Ethical obliqations and the dental office team.

A hypothetical case of alleged sexual misconduct in a practice with high employee turnover and stress is analyzed by three experts. This case commentary examines the ethical role expectations of an office manager who is not directly involved but becomes aware of the activities. The commentators bring the perspectives of a dental hygienist, academic administrator, and attorney; a teacher of behavioral sciences in a dental school; and a general dentist with many years of practice experience.

Writing off the copayment.

Three dentists who have been involved in teaching ethics comment on a case where an associate discovers that the 40% of collections she was expecting as compensation is being reduced because of the practice in the office of routinely writing off patient copays. The commentators note legal requirements and professional codes, but generally seek alternatives that do not require that patients pay the amount agreed by insurance contracts.

The future of dental ethics: promises needed.

The future development of professional dental ethics requires a core group of dentists well-trained in ethics: teachers, scholars, and researchers who are also firmly grounded in the clinical aspects of the profession.This will require a significant increase in the number of individuals who can work with a range of moral views, ethical communities, and religious traditions. Proposals for addressing this situation include: the creation of a dental ethics institute, the funding of an endowed dental ethics chair, a one-year professional dental ethics fellowship program, the development of a program of ethics certification, and the initiation of a "positive ethics" self-assessment program designed specifically for dental practices and organizations. Systemic and philanthropic efforts from dental organizations will be needed to support these endeavors. Some can be initiated through existing programs and organizations.

The need for dental ethicists and the promise of universal patient acceptance: response to Richard Masella's "Renewing professionalism in dental education".

Richard Masella's "Renewing Professionalism in Dental Education: Overcoming the Market Environment" reveals why professionalism is nearly dead in America; it also shows the good of commerce and the excesses of commercialism in the market. More importantly, it collects and summarizes most of the relevant forms of education currently available to teach professionalism and professional ethics in dentistry; it then briefly examines whether those forms of education are used and if they are effective. Masella also asks some key challenging questions. His select and limited references lead to deeper studies about the nature and definition of professionalism and how it might be learned and presented. His suggestions for renewing professionalism are minimal; this sets the stage for proposing and selecting other ideas that need attention and development. Some of those ideas and suggestions, such as competition and collaboration, four types of dentistry, understanding two conflicting meanings of desire and need, and universal patient acceptance were recently explored in a workshop, "Professional Promises: Hopes and Gaps in Access to Oral Health Care" (procedings published in the November 2006 Journal of Dental Education), and were not yet available to Masella when his article was authored. His article, though, stimulates good discussion and action. Its data and substance show why, for example, dentistry needs to develop a core cadre of full-time practicing professional dental ethicists. Currently, there is only a small but very dedicated group of volunteers trying to meet our society's need to bring new life to professionalism in dentistry and our market.

How did we get here? Where are we going? Hopes and gaps in access to oral health care.

This article reviews the history and future good of acceptance ethics and helps frame the publication of papers presented at the workshop on Professional Promises: Hopes and Gaps in Access to Oral Health Care. Discovery and development of Universal Patient Acceptance (UPA), a practical application of acceptance ethics, is key to systematizing access to oral health; UPA expands partnerships among professional volunteerism, culture, and economic structures. A Veterans' Administration health services preventive dentistry research project and a West Virginia school children's preventive dental program raised awareness of acceptance. A state insurance crisis revealed an underlying systems ethics problem that was not purely legal, political, educational, economic, or scientific in nature. Key players were identified for dialogue, and questions were ranked. UPA was articulated and proposed as a unique, practical, and positive professional promise. The experience involved PEDNET, a dental ethics education group. An intensive applied dental ethics course for practicing dentists was developed; it attracted the American College of Dentists (ACD) and American Dental Association (ADA). Annual ACD LeaderSkills helped expand continuing education of ethics; several dental ethics summits were initiated. Concepts like discourse, adequate care, and viewing organizations as both persons and machines motivated further exploration of acceptance. Separating acceptance from diagnosis, treatment, and payment improves discourse on the various philosophical notions and practical applications that dominate each area.

The ethical and practical aspects of acceptance and universal patient acceptance.

"Acceptance" is an often presupposed, hidden core value and ethic focused on how dental and other health practitioners first accept people as possible patients. The three basic styles of patient acceptance are random, selective, and universal. Reduced public access to care results from the practice of random and selective acceptance. Only universal acceptance creates a potential pathway for improved access to care. The notion of Universal Patient Acceptance (UPA) is discussed here as one kind of applied ethical tool or clinical practice that allows for the ethic of acceptance to be more effectively pursued in daily practice. We suggest that health providers falsely surmise that they already understand and practice Universal Patient Acceptance. That myth and perspective are partly what keeps Acceptance hidden as an ethic and overlooked as a potential way to foster dialogue and indirectly promote better access to care. Without Universal Patient Acceptance, dental and health providers will continue to silently engage in practice patterns that adversely affect public access to care. The actual benefits of Universal Patient Acceptance are the subject of ongoing review and debate. Whatever those benefits might be will not likely be realized until Acceptance and Universal Patient Acceptance are included as part of dental and other health professional codes of ethics and training curricula. That is what we argue for here.