Ethical and Legal Considerations
Updated December 2001 — Currently Under Revision
I. ETHICAL CONSIDERATIONS
A dentist practicing in New York State is bound by specific laws, including those outlined in the Principles of Ethics and Code of Professional Conduct of the ADA, the Principles of Ethics and Code of Conduct of the New York State Dental Association, and the code of ethics of the component society of which he/she practices.1,2
Providers and patients should have open discussions regarding treatment options and the potential sequelae of treatment choices.
The Principles of Ethics and Code of Professional Conduct of the American Dental Association (ADA) defines five principles of ethical behavior: patient autonomy (self-governance); non-maleficence (do no harm); beneficence (do good); justice (fairness); and veracity (truthfulness).1 It provides extensive guidance for oral health professionals in ethical behavior for treatment of all patients, including those with HIV infection.
The foundation of the Principles of Ethics and Code of Conduct of the New York State Dental Association is that service to the public is the oral health care provider’s primary professional obligation. In serving the public, a dentist may exercise reasonable discretion in selecting patients for his/her practice. However, he/she may not deny dental care to an individual solely based on race, creed, color, sex, handicap, disability (including HIV), or national origin.
Oral health care providers should strive for informed decision-making by all patients. HIV disease prevention should be included in the discussion of the patient’s health when deemed appropriate.
As stated in the ADA code of ethics, “qualities of compassion, kindness, integrity, fairness and charity complement the ethical practice of dentistry and help to define the true professional.”1
II. LEGAL CONSIDERATIONS
The ADA Principles of Ethics and Code of Professional Conduct states that all dentists are obligated to provide care to patients who seek it if the indicated treatment is within the scope of their practice.1 Even if a practitioner is unfamiliar with management of HIV disease, routine care of an HIV-infected patient should not be refused, although referral to an experienced provider may be made.
Under federal, state, and municipal laws, it is illegal to refuse routine treatment based on HIV status alone. The employer must include reasonable accomodations for people with disabilities. HIV is classified as a disability under the ADA. Even if a practitioner is unfamiliar with management of HIV disease, routine care of an HIV-infected patient should not be refused, although referral to an experienced provider may be made. Referral should not be based on inadequate infection control procedures, unfamiliarity with HIV disease, or the belief that a hospital setting is better suited to treating patients with HIV. Failure to follow scientifically accepted infection prevention techniques in health care practice is unprofessional conduct.
All medical and dental records are confidential. Oral health care providers and their employees may be subject to criminal or civil prosecution if they release information regarding the health or treatment of their patients without authorization. In addition, special regulations apply to disclosure of a patient’s HIV status. Information related to HIV infection may be shared only with the patient’s written consent (see Appendix II). Disclosure of HIV information is allowed without patient consent only under specific conditions. These conditions, including medical necessity for the treatment of the patient, are stipulated in New York State Public Health Law, which specifies confidentiality requirements regarding HIV-related information.3
New York State Public Health Law states that patient-identifiable HIV information may be disclosed “to a health care provider or health facility when knowledge of HIV-related information is necessary to provide appropriate care or treatment to the protected individual or a child of the individual.”4
1. American Dental Association. The Principles of Ethics and Code of Professional Conduct. Chicago, IL: American Dental Association; 2000.
2. New York State Dental Association. The Principles of Ethics and Code of Conduct. Albany, NY; 1999.
3. New York State Public Health Law, Art 27-F.
4. New York State Public Health Law, §2782 (1) (d).
Dental Alliance for AIDS/HIV Care. Principles of Dental Management for the HIV/AIDS Patient. New York, NY. June 2000.