Litigation, legislation, and ethics. An ethical dilemma.

The Florida Dental Association's Code of Ethics, like those of most states, notes that shall be obliged to report to the appropriate reviewing agencies instances of gross and/or continual faulty treatment or violation of the Florida Dental Practice Act by another dentist. If there is evidence of such treatment the patient should be informed.l The same paragraph contains what some commentators have considered to be a contradictory statement: shall be obliged to refrain from commenting disparagingly without justification about the services of other dentists. 1 The potential contradiction is that making a comment to a patient or agency concerning a colleague's treatment of a patient may appear to fulfill an obligation to report; the contrary interpretation of such verbiage may, in reality, be a disparaging remark that could subject the reporting dentist to administrative and legal consequences.2 How should dentists balance the ethical responsibilities to the public, the profession, and to colleagues, without improperly violating the code of ethics? Therein lies the dilemma. The same situation exists in the American Association of Orthodontists' (AAO) Principles of Ethics and Code of Professional Conduct.3 Among the advisory opinions listed therein, there exists similar language. On one hand, we are obligated to report to the appropriate reviewing agencies instances of gross or continual faulty treatment by other practitioners; while on the other, our patients are to be informed of their present oral health status without disparaging comments about prior treatment. The AAO Code, in its advisory opinions, is more restrictive .regarding what is considered a compulsory reportable event. Because orthodontists practice differently from one another, in part based on their training and experience, we have different and individual perspectives and philosophies regarding diagnosis, treatment planning. and the mechanotherapeutic approaches to be used. In order to minimize disputes, the Code states that it is unethical to propound a specific technique, philosophy, training or ability as superior.3 Therefore, remarks made to a patient or professional agency based on technical or philosophical differences could be considered disparaging comments, if they are based on these differences and not on the provision of faulty treatment per se.