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ADA House considers ethics matters

Honolulu—The ADA House of Delegates registered its support for collaborative efforts on the part of several councils and dental organizations to address ethical issues in dental education and practice.

For at least the past three years, several groups within the dental profession have sharpened their focus on ethical issues. Through the adoption of Resolutions 39H-2009 and 40H-2009, the House directed the Joint Subcommittee on Ethics and Integrity in Dental Education and Practice to move forward with its Action Plan to Enhance Professionalism in Dentistry.

"Given our current budget condition, I consider this a strong show of support," said Dr. David F. Boden, chair of the ADA Council on Ethics, Bylaws and Judicial Affairs. "The Board of Trustees is strongly supportive of what we are doing, and the House agreed. The House has just asked us to do everything possible within a tight budget."

Res. 39H-2009 directs the Joint Subcommittee to continue its activities in 2010-11 as outlined in the Action Plan; and develop a presentation on the ethics initiatives for relevant council, committee and ADA-sponsored meetings in 2010. Res. 40H-2009 grants permission for the ADA to be recognized as a founding member of the Professional Ethics Initiative on marketing and fundraising materials, provided that the appropriate ADA agencies have the opportunity to review materials prior to distribution.

The House actions continue the work of the Joint Subcommittee, which was formed in 2007 to develop recommendations for advancing ethics in dental education in an effort to curtail unethical and unprofessional conduct. The group includes representatives from CEBJA and the Council on Dental Education and Licensure; and has received input from stakeholder organizations that include the American Dental Education Association, American Student Dental Association, American College of Dentists, Commission on Dental Accreditation, American Society for Dental Ethics, American Association of Dental Examiners (now American Association of Dental Boards) and the Joint Commission on National Dental Examinations. Earlier this year, the Council on Dental Practice was added in order to extend the subcommittee's work to practicing dentists.

The Action Plan proposed to the 2009 House of Delegates is a set of strategic goals designed to raise awareness of ethical challenges in the professional environment, and initiate and integrate programs to address those challenges.

"It is more critical than ever that our patients, the public and the nation's decision-makers correctly see us as always putting our patients' interests first—and the mechanism the ADA has for that is our Code of Ethics," said Dr. Boden, who has been a member of the subcommittee since its inception. "To keep and elevate our honored position, the Joint Subcommittee determined that there are two pathways we need to take."

First is to encourage a strong culture of ethical behavior across the entire Association. "Positive reinforcement of sound, ethical decision-making will, I believe, ultimately yield the greatest results," said Dr. Boden. Enforcing the Code is the second part.

"This is always uncomfortable to do, but we cannot be credible if we as an Association do not actively deal with improper behavior," Dr. Boden said. "The Joint Subcommittee is keenly aware of the delicate nature of this, but is determined to make sure we have fair and active mechanisms to deal with complaints.

"We are already known as one of the most trustworthy professions," he added. "It is our aim to continue to burnish not just the image, but the reality that creates that image."

There are a number of activities proposed in the Action Plan, such as:

  • Using a predictor of professional behavior for students. An example is the University of Michigan Multiple Mini-Interview pilot program that shows significant promise in predicting ethical behavior of candidates in clinical and academic settings.
  • Adopting methods to evaluate and improve the ethical and professional environment of dental practices. The American College of Dentists and David Chambers, Ph.D., a dental ethicist at the University of the Pacific Arthur A. Dugoni School of Dentistry, have developed a practice ethics self-assessment program, which Dr. Boden says is adept at encouraging dentists and their staff to use an "ethical lens" when looking at their daily practice routines.
  • Elevating awareness of the ADA Code by asking every member to agree to abide by the Code at every renewal of their membership; not just the initiation.
  • Communicating to outside entities—government, vendors, advertisers—that when doing business with ADA members and the Association, they are expected to abide by the same high standards our members practice every day.

But the success of any initiative hinges on collaboration with other organizations, Dr. Boden emphasized.

"The American College of Dentists has a keen interest in ethics and has been very active in developing the Professional Ethics Initiative, and we intend to work closely with ACD to find ways to implement their best ideas in the most cost-effective manner possible," said Dr. Boden.

The Professional Ethics Initiative began in 2007 with the goal of increasing the number of individuals who have expertise in dental ethics. The 2009 House gave permission for the ADA to be recognized as a founding member on the PEI's marketing and fundraising materials. Collaborating organizations include ACD, ADA, ADEA and ASDE.

"The participating organizations have their own interests and constituencies, but recognize that cooperation is highly advantageous," he said. "ACD and Dr. Chambers have put in a lot of hard work examining the overall concept of not only ethics for individual dentists, but also dental practices and organizations. While the Board and House are not yet ready for any financial commitment due to our current budget situation, they encouraged us to push forward ideas that will not have significant immediate costs."

The Professional Ethics Initiative has an aspirational focus, added Dr. Stephen A. Ralls, executive director of the American College of Dentists.

"This is about self-improvement and self-assessment, and builds on peoples' desires to create an ethical climate," said Dr. Ralls. "It is not an attempt to impose regulations on people."

Four subprograms comprise the PEI:

  • increasing the number of individuals in dentistry with ethics knowledge and training.
  • a voluntary self-assessment that enables dentists to gauge the ethical climate of practices.
  • organizational self-assessment for dental schools, the dental industry and dental associations.
  • the Ethics Resource Clearinghouse of materials designed to improve ethics efforts.

"We are making good progress in some of these areas," said Dr. Ralls. "We had our Introduction to Dental Ethics course during our annual meeting in Honolulu, and will sponsor another one in 2010 in Orlando. We're working with the Kennedy Institute of Ethics to develop an advanced weeklong program at Georgetown University. And the voluntary self-assessments will be tested by focus groups and practitioners over the next six months."

Moving forward, Dr. Boden said the Joint Subcommittee will operate as a think-tank—not necessarily implementing programs itself, but by coordinating and supervising actions.

"We will also continue to propose solutions, and then press for debate, implementation and follow through of the best ideas," he said.