Principles of Ethics for Dental Practitioners

Society has recognised that certain vocations stand apart from others by the nature of their work. These vocations are regarded by society as "professions" and dentistry is one of them.

A profession is recognised as such by exhibiting three cardinal characteristics:

The primary duty is of service to the public, prolonged specialised education and the responsibility of self discipline. The privileges and rights of any profession are justified only by the heavier duties and obligations which members of the profession are expected to fulfill. Society gives the gift of education and the privilege of self discipline in return for the profession's inherent talents and abilities.

The statutory control of the dental profession is vested in the Dental Council of Hong Kong under the Dentist Registration Ordinance Cap. 156. All dental practitioners are advised to observe their legal obligation in relation to dental practice set forth in the "Warning Notice for the Guidance of Dentists" published by the Council

However, in being transformed from "ordinary citizen" to "healer" the dentist is expected to follow to an extraordinary degree those unwritten and unenforceable laws of society known as ethics. These are the beliefs, values and attitudes of man which have evolved into the norms, rules and guidelines for accepted human behavior. A breach of these laws will be met with reproach, loss of reputation, contempt and isolation.

These Principles of Ethics are a standard by which a dentist may determine the propriety of his conduct in his relationship with patients, with colleagues and with the public. Compliance with these principles is a moral obligation by all dentists.

By being a document of obligation and limitation for the profession, the Principles of Ethics is a document to protect the public we serve.

In these Guidelines, unless the context otherwise requires, words and expressions importing the masculine gender shall include the feminine gender.

1. The Dentist and the Patient

The primary duty of the dentist is to safeguard the health of patients irrespective of their nationality, sex, race creed, political views or social and economic standing.
The dentist shall use the highest standard of care of which he is capable in discharging his duty to all patients.
The dentist should at all times be aware of the patients right to a complete and thorough examination and treatment plan; the action taken or advice given should be of sound judgement and always in the patient's best interests.
A dentist has the right to decline to treat a patient except in the case of emergencies or where, for humanitarian reasons, treatment should not be withheld. A course of treatment once commenced should not be discontinued except for exceptional reasons and then the dentist should co-operate in making alternative arrangements for its completion. The dental practitioner does, however, have the obligation to refer the patient to a colleague for treatment of his dental needs.
The dentist should uphold the principle that the patient has a free choice of practitioner. If it is obvious that treatment is recent and incomplete, the dentist should contact the patient's previous dentist to discuss the continuation of a treatment plan which would be in the best interest of the patient. If it is considered that previous treatment is sound and of good quality, then the patient should be informed as such.
The dentist should strive to establish a relationship of trust, confidence and mutual respect with the patient.
The dentist should keep accurate records and refrain from disclosing to any third party any information which is learnt in the professional relationship with the patient without the consent of the patient. It is also the obligation of the dentist to see that auxiliary personnel observe this rule.
Any act or omission by a dentist in connection with his practice which is calculated to mislead the public would constitute disgraceful conduct. Dental records, health certificates, insurance forms and reimbursement requests maintained or issued by a dentist must be accurate and truthful.
Every patient has the right to seek a second opinion and the dentist should respect such a wish.
When a minor, unaccompanied by a parent or guardian presents himself at a dental clinic or treatment, the dentist should first seek consent from a parent or guardian before performing any irreversible procedures such as restorations or extractions. A dentist may render emergency treatment to a minor without parental consent if such treatment is to relieve pain or is in the best interest of the patient's oral health.
When consulted in an emergency by the patient or another dentist, the dentist should immediately concentrate on relieving the emergency symptoms only. Afterwards the patient should be referred back to the regular dentist, preferably with a written account of the condition found and the action taken to relieve it.
When providing emergency treatment to one who is not his regular patient, the dentist should draw due attention to other treatment needs that may be noticed in the mouth and refer the patient back to the regular dentist.
The needs of the patient are the overriding concern. The dentist should bear in mind the need for referral to other qualified dental or medical colleagues who possess special knowledge or greater expertise.

2. The Community

2.1	Dentists are encouraged to participate in dental health education and to promote and support accepted measures to improve the general and dental health of the public. However, in participating in such presentations, be it through the media or radio, television, the press or public meetings, no dentist should attempt to draw undue attention to himself.

2.2	Dentists may advance their professional reputation only through professional services to patients and society. Details on nameplates, letterheads, directories, announcements and name cards should conform to the regulations listed below. The general rule should be that information is limited to assist the public in obtaining dental services. The form and lettering should be consistent with the dignity of the profession. False certification and misleading statements are unethical.

Newspapers

A notification placed in a newspaper shall be limited to announcing the commencement at practice, moving of the practice and termination of an individual working in the practice.
A notice maybe placed in two English and two Chinese newspapers on three consecutive days and must appear within two months of the event.
The notice should be in black type only, with no decoration other than a black boarder and should not exceed 60 square centimeters.
The notice should be restricted to the announcement classification.

