Professional Ethics and Management Flashcards

A patient with clinically sound amalgam restorations requests that they all be replaced with composite fillings due to a fear of mercury toxicity, despite the dentist's explanation that there is no scientific evidence to support this concern. Which of the following is the most ethical course of action for the dentist?

Answer: Educate the patient about the longevity of their current restorations and the risks of unnecessary treatment, and then decline to perform the procedure.

The correct action balances the principle of patient autonomy with the principles of nonmaleficence (do no harm) and beneficence (act in the patient's best interest). Simply performing an unnecessary procedure violates nonmaleficence. The dentist's primary duty is to educate the patient and refuse to provide treatment that is not clinically indicated and could cause iatrogenic harm. Dismissing the patient without due process or referring them for a procedure you believe is unethical are not appropriate actions.

According to the Health Insurance Portability and Accountability Act (HIPAA), which of the following actions constitutes a permissible disclosure of Protected Health Information (PHI) without the patient's explicit authorization?

Answer: Reporting suspected child abuse to the appropriate state authorities.

HIPAA's Privacy Rule permits covered entities to disclose PHI without patient authorization to public health authorities or other appropriate government agencies authorized by law to receive reports of child abuse and neglect. Disclosures to family members, social media, or employers for non-treatment purposes without specific patient consent are generally violations of HIPAA.

A new associate dentist observes the senior partner, who is the practice owner, consistently billing insurance for a full mouth debridement on new patients who only require a routine adult prophylaxis. What is the associate's most appropriate initial ethical action?

Answer: Privately discuss the observation and concerns with the senior partner, referencing proper ADA coding and billing guidelines.

The most appropriate initial step is direct, private communication to address the potential issue. This allows for clarification, correction of a possible misunderstanding, or addressing the unethical behavior internally before escalating the matter. Reporting to the state board is a later step if the behavior is confirmed as fraudulent and continues uncorrected. Ignoring the issue or participating in it would be unethical.

The ethical principle of Veracity requires a dentist to communicate truthfully with patients. Which of the following actions is a direct violation of this principle?

Answer: Guaranteeing to a patient that a newly placed porcelain crown will 'last a lifetime'.

The principle of Veracity is centered on truthfulness and honesty. Guaranteeing the longevity of any dental treatment is misleading because clinical outcomes can never be certain and are dependent on many factors. Recommending a specialist is an example of nonmaleficence, charging appropriately is a matter of practice management, and disclosing a procedural error is an application of veracity.

A dentist decides to terminate the provider-patient relationship with a patient who has been repeatedly non-compliant and verbally abusive to staff. To avoid a charge of patient abandonment, which of the following steps is essential?

Answer: Sending the patient a certified letter providing notice and offering to provide emergency care for a reasonable period.

To legally and ethically terminate a patient relationship without risking abandonment, the dentist must give the patient written notice, preferably by certified mail. This notice should state the reasons for termination and provide a reasonable period (e.g., 30 days) during which the dentist will be available for emergency care, allowing the patient time to find another provider.

A dental hygienist, while performing their duties, negligently causes an injury to a patient. Under the legal doctrine of *respondeat superior*, who is held ultimately liable for the employee's actions?

Answer: The employing dentist, as the 'master' or employer.

*Respondeat superior*, Latin for 'let the master answer,' is a legal doctrine holding that an employer is vicariously liable for the actions of an employee when the actions take place within the scope of employment. Therefore, the practice owner or supervising dentist is ultimately responsible for the negligence of their staff, including hygienists and assistants.