NBDHE Professional Ethics and Law Questions and Answers — Questions and Answers
Question 1: A dental hygienist completes a prophylaxis on an adult patient. Without discussing it first, the hygienist applies a fluoride varnish, assuming the patient would want it. The patient later expresses they did not want the treatment. This action could be legally classified as which of the following?
- Negligence
- Abandonment
- Battery (Correct answer)
- Defamation
Correct answer: Battery
Battery is the intentional, unconsented touching of another person. Applying a treatment without consent, even if it is not harmful, constitutes battery because it violates the patient's right to autonomy over their own body. Negligence involves a breach of the standard of care resulting in harm, which is different from unconsented contact.
Question 2: A dental hygienist is asked by the employing dentist to use an outdated and less effective method for sterilization because it is faster. The hygienist knows this method does not meet the current CDC standard of care and could risk patient safety. By refusing to comply, the hygienist is primarily upholding which ethical principle?
- Autonomy
- Veracity
- Justice
- Non-maleficence (Correct answer)
Correct answer: Non-maleficence
The principle of non-maleficence dictates the duty to 'do no harm.' Using a substandard sterilization method could directly harm patients by failing to prevent cross-contamination. By refusing, the hygienist prioritizes patient safety and upholds this fundamental principle. Autonomy relates to the patient's right to decide, Veracity to truthfulness, and Justice to fairness.
Question 3: Which of the following is a permissible disclosure of Protected Health Information (PHI) under the HIPAA Privacy Rule without requiring the patient's specific written authorization?
- Submitting a claim with diagnostic codes to the patient's insurance company for payment. (Correct answer)
- Providing a patient's name and diagnosis to a pharmaceutical sales representative.
- Discussing a patient's complex case with a colleague in the public waiting room.
- Confirming a patient's presence at the clinic to their inquiring spouse over the phone.
Correct answer: Submitting a claim with diagnostic codes to the patient's insurance company for payment.
The HIPAA Privacy Rule permits covered entities to use and disclose PHI without patient authorization for the purposes of Treatment, Payment, and healthcare Operations (TPO). Submitting a claim to an insurance company clearly falls under the 'Payment' category. All other options represent violations of patient confidentiality.
Question 4: A dental hygienist with a standard license is working in a state where the administration of local anesthesia is not within the dental hygiene scope of practice. The dentist, who is running behind schedule, directs the hygienist to administer an infiltration to the patient. What is the hygienist's most appropriate and legal course of action?
- Administer the anesthetic since it was directed by the dentist.
- Ask the patient if they consent to the hygienist administering the anesthetic.
- Inform the dentist that this task is outside the legal scope of practice and respectfully decline. (Correct answer)
- Document the dentist's request in the patient's chart and then proceed with the injection.
Correct answer: Inform the dentist that this task is outside the legal scope of practice and respectfully decline.
A dental hygienist is legally and ethically bound to practice only within their state-defined scope of practice. Performing a task outside this scope, even under a dentist's direction, is illegal and can result in disciplinary action against the hygienist's license. The primary responsibility is to adhere to the law, protecting both the patient and one's professional license.
Question 5: A patient asks the dental hygienist if a dark spot on their radiograph is a cavity. The hygienist sees clear evidence of incipient caries, but the dentist has a policy of 'watching' these spots without alarming the patient. The hygienist feels conflicted about not being fully truthful. This situation creates a conflict between which two ethical principles?
- Justice and Autonomy
- Veracity and Beneficence (Correct answer)
- Confidentiality and Non-maleficence
- Societal Trust and Justice
Correct answer: Veracity and Beneficence
This dilemma involves a conflict between Veracity (the duty to be truthful and honest with the patient about clinical findings) and a misguided sense of Beneficence (the dentist's belief that withholding information is 'doing good' for the patient by avoiding alarm). The hygienist must balance the duty to provide complete information with the perceived intent to act in the patient's best interest.
Question 6: For a civil lawsuit alleging professional negligence (malpractice) against a dental hygienist to be successful, the plaintiff must prove all of the following elements EXCEPT:
- There was a duty of care owed by the hygienist to the patient.
- The hygienist breached the standard of care.
- The hygienist's actions were the direct cause of an injury.
- The hygienist acted with malicious intent. (Correct answer)
Correct answer: The hygienist acted with malicious intent.
Professional negligence (malpractice) is based on a failure to meet the standard of care, not on intent. The four elements that must be proven are: 1) a Duty existed, 2) the duty was Breached (dereliction of duty), 3) the breach was the direct Cause of injury, and 4) Damages (harm) occurred. Malicious intent is not a required element for a negligence claim, but it would be relevant for an intentional tort like battery.
NBDHE Professional Ethics and Law Questions and Answers
A dental hygienist completes a prophylaxis on an adult patient.
Without discussing it first, the hygienist applies a fluoride varnish, assuming the patient would want it.
The patient later expresses they did not want the treatment.
This action could be legally classified as which of the following?