ADA cautions that charity clinics should take care with ethical issues

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

Photo: Chicago Dental Society via Flickr

Photo: Chicago Dental Society via Flickr

Organizers of free megaclinics at city stadiums and rural fairgrounds frequently describe their efforts as “Band-Aid” solutions to a much deeper problem with access to health services in many communities.

The shortage of oral health providers in poor and isolated areas is often severe, for example. The need for dental care tops the list of many of the people seeking care.

The charity clinics, run by groups such as Mission of Mercy, serve a tremendous need. Yet the vulnerability of patients who may be suffering from untreated disease and infection, coupled with the transient nature of these free events, raise potential ethical concerns.

These are among issues that charitable groups and volunteer providers should consider, according to a new white paper from the American Dental Association (ADA.) A leading concern is the ability of patients to make informed decisions about any treatment they receive at these events.

“Many factors play into treatment choices, but the provider must take responsibility to ensure that the patient understands the options available and the risks and benefits of each option,” note authors of the paper, which was produced by the ADA’s Council on Ethics, Bylaws and Judicial Affairs.

For example, a patient who agrees to have an infected tooth extracted should understand the long-term consequences of that tooth loss, the authors write.

On the other hand, “a patient may opt to have root canal treatment to save an abscessed tooth but not realize that this treatment option also requires a crown to protect the now brittle tooth,” they note. “If the patient cannot afford to complete the treatment and have the crown placed, the tooth could break later, resulting in an emergency surgical extraction.”

The potential for patient abandonment is another concern. If follow-up procedures are required, the patient should be informed about when and where they can be obtained.

Patient records must be handled in a way that ensures privacy and provides for future access, the authors write.  In addition, patients need to understand that care obtained from a free clinic is no substitute for timely and ongoing services offered by regular providers in a “dental home.”

Lastly, just as at a dental office or clinic, health and safety protocols need to be carefully observed, they said. “Infection control and barrier techniques should be utilized to minimize disease transmission and cross contamination in order to protect patients, staff and providers.”

Is a free clinic coming to your area? It might be worthwhile to explore these ethical issues with organizers.

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