___________________________________________ DCA05DE Dental Ethics and the Digital Age, 3rd Edition
Ultimately, Dr. S’s decision should be guided by the principles of beneficence and non-maleficence—acting in the patient’s best interest while minimizing potential harm. By maintaining open communica- tion and offering practical solutions, Dr. S can responsibly uphold professional standards and address Mr. J’s immediate needs. CYBERBULLYING It is well known that not all digital communication is positive. As people find more ways to communicate and build relation- ships via the Internet and mobile devices, they also acquire the ability to communicate negatively. Cyberbullying refers to bullying that occurs through electronic means. Whether it occurs through texting, social media, or picture messaging, cyberbullying is a form of abuse (stopbullying.gov, n.d.a.). Unlike face-to-face bullying at school, cyberbullying does not stop when the school day ends. Electronic media are always accessible. Just like physical bullying, cyberbullying can be devastating to the victim. Headlines tell a tragic tale of the effects of cyberbullying on the nation’s youth. Studies have shown links between cyberbullying and suicidality in adoles- cence (Arnon et al., 2022; Children’s Hospital of Philadelphia, 2022). Dental professionals may not think this topic is relevant to them; however, dentists are ethically obligated to be aware of this form of abuse. As healthcare providers and mandated reporters, dentists and dental hygienists have an ethical and legal obligation to report suspected cases of child abuse. The ADA Code dictates this obligation, as do laws in all 50 states under the Child Abuse Protection Act of 1974 (ADA, 2023; Mele et al., 2023; HHS, n.d.a.). When the ADA Code (2023) addresses the topic of abuse, it does so under the principle of beneficence. Under this prin- ciple, dentists have the ethical duty to put the patient’s welfare first. The code states: The public and the profession are best served by dentists who are familiar with identifying the signs of abuse and neglect and knowledgeable about the appropriate intervention resources for all popula- tions. A dentist’s ethical obligation to identify and report the signs of abuse and neglect is, at a minimum, to be consistent with a dentist’s legal obligation in the jurisdiction where the dentist practices. Den- tists, therefore, are ethically obliged to identify and report suspected cases of abuse and neglect to the same extent as they are legally obliged to do so in the jurisdiction where they practice. Dentists have a concurrent ethical obligation to respect an adult patient’s right to self-determination and confidenti- ality and to promote the welfare of all patients. Care should be exercised to respect the wishes of an adult patient who asks that a suspected case of abuse and/ or neglect not be reported where such a report is not mandated by law. With the patient’s permission, other possible solutions may be sought.
• Mobile Health (mHealth): Health care and education are delivered via mobile devices such as cell phones, tablets, and PDAs. The ethical concerns regarding teledentistry involve ensuring that the dentist who uses teledentistry has adequate knowl- edge of the nature and availability of local dental resources to provide appropriate follow-up care to a patient following a teledentistry encounter as needed. Dentists must also be able to refer patients to an acute care facility or an emergency department when a referral is necessary for the patient’s safety or in an emergency (ADA, 2020). Using secure technology to protect patient privacy is also critical, along with verifying patient identity when using text messaging, email, and other non-face-to-face communication methods. Consider the fol- lowing case. CASE STUDY 3 Dr. S, a dentist in a rural community, recently began offering teleden- tistry consultations to increase access for patients who struggle with in-person visits. One day, a new patient, Mr. J, schedules a virtual consultation, complaining of severe tooth pain. During the video call, Dr. S examines Mr. J’s mouth through the camera and suspects an abscessed tooth that requires immediate attention. However, Mr. J insists he cannot afford an in-office visit and asks Dr. S to prescribe antibiotics and painkillers without further examination. Dr. S faces an ethical dilemma. Should medication be prescribed based on the limited information from the virtual consultation, potentially providing temporary relief but risking misdiagnosis? Or should the dentist refuse to prescribe without a physical exam, adhering to profes- sional standards but leaving the patient in pain and potentially losing his trust in the service? 1. How can a dentist balance the limitations of teledentistry with the need to provide immediate care, while still ensuring the patient understands the importance of an in-person examination? 2. What ethical principles should guide a dentist when deciding whether to prescribe antibiotics for a suspected dental abscess without an in-person examination? 3. How can a dentist effectively communicate with a patient about the necessity of in-office treatment while addressing concerns about cost and access to care? To address Mr. J’s situation, Dr. S could start by clearly explaining the limitations of teledentistry for diagnosing and treating conditions like a suspected abscess. They should emphasize the importance of a physical examination to accurately diagnose and treat the issue, including prescribing the appropriate medication or performing an emergency procedure. One potential solution is for Dr. S to offer a compromise. They could prescribe a short course of antibiotics to manage the immediate infection risk but clarify that this is temporary. They should strongly advise Mr. J to schedule an in-person visit for a thorough examination and definitive treatment as soon as possible. Dr. S might also explore alternative solutions, such as referring Mr. J to a nearby clinic that offers low-cost care or discussing a payment plan to make the necessary in-office treatment more affordable.
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