Magazines

Advertisements and announcements of dental practice in periodicals/magazines shall be deemed unethical.

Limited circulation print

Announcement at initial membership may appear in club newsletters provided that bulletin is circulated only to members of that organization.
A dentist's name may appear in a membership directory, stating that he is a dentist and give his business address and telephone number.

Individual notices

Notices may be sent out by a dentist announcing the commencement of dental practice and change(s) of telephone number and address to all registered dental and medical practitioners in Hong Kong.
Information on this notice shall be limited to date of commencement, recognized degrees, specialty, address, telephone numbers and office hours.
Notices may he sent out by a dentist announcing the change of telephone number or address, to his patients. Recall reminders may also be sent by a dentist to his patients.
No other forms of individual circular is permissible.

Telephone directories

A dentist may be listed in business telephone directories in the alphabetical section under his own name or under the name by which the practice is known. This notice shall be limited to name, address and telephone number.
A dentist may be listed in classified business telephone directories under "Dental Practitioners" by his own name as well as the name by which the practice is known. This notice may include the address, telephone number, recognized qualifications, specialty and telephone number for emergency service.
All listings will be in standard print in black only. Bold type is not permitted.
The display of boarders logos, office hours and colour are not permitted.

Stationery - letterheads, name cards, envelopes, prescription slips, etc.

Stationery may bear the name of the dentist, appropriate title, registerable qualifications, where qualifications are from, the practice address and telephone number, hours in attendance, emergency contact, residential telephone number and membership in Hong Kong Dental Association.

Name cards used by members of organizations in dentistry may state the particulars of that organization and one's related activities. Particulars of one's private dental practice and or one's involvement in organized dentistry should not be mixed other than as stated above.

Signboards

Information displayed on signboards is limited to that which is found on stationery with the addition or an indication depicting the situation of the office within the building. The signboard must not be ornate, nor shall it be illuminated except at night or when situated in a dark place.

The size and placement or signboards must comply with regulations as stipulated by the Dental Council of Hong Kong.

Radio Television and Press

A dental practitioner being approached for comment on dental-political matters, professional matters or public interest or in connection to one's own public activities should avoid the linking of name and profession with practice address.

Official spokesmen for government, university, professional associations, hospitals and charitable organizations when discussing matters of public interest may, however, find it necessary, in order to lend authority to their statements, to divulge their names. but no mention should be made of qualifications, experience or other personal professional particulars (such as the fact that they are in practice).

Lectures

A dental practitioner delivering lectures to lay audiences should take all reasonable steps to see that, in any preliminary announcement or subsequent press report of the lecture, his professional qualifications and/or ability are not made the subject of laudatory references.

Practice Name

A private dental practitioner shall practise only under his own name, the name of a registered dentist employing him, a partnership name composed only of the name of one or more dentists practising in a partnership or a corporate name composed only of the name of one or more of the dentists practising as employees of the corporation.

The use of a trade name or an assumed name is unethical. The use of the name of a dentist no longer actively associated with the practice may be continued for a period not to exceed one year.

Third Party

The provision of dental care should be in the hands of those who are trained to identify the patient's needs and who carry personal responsibility for meeting them.

A dentist may enter into an agreement with individuals and/or organizations to provide dental health care provided that the agreement does not permit or compel practices which lead to unethical conduct. In performance of such contracts the dentist is required to deal fairly with the public and fellow practitioners. It is unethical for a dentist to contract his services under conditions that make it impossible to render service to his patients in a timely and reasonable manner.

Advertising and canvassing

It is contrary to the public interest and discreditable to the profession for a dentist to canvass for the purpose of obtaining patients or promoting his own professional advantage. A dentist who canvasses for such a purpose, or who employs or is professionally associated with anyone who does so, or who procures or acquiesces in the publication or notices commanding or drawing attention to his professional skill and knowledge or depreciating those and other dentists, is engaged in unethical conduct.

Display of Diplomas and Certificates

Diplomas, board certificates and academic awards from educational institutions, government bodies and responsible boards, as relating to the degree under which one is practising dentistry in Hong Kong may be displayed in public areas at the place of business.

Certificates of membership in national and international professional organizations and in specialty organizations of those specialties recognized by the Dental council of Hong Kong and certificates of appreciation may be displayed within he confines or the dental surgeries (i.e. treatment areas) themselves.

2.3	A dentist has the duty to maintain the honour and integrity of the profession and to avoid any conduct which might lower the public esteem of the profession.

2.4	The dentist should assume a responsible role in community life. However, in joining clubs, societies or service organizations, he should not draw undue attention to himself as a practising dentist. If he accepts appointments or arrangements to treat members of a particular organization or institution, he should ensure that restraint is used in the manner in which his name appears in any prospectus or publication of that body.

