Your next patient is a friendly 31-year-old woman who recently moved to your town from a military base on the East Coast. She is newly divorced from a serviceman who reenlisted for another tour in Afghanistan. She is wearing full appliances, and while you complete the examination, her 2 young sons play in your reception area. It appears that at least 1 year of treatment remains. You explain your transfer protocol, including records production and establishment of a fee structure, and she suddenly appears dejected. You ask what troubles her, and she blurts out tearfully, “I owe the other orthodontist almost $1500!” You feel your heartbeat rise as you consider the stress this young family has probably endured, compounded by your loyalty to another colleague who has not been remunerated for his effort. Is it ethical to accept her for treatment? Whom could you ask for guidance with this conundrum?
Ethical dilemmas have been ubiquitous since man learned to communicate. In health care, ethical issues are especially pertinent as the vulnerable public extends its trust in our care. Early ethical codes predating the Hippocratic Oath were developed to guide practitioners in appropriate conduct as they cared for the ill. The Hindu Upanishads, the philosophical basis of the Hindu religion, predate the Hippocratic Oath by 2 centuries. This early ethical code contains excerpts from the Atreya Anushasana, a document developed in the seventh century bc that advocates thorough diagnosis, universal beneficence, unselfishness, and respect for life.
Ethical codes evolved to define a professional’s obligations in a community and to educate a profession’s new members in appropriate conduct. Developed by veteran members of a profession, ethical codes do not necessarily define the general population’s perception of acceptable behavior. Therefore, ethical codes are not usually enforceable by law. Violation of an organization’s ethical code can involve disciplinary action within the organization.
Ethical codes comprise 2 components. The first is ethical principles: the profession’s behavioral aspirations or ideals. An example of this is beneficence (doing good), a worthy aspiration of all who care for others. In contrast, ethical standards are dictates that are enforceable by the parent organization. Prohibition of advertising oneself as an ABO diplomate after board certification has expired is one such example.
The accountability that the ethical codes provide is a means of protecting the public that we serve. Professional ethical codes are a proactive impetus to deliver optimal care, for example, by maintaining knowledge of current treatment techniques or by respecting the rights of every patient we treat. A more effective form of defensive practice might not exist. Our Principles of Ethics and Code of Professional Conduct is readily available on the AAO Web site. Whether one is a seasoned veteran or a neophyte orthodontist, there’s plenty there to learn.
Your new patient’s young sons are becoming impatient. Will you accept her for treatment knowing that there is an outstanding balance owed to her previous orthodontist? Although Article VI, Section D, of the Principles of Ethics and Code of Professional Conduct asserts that “It is not unethical to accept for treatment or complete treatment on a patient who has an outstanding balance with a previous practitioner,” you should seek her permission to dialogue with her former orthodontist before you can promise anything.
And you now realize that at least a glance at our Code of Ethics could be time well spent.