Dental ethics case 19: What are my ethical responsibilities when I suspect a colleague of substance abuse?

The situation described in this case scenario is an unwelcome one and can often lead to a breakdown in the relationship between professional colleagues. Many of these must be handled by scrupulous adherence to basic ethical principles. Where such conflicts do arise, every effort should be made to contain them in a manner which: avoids placing patients at risk; maintains the continuity of patient care and safeguards their rights and the quality of the dental care they receive; avoids bringing the profession into disrepute; maintains public confidence in the profession; treats professional colleagues as we would wish to be treated ourselves.

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.

Commercialization of dental education: have we gone too far?

Early U.S. dental training involved a closer relationship between commercialism and education, which was strongly counteracted by university affiliations at the beginning of the twentieth century. With recent decreases in public support for higher education, schools have become increasingly dependent on private revenue sources, including corporate support. There are ethical risks as well as benefits from dental schools establishing business partnerships with corporations. In 2002, a private, for-profit company was responsible for the inception and direct funding of an orthodontic postgraduate program at a private U.S. university. In the last four years, this company has begun funding two additional orthodontic programs, both associated with U.S. public dental schools. Such partnerships with academic institutions represent unique corporate relationships with dental education that are fraught with ethical risks. The dental profession needs to preserve the appropriate autonomy of dental education from commercial influences in order to prevent erosion of academic and ethical standards that are critical to professional integrity and public trust.