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Statement on measles from ADA Council on Ethics, Bylaws and Judicial Affairs

May 20, 2019 “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.’”