2.5	Expert Testimony
	Any dentist, who has pertinent knowledge due to examination or treatment of a patient or has expert knowledge due to training or experience, maybe called upon to give testimony in a court of law. Any dentist so requested must give his testimony to the best of his knowledge and impartially when passing judgement on the treatment, workmanship or neglect by a fellow dentist.

2.6	Debt collection
	A dentist in private practice has the right to expect reasonable financial compensation for service rendered. In collecting such fees the dentist must use only proper and legal means for such debt collection. Any methods unbecoming to the profession shall be deemed unethical.

2.7	Financial Matters
	All personal and professional financial conduct must be in keeping with the dignity of the profession. Personal indebtedness shall be deemed unbecoming.

3. The Dentist and the Health Professions

A dentist is one of a team of professionals united by bonds of similar education and common purpose.

Colleagues in all disciplines of health care should be treated with courtesy, consideration and co-operation.
Dentists should maintain the prestige, honour and dignity of the profession by avoiding in their private and working lives any behaviour which may tend to discredit the profession.
A dentist should aim at completing treatment promptly and with due competence. In the interest of the patient, referral should be considered if this would avoid any harmful delay.
When a dentist considers that the condition of his patient requires his consultation with another dentist who has special skill, knowledge or experience, he should write a letter explaining the reason or the referral as well as all relevant information concerning the case to the dentist consulted. The dentist consulted may give to the patient such information as he judges appropriate to the occasion.
It is unethical to charge a fee for referral to another dental colleague specialist or medical practitioner.
A consulting dentist should not attempt to secure for himself the care of the patient referred for consultation, except with the consent of the dentist who referred the patient.
A dentist should always speak out in recognition of good work. Such recognition is just and generous and gives pleasure to the patient and much encouragement to a fellow practitioner.
The dentist is duty bound to indicate to the patient previous dental care which is obviously detrimental to his oral health but in doing so should not refer disparagingly to the previous dentist.
Professional secrecy is absolute, except where the laws of the territory dictate otherwise. It is also the obligation of the dentist to see that auxiliary personnel observe this rule.
A principal dentist has a particular responsibility to be fair and just to an associate or assistant dentist in both business arrangements and as to representations concerning professional expectations.
An associate or assistant dentist should faithfully observe the principals wishes, unless they are in conflict with legal and ethical codes or at variance with that consideration always due to a patient.
A dental practitioner should do nothing to entice any employee from a fellow practitioner's employment. If in reply to a press advertisement, a technician, dental surgery assistant, or receptionist, employed by another dental practitioner seeks to enter the advertiser's employment, the advertiser should inform that practitioner before agreeing to employ the person.
The practice of fee-splitting refers to any arrangement entered into between members of the dental and medical professions under which, unknown to the patient, part of the fees received by one in respect of the attendance upon or treatment of a patient is passed to the other. This does not of course apply when practitioners are in the legal relationship of partners or principal and assistant, but most frequently occurs between a general practitioner and a specialist whereby the former receives part of the latter's fees in respect of patients he refers to the specialist. This practice is highly unethical and detrimental to the honour of the profession and should be condemned.
When a dentist suspects that his patient has some constitutional disorder and considers some major dental procedure is necessary, he should consult the patient's doctor before carrying out such treatment. He should communicate to the doctor any relevant information or opinion which he considers should be available to him.
When the patient has no doctor, the dentist should advise the patient to seek medical opinion from any medical practitioner at his own free will. On the specific request of the patient, the dentist may indicate the name of a doctor known to him, who might be consulted.
When there is a conflict of opinion between a doctor and a dentist concerning the diagnosis and/or treatment of the condition of a patient, they should consult with each other and reach an agreement which is satisfactory to both. When the conflict of opinion remains unresolved, the patient should be so informed and invited to choose one of the alternatives or be assisted in obtaining other professional advice.
When a patient, in the opinion of his doctor, needs dental treatment, the patient should be referred in all but exceptional circumstances to his own dentist. In the event of the patient having no regular dentist, there is no objection to doctor recommending a dentist of his own choice.
When a doctor needs dental advice concerning one of his patients the doctor should communicate in the first instance with the patient's own dentist. In the event of the patient having no regular dentist, there is no objection to the doctor consulting the dentist of his own choice.
When a dentist is consulted by a doctor needing dental advice, he should find out if the patient referred to him has a regular dentist and should satisfy himself that the latter is willing that the consultation should take place. The dentist consulted should subsequently notify the patient's dentist as well as the doctor regarding:

A dentist should make the results of research available to all when those results may be useful in protecting or promoting the dental health of the public.
Dentists have the obligation to support the advancement of their profession through membership in scientific and professional organizations and to observe their rules of ethics.