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ADA council addresses ethics of measles crisis

May 13, 2019

By Mary Beth Versaci

Dr. James A. Smith
What to do: The ADA Council on Ethics, Bylaws and Judicial Affairs, chaired by Dr. James A. Smith, has released a statement offering ethical guidelines to dentists amid the growing measles outbreak in the U.S. 
Dentists should have policies in place that allow for the treatment of all patients, including those who are unvaccinated, amid the growing measles outbreak in the U.S., according to the American Dental Association Council on Ethics, Bylaws and Judicial Affairs.

The council recently released a statement offering guidelines to dentists on dealing with the complicated ethics of the outbreak.

“There really are critical ethical issues that dental providers need to consider,” said Dr. James A. Smith, council chair. “A provider may think, ‘Well, I just won’t see anyone who’s not vaccinated or if anyone chooses not to be vaccinated,’ or they might have questions such as, ‘How do I do this? Do I put my other patients at risk if I allow people who are not vaccinated into my practice?’ There are a lot of questions, and it’s a complex issue. Our council wanted to provide some guidance and considerations in the face of the measles outbreak.”

In its statement, the council offers a series of policy suggestions, including asking sick patients to delay their appointments until they are no longer contagious or scheduling unvaccinated patients at different times from patients with a compromised immune system or an inability to get vaccinated.

Policies should “respect autonomy, reflect beneficence and nonmaleficence, be fair to all involved and be accurately communicated to all impacted,” the council stated.

While refusing to care for certain patients or dismissing them is not unethical in itself – as long as dental providers take the necessary precautions as dictated by their state and patient abandonment does not occur – doing so would miss out on “a teachable public health opportunity,” according to the council.

“There’s a lot of misinformation that patients may hear from various sources, and it’s a big concern,” Dr. Smith said. “And so by continuing to see those patients in your practice, it allows the opportunity to have an ongoing discussion about vaccine hesitancy.”

More than 830 measles cases have been reported in 2019 in the U.S. – the nation’s largest measles outbreak since 1994 – and a majority of those people were unvaccinated, according to the Centers for Disease Control and Prevention.

As part of the larger community of health care providers, it is important for dentists to be knowledgeable of the measles issue and able to talk to patients about it, Dr. Smith said.

“We just want to do things in a way that we have the best interest of our patients in mind,” he said.

The ADA Center for Professional Success offers practice-related information about infectious disease and workplace liability at The CDC also has additional information and guidance for health care professionals at

Full statement from ADA Council on Ethics, Bylaws and Judicial Affairs:
“With the number of measles cases rising on a daily basis, dentists must consider the ethical implications of treating or not treating patients with active illness, accepting or rejecting patients who have not been vaccinated, and dismissing or maintaining patients who have not been vaccinated. The American Dental Association Principles of Ethics & Code of Professional Conduct is a useful guide in navigating these challenging questions: ‘The ethical dentist strives to do that which is right and good.’ This requires consideration of the interests of the individual patient, other patients in your practice, your staff, the broader community and the profession. Given the communicable nature of measles, looking at office policies that accommodate those who choose not to be vaccinated, those who cannot be vaccinated and those who are actively ill is necessary. Such policies must respect autonomy, reflect beneficence and nonmaleficence, be fair to all involved and be accurately communicated to all impacted. Asking patients with active illness to defer appointments until they are no longer contagious, for example, would reflect respect for each of the principles outlined in the code. Another possible solution would be to schedule unvaccinated patients at different times than those patients who may be immunocompromised or who may not be able to get vaccinations and therefore depend on herd immunity. Keeping the interests of staff in mind, staff who are also at risk from exposure would have the opportunity to take necessary precautions to protect themselves if appointments are scheduled in this way. Refusal of care altogether or dismissing patients is not per se unethical, so long as necessary precautions are taken as may be dictated in your state and patient abandonment does not occur; however, this misses a teachable public health opportunity and an opportunity to build trust with patients. As with most ethical dilemmas, the risks and benefits must be evaluated on the particular facts and circumstances, and the dentist should demonstrate the ‘[q]ualities of honesty, compassion, kindness, integrity, fairness and charity.’”