures- dentist who incorrectly describes a treatment to a third party claim to receive greater payment or reimbursement (non-covered procedure as a covered procedure) is unethical and misleading.

Veracity (representation of fees)


Unnecessary services- recommends and performs unnecessary dental services or procedures are unethical.

Veracity (representation of fees)


Disclosure of conflict of interest- promoting or endorsing a certain company or product should be disclosed to patients when being educated or informed.

Veracity (representation of fees)


Devices and therapeutic methods- obligated to prescribe, dispense, or promote only devices/drugs/other agents whose complete formulae are available to other dental profession. Not holding out certain devices/agents/methods/techniques

Veracity (representation of fees)


Reporting adverse reactions- if a dentist suspects an adverse reaction to a drug or dental device must report it to the proper authorities.

Veracity (representation of fees, devices and therapeutic methods)


Marketing or sale of products or procedures- cannot promote or employ procedures for their own financial gain (inducing patients to purchase products for the dentists own benefit). Has to inquire into the truth and accuracy of distributor's products to verify that they are founded and accepted scientific knowledge. Dentist should disclose information to their patients relevant to an informed purchase decision.

Veracity (representation of fees, devices and therapeutic methods)


Professional announcement- represents themselves in a manner that contributes to the esteem of the profession. Should not misrepresent their training or competence in a false or misleading way.

Veracity (representation of fees)


Advertising- shall not advertise or solicit patients in any false or misleading material.

Veracity (representation of fees)


Published communications- must disclose source and authorship of published materials.

Veracity (representation of fees, advertising)


Examples of 'false or misleading'- omit facts, unjustified expectation, objective representation, subjective statements (can raise ethical concerns).

Veracity (representation of fees, advertising)


Unearned, nonhealth degrees- unethical to advertise/ announce unearned academic degrees

Veracity (representation of fees, advertising)


Referral services- dentist is not generally allowed to make payments to another person or entity for the referral of patient for professional services.

Veracity (representation of fees, advertising)


Infectious disease test result- dental practices shall not seek to attract patients on the basis of partial truths which create a false impression. (i.e. advertising to the public HIV negative rest results without conveying additional information... like this negative HIV test cannot guarantee that I am currently free of HIV).

Veracity (representation of fees, advertising)


Name of practice- the use of a trade name or an assumed name that is false or misleading in any material respect is unethical. The name of a dentist no longer in practice maybe be continued for a period not to exceed one year.

Veracity (representation of fees)


Dentist leaving practice- dentist leaving a practice who authorize continued use of their names should receive competent advice on the legal implications of this actions.

Veracity (representation of fees, name of practice)


Announcement of specialization and limitation of practice- public to make an informed selection between the practitioner who has completed an accredited program beyond the dental degree and a practitioner who has not completed such a program.

Veracity (representation of fees)


Dual degreed dentists- they shall not be prohibited to announcing to the public that they have a dual degree, as long as they meet the educational, experience and other standards set forth.

Veracity (representation of fees, announcement of specialization and limitation of practice)


Specialist announcement of credentials in non-specialty interest areas- a dentist who is qualified to announce specialization under this section may not announce to the public that he or she is certified or a diplomat or otherwise similarly credentialed in an area of dentistry not recognized by the ADA.

Veracity (representation of fees, announcement of specialization and limitation of practice)


General practitioner announcement of service- general dentist can announce services available in their practice as long as it does not imply specialization.

Veracity (representation of fees)


General practitioner announcement of credentials in interest areas in general dentistry- a general dentist may not announce to the public that he or she is certified or a diplomate or otherwise similarly credentialed in an area of dentistry not recognized as a specialty by the ADA (unless grated, discloses they are a general dentist, or say that it is not recognized).

Veracity (representation of fees, general practitioner announcement of service)


Credentials in general dentistry- allowed to announce fellowships or other credentials earned in the area of general dentistry as long as they don't imply specialization and announcement includes a disclaimer.

Veracity (representation of fees, general practitioner announcement of service)


The art or practice of arriving at the
truth by the exchange of logical arguments.”



The ability of the individual to make an informed decision



the degree of mental soundness necessary to make decisions about a specific issue or to carry out a specific act



the WHO perspective on “health”

[S]tate of complete physical, mental,
and social well-being and not merely the absence of disease, or infirmity”


the hard work of staying present(presence) even with those with whom we have deep-rooted and fierce disagreements…”



“seeing pain and then reflecting about how it connects
to yourself”



“recognizing it, understanding it, and then ‘sharing’that you understand their pain, suffering, or discomfort”



Strengths-Based Approach:

i. People are active participants in the helping process (empowerment). ii. All people have strengths, often untapped or unrecognized. iii. Strengths foster motivation for growth. iv. Strengths are internal and environmental.


i. The body is mechanical ii. Living is mechanical iii. Etiology = one cause for each disease iv. Doctor acts as detached observer

Doctor-centered Care


i. Multiple, inseparable influences on health
ii. Living involves organic growth, healing, learning…iii. Etiology = a complex web of interacting causes iv. The doctor stands within and participates in the healing process.

Relationship-centered Care


i. Cumulative effect of repeated exposure to trauma ii. Brings about changes over time in clinical settings iii. Behavioral changes: sleeping, eating and self-care

Vicarious Trauma


i. Watching patients’ immense ability to heal and endureii. Exposure to resilience can bring about a positive and
adaptive change

Vicarious Resilience


focuses on decision making, active member involvement, honest praise and criticism and comradeship.



characterized by domineering and hierarchical leader



uninvolved, non-directive approach



leaders emerge out of the requirements of a particular situation



leaders are created by the positions they hold (e.g., position of chair or president)



Leadership that assists a group to achieve its goals.

Functional Leadership


the potential for individuals to behaviorally deviate from group norms without being sanctioned.

Idiosyncrasy Credit


practice of giving the appearance of representation and access to resources or decision making w/out actually doing so



“mode of thinking that people engage in when they are deeply involved in a cohesive in-group, when the members’
striving for unanimity override their motivation to realistically appraise alternative courses of action….”

Group think