Download (eg, dental, medical, legal) have a written code of ethics. These are

Essentials of Dental Assisting, 4e
Professional & Legal Aspects of Dental
Assisting
Chapter 2
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Introduction
Dentistry is a profession different from
general businesses.
As a professional dental assistant, you are
bound by an ethical code of conduct.
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Introduction-cont’d
Ethics deals with moral conduct (right and wrong
behavior), and good and evil.
 Ethics includes the values, high standards of
conduct, and professional and personal
obligations in interacting with each other.
 As dental healthcare professionals, these
qualities are important to us as we provide
dental care to our patients.

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Introduction-cont’d


Ethics seeks to answer two basic questions:
– What should I do?
– Why should I do it?
Ethics refers to what you should do, not what you
must do. The law deals with what you must do.
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Professional Code of Ethics
• All the major professions (e.g., dental, medical, legal)
have a written code of ethics.
• These are voluntary standards of behavior, not laws,
and serve as a method of self-policing within a
profession.
• The code of ethics of most professions has been
revised on several occasions to keep it consistent
with the times, but there has never been a change in
the moral intent or overall idealism.
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Reasons for a Code of Ethics

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To demonstrate to the public the standard of
conduct it can expect from its members.
To increase the ethical consciousness and
ethical responsibility of its members.
To guide its members in making informed
ethical decisions.
To establish a standard for professional
judgment and conduct.
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Difference Between Ethics and Law
Legal issues are settled by using laws and
court decisions. Ethical issues are subject
to individual interpretation as to the right
or wrong of particular situations.
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Difference Between Ethics and Law-cont’d
• Laws are very specific and are written by
people authorized to write them.
• The law is often referred to as being “black
and white” or “right or wrong.”
• Ethics are less specific and have more gray
areas. Ethics are the conscience of the
profession.
• Laws set the minimum standard of behavior;
ethics set the highest standard of behavior.
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Introduction
Regulations regarding dental auxiliaries
vary greatly from state to state, and the
roles and the responsibilities of the dental
auxiliaries also vary from state to state.
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
State Dental Practice Act

Primary Purpose



To protect the public from incompetent
practitioners
The dental practice act specifies the legal
requirements for the practice of dentistry
within each state.
An administrative board, usually called the Board
of Dentistry, interprets and implements state
regulations.
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
State Board of Dentistry



The members of the state Board of Dentistry
(also referred to in some states as the Dental
Board) are appointed by the governor of the
state.
The board adopts rules and regulations that
define, interpret, and implement the intent of the
dental practice act.
The board regulates and enforces the laws
of practice for dentistry within the state.
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Licensure



The purpose of licensure is to protect the public
from unqualified or incompetent practitioners.
It is very important to understand the requirements
for practice in your state.
In every state, anyone who practices dentistry
without a license is guilty of an illegal act.
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Types of Supervision: Direct

Direct supervision means that the dentist has
delegated a specific procedure to be performed for
a patient of record by a legally qualified dental
auxiliary. The dentist must examine the patient
before delegating the procedure and again when
the procedure is complete.

The dentist must be physically present in the office
at the time the procedures are being performed.
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Types of Supervision: General



General supervision (indirect supervision) means that the
dentist has authorized and delegated specific procedures
that may be performed by a legally qualified dental
auxiliary for a patient of record.
Exposing radiographs and recementing a temporary crown
that has become dislodged are examples of functions that
are often delegated under general supervision.
The dentist need not be physically present in the office at
the time the procedures are being performed.
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Unlicensed Practice of Dentistry



A dental assistant or dental hygienist may legally perform
only functions delegated under the dental practice act of
the state.
Performing procedures that are not legal is practicing
dentistry without a license and this is a criminal act.
Ignorance of the dental practice act is no excuse for
illegally practicing dentistry.
This means that if the dentist asks you to perform an
expanded function that is not legal in your state, and you
choose to do so, you are committing a criminal act.
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Dentist’s Responsibility to the Patient

Duty of care

Licensed
 Use reasonable skill, care, and judgment
 Use standard drugs, materials, and techniques

Abandonment

The dentist may refuse to treat a patient; however,
this action must not be based on the patient’s race,
color, or creed.
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Patient’s Responsibilities


