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3 — Principle: Beneficence ("do good")
The
dentist has a duty to promote
the patient's welfare.
Report of the Council on Ethics, Bylaws and Judicial
Affairs on Advisory Opinion 3.E.1. Reporting Abuse and Neglect
Reporting Abuse and Neglect under ADA
Code: The American Dental
Association recognizes the responsibility of its members to
report suspected cases of abuse and neglect of patients to
appropriate authorities, consistent with the members' legal
obligations in the jurisdictions where they practice. Section
3.E of the ADA Principles of Ethics and Code of Professional
Conduct ADA Code states:
Dentists shall be obliged to become familiar with the signs
of abuse and neglect and to report suspected cases to the
proper authorities, consistent with state laws.
This Code section emphasizes dentists' duty to educate themselves
on how to recognize signs of possible abuse or neglect of
patients and to report such cases as required by law. This
section also recognizes that laws mandating reports of suspected
abuse or neglect vary by jurisdiction.
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to Top Ethical and Legal Concerns Related
to Reporting Suspected Cases of Abuse and Neglect: The Council observes that, in considering
whether to report suspected abuse or neglect of a patient,
a dentist must keep in mind two principles that could, at
times, conflict: the principles of beneficence and patient
autonomy. Moreover, if a dentist is not a mandated reporter
who is protected by an immunity statute in his or her jurisdiction,
the dentist could face legal liability for reporting suspected
abuse or neglect.
First, dentists must remember their duty to promote their patients'
welfare. Dentists should be aware of signs of possible abuse
or neglect that may be observed in patients. Dentists also
should learn appropriate techniques for interviewing a potential
victim of abuse or neglect, if possible, to assist in making
a good-faith determination as to whether abuse or neglect
should be suspected. If legally obligated to do so, the dentist
must report a suspected case of abuse and neglect to proper
authorities.
However, a dentist's legal obligation to report suspected abuse
or neglect will vary, depending on the jurisdiction where
the dentist practices. For example, dentists are obligated
to report suspected cases of child abuse in virtually all
jurisdictions, but dentists may not necessarily be required
to report suspected child neglect. Laws vary as to whether
dentists are required to report possible mistreatment of older
adults, disabled adults, and spouses. If a dentist is not
a mandated reporter of a particular type of suspected abuse,
and is not immunized from liability for making such good-faith
reports, the dentist could be legally liable for making the
report. The Council concluded that a dentist should not be
ethically bound to report suspected abuse or neglect under
circumstances that could subject the dentist to liability.
Additionally, dentists must respect adult patients' rights
to self-determination and confidentiality. If a dentist suspects
an adult patient has been abused or neglected, but the dentist
is not a mandated reporter, and the patient does not want
the dentist to report the suspected mistreatment, the dentist
should respect the patient's wishes. Failure to do so would
not only violate the principle of patient autonomy, but could
also subject the dentist to legal liability for violating
the confidentiality of the dentist-patient relationship. The
dentist may inform the patient of appropriate community resources,
and assist the patient in accessing those resources, if the
patient agrees.
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Top Need for the Advisory Opinion: The Council decided it would
be helpful to the membership to elaborate upon Section 3.E
of the ADA Code, which recently was amended to require dentists
to report suspected cases of abuse and neglect of all individuals,
not just children, consistent with state laws. Previously,
dentists were obliged to report only perioral signs of child
abuse, as consistent with state laws.
In its discussions of the amendment of Section 3.E, the Council
observed that state laws were evolving to mandate reporting
of suspected abuse and neglect of various populations. According
to statistics compiled by the U.S. Department of Health and
Human Services' National Clearinghouse on Child Abuse and
Neglect Information, all states mandate that health care professionals
report suspected cases of child abuse. Some states also mandate
reporting of suspected neglect, and expand the definitions
of abuse or the populations whose possible mistreatment will
be cause for mandated reporting.
Dentists, among all healthcare professionals mandated to report,
account for only a small percentage of total reports filed,
even though a study showed 65 percent of all physical trauma
associated with child abuse occurs in the face or neck area.
The Council noted this and the increasing social concern over
abuse and neglect of other populations, such as the elderly
and disabled. Based on its research, the Council decided that
the public and profession would be better served if dentists'
ethical obligations reflected evolving state laws that mandate
reporting of suspected abuse and neglect of various populations.
The Advisory Opinion is designed to further explain the rationale
behind the newly amended Section 3.E of the ADA Code.
Return to
Top Text of Advisory Opinion: Advisory Opinion 3.E.1. Reporting
Abuse and Neglect of the ADA Code reads as follows:
The public and the profession are best
served by dentists who are familiar with identifying the
signs of abuse and neglect and knowledgeable about the
appropriate intervention resources for all populations.
A dentist's ethical obligation to identify and report the signs
of abuse and neglect is, at a minimum, to be consistent with
a dentist's legal obligation in the jurisdiction where the
dentist practices. Dentists, therefore, are ethically obliged
to identify and report suspected cases of abuse and neglect
to the same extent as they are legally obliged to do so in
the jurisdiction where they practice. Dentists have a concurrent
ethical obligation to respect an adult patient's right to
self-determination and confidentiality and to promote the
welfare of all patients. Care should be exercised to respect
the wishes of an adult patient who asks that a suspected case
of abuse and/or neglect not be reported, where such a report
is not mandated by law. With the patient's permission, other
possible solutions may be sought.
Dentists should be aware that jurisdictional laws vary in their
definitions of abuse and neglect, in their reporting requirements
and the extent to which immunity is granted to good faith
reporters. The variances may raise potential legal and other
risks that should be considered, while keeping in mind the
duty to put the welfare of the patient first. Therefore a
dentist's ethical obligation to identify and report suspected
cases of abuse and neglect can vary from one jurisdiction
to another.
Dentists are ethically obligated to keep current their knowledge
of both identifying abuse and neglect and reporting it in
the jurisdiction(s) where they practice.
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Council
Authority to Issue Advisory Opinions: The Council has
authority under the ADA Bylaws to issue advisory opinions
that give guidance on how the Council would interpret the
ADA Code if faced with a particular question on appeal. As
expressions of the Council's position, advisory opinions take
effect when they are adopted by the Council. Advisory Opinion
3.E.1 was adopted by the Council on April 7, 2000. Return
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