Andrea Loving

Case Study #2
DHY245
3/4/20

1. One ethical principal that is being broken is societal trust. As dental care providers, our
patients trust us with their health and expect us to treat them only to the extent that we are
educated. If we “help out” the doctor when he is compromised, we might be performing
duties that we are not legally able to perform. Not only is this an ethical issue, it is a
legal issue. The office could get into major trouble for covering up this problem. They
are also breaking nonmaleficence, beneficence, veracity, and fidelity. If our patients care
is being compromised because of the dentist, we are putting their health in harms way
and it won’t be to their benefit.
2. The Act does mention that a practitioner may be disciplined in the case of substance
abuse problems. The act states, “The board may issue an order to discipline a licensed
dentist or dental hygienist, or registered dental assistant, for any of the grounds set forth
in this chapter, chapter 272C, or Title IV. Notwithstanding section 272C.3, licensee or
registrant discipline may include a civil penalty not to exceed ten thousand dollars. . .
Inability to practice dentistry, dental hygiene, or dental assisting with reasonable skill
and safety by reason of illness, drunkenness, or habitual or excessive use of drugs,
intoxicants, narcotics, chemicals, or other types of materials or as a result of a mental or
physical condition. At reasonable intervals following suspension or revocation under this
subsection, a dentist, dental hygienist, or dental assistant shall be afforded an
opportunity to demonstrate that the dentist, dental hygienist, or dental assistant can
resume the competent practice of dentistry, dental hygiene, or dental assisting with
reasonable skill and safety to patients.”
3. I was unable to find anything in the ADHA code of ethics specifically regarding
substance abuse, but it does talk about promoting a work environment that provides
wellness, refer clients in order to not work out of our scope of practice, and to document
and report inappropriate, inadequate, or substandard care. All of these situations do apply
to this scenario. It does address substance abuse in the ADA code of ethics. The code
states, “2.D. PERSONAL IMPAIRMENT. It is unethical for a dentist to practice while
abusing controlled substances, alcohol or other chemical agents which impair the ability
to practice. All dentists have an ethical obligation to urge chemically impaired
colleagues to seek treatment. Dentists with first-hand knowledge that a colleague is
practicing dentistry when so impaired have an ethical responsibility to report such
evidence to the professional assistance committee of a dental society.
4. The ethical dilemma in this scenario is considering would it be right if Lesa were to turn
a blind eye to Dr. Harris’ issue, or would it break the ethical concepts of societal trust,
beneficence, and nonmaleficence. The answer is that it would be not only ethically
 wrong but it is a legal obligation for Lesa to help Dr. Harris get some assistance. The
information regarding this issue is that Dr. Harris is using his authority to take advantage
of his employees. Because he is the one paying his employees, they feel obligated to pick
up the slack. The options that exist for Lesa is that she can either report him to the state
dental society, have a conversation with him about self reporting to the society, or keep
her mouth shut and continue to allow illegal treatment of patients to occur.
If she chooses the first option, she is using autonomy because she is making her own
choice. She is being accountable and professional by reporting, so societal trust is being
fulfilled. She is protecting patients from harm, doing what will benefit them, and also
telling the truth. She is fulfilling her fidelity to provide standard of care and protecting
and improving their interest. This action would be of utility to the patients of the
practice. Choosing the second option would fulfill the same ethical principles. The
concept of paternalism would be shifted to protecting not only the patient but protecting
the Dr. as well since he is unwilling to report himself. Choosing the last option would be
putting all of the patients in harms way and not protecting them or keeping her promise to
protect the patient. At the same time, she would also need to rank the needs and wants of
her coworkers. She would be protecting the public, but she also needs to determine how
it will affect the lives of the others that she works with if the practice were to close while
the Dr. is in treatment. If I were Lesa I would choose the second option because it may
put the Dr. in the best possible situation to receive care and maintain his practice.
Implementing this would need to be done in a positive way from a place of care and
concern, as to not come off as judgmental.

Resources: https://www.legis.iowa.gov/docs/code/153.pdf
https://www.ada.org/~/media/ADA/Member%20Center/Ethics/Code_Of_Ethics_Book_With_Ad
visory_Opinions_Revised_to_November_2018.pdf?la=en