The patient is legally required to pay a
reasonable and agreed-upon fee for services.
The patient is expected to cooperate and to
follow instructions regarding treatment and
home care.
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 2-4 An important role of the dental assistant is to
help maintain good communication with the patient.
(Courtesy Pamela Landry, RDA.)
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Categories of Law

Criminal Law


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Felony
Misdemeanor
Infraction
Civil Law


Contract law
Administrative law
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Contract Law


Expressed contracts
Implied contracts: Most dental contracts are
implied contracts. For example, if a patient
comes to the dentist with a toothache and
allows the dentist to examine him, it is implied
that he wants treatment.
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Torts


A tort is a wrongful act that results in injury to one person by
another. It may be done accidentally (negligence) or
intentionally.
Example: A dental auxiliary mounted x-rays on the
wrong side of the mount. The dentist noticed the error and
turned the films over, and no harm was done to the patient.
No tort occurred. However, if the dentist did not notice the
error and extracted the tooth on the wrong side of the mouth
because of the error in film mounting, a tort did occur.
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“Four Ds”

Must all be present for a malpractice lawsuit to
be successful:

Duty: There must be a dentist/patient relationship
to establish the duty.
 Derelict: Negligence occurred as a result of not
meeting the standard of care.
 Direct Cause: The negligent act was the direct
cause of the injury.
 Damages: May include pain and suffering, loss
of income, medical bills, and so on.
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Types of Malpractice
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
Act of omission: Example, A dentist failed to
diagnose periodontal disease because he did
not take x-rays or do a periodontal probing.)
Act of commission: Example, A dentist
administered 15 cartridges of a local anesthetic
to a very small child, and a serious overdose
resulted in the death of the child.
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Risk Management

The major areas of risk management (prevention of
lawsuits) involve:



maintaining accurate and complete records
gaining informed consent
Legal authorities have noted that the primary factor
in avoiding legal problems with patients is
maintaining a climate of good rapport and open
communication with all patients.
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Avoiding Malpractice Suits

Prevention and good communication with the patient
are the best defenses against malpractice. Patients
are less likely to initiate a lawsuit when they have a
clear understanding of:
• What is the planned treatment?
• What are the reasonable results?
• What are the potential complications?
• What are the patients’ financial obligations?
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Res Gestae: “Part of the Action”


The dental assistant or dental hygienist must never
make critical remarks about dental treatment
rendered by his or her employer or
any other dentist.
Statements made spontaneously by anyone
(including the dental assistant) at the time of an
alleged negligent act are admissible as evidence
and may be damaging to the dentist and dental
assistant in a court of law.
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Types of Patient Consent

Implied Consent
–

Is given when the patient agrees to treatment,
or at least does not object. Implied consent is
a less reliable form of consent in a court of law
should there be a malpractice suit.
Written Consent
–
Written consent is a preferred means of obtaining
and documenting the patient’s consent and
understanding of the procedure.
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Guidelines for Informed Consent

To assist the patient in making an informed decision
about having the proposed treatment, the dentist should
explain:

The nature of the proposed treatment.
 The benefits of the proposed treatment, and the
consequences of not having the proposed treatment.
 The most common and severe risks associated with the
proposed treatment.
 Reasonable alternatives to the proposed treatment,
including the risks and benefits of each.
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Informed Refusal

If a patient refuses the proposed treatment, the
dentist must inform the patient about the likely
consequences and obtain the patient’s informed
refusal.

An informed refusal does not release the dentist from
the responsibility of providing the standard of care. A
patient may not consent to substandard care, nor may
the dentist ethically or legally agree to provide it.
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Informed Consent for Minors



For minor children, the parent, custodial parent, or
legal guardian must give consent.
When parents live separately, the child’s personal
information form should indicate which parent is
the custodial parent.
Where separated parents share custody, the
child’s record should contain letters from each
providing consent and authorization to treat.
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Patient Clinic Records



These records are important legal documents that
must be protected and handled with care.
All examination records, diagnoses, radiographs,
consent forms, updated medical histories, copies
of medical and laboratory prescriptions, and
correspondence to or about a patient are filed
together in the patient’s record.
Financial information is not included in the
patient’s chart.
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Ownership of Dental Records




The dentist technically “owns” all patient records and
radiographs.
Patients have the right to access (review) and retrieve
(remove) their records and radiographs.
Original records and radiographs are never allowed to
leave the practice without the dentist’s permission.
In most situations, duplicate radiographs and a
photocopy of the record will satisfy the patient’s needs.
Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved.