Ethical Botox Moment

I don’t know which section of the JADA journal you go to first. I don’t know if you even get the JADA anymore. I used to go straight to the classifieds to see if the University had an ad in for my job. But now that I am back in private practice the first section I go to is the “EthicalMoment”.

I think it’s wonderful that my profession has finally realized we need a forum to find our way through the ethical dilemmas of private practice. I don’t always agree with the solutions offered by the writers (JADA 2006;137:243 free at jada.ada.org). I was excited to open my March JADA and read this month’s ethical dilemma.

This month’s dilemma was delivered via a letter from a dermatologist who wanted to know if it was ethical for a general dentist to administer Botox injections to their patients. It seems the dermatologist feels that the dentist is practicing outside of his scope of practice and thus violating the ADA Code of Ethics. (Hmm…Did he get this idea from the plastic surgeon who wrote a letter to the Journal of Dermatology?)

The responding author does a great job of explaining why it may or may not be unethical. The only problem is that he also assumes that Botox is healthcare and not personal enhancement. And that makes a difference, at least to me.

There is no healthcare benefit to personal enhancement. That means that there is no Beneficence either. I know that Botox may make people feel better about themselves for a short period of time. It may improve their emotional well being or state of mind. But treating the patient’s psyche or emotional state is much farther outside of the dentist’s scope of practice than administering Botox. And yet we use the argument of improving emotional well being or self esteem to justify cosmetic dental treatment that no dermatologist would deem unethical. We bleach teeth that are already whiter than any natural tooth shade. We veneer orthodonically aligned and bleached teeth to make them even straighter and whiter. And we do this because we think it improves self esteem and because…that’s what the patient wants.

“That’s what the patient wants” is not a treatment rationale for dental or medical treatment. But it is a treatment rationale for personal enhancement. When we decided to promote (not offer, but actively promote) non healthcare related personal enhancement procedures we crossed the line from being healthcare providers to something else. The problem is we haven’t yet defined what that something else is. And we haven’t figured out if our ethical obligations to patients change when they become “clients” or “guests”.
I believe that dentists can ethically administer Botox (with appropriate training) because it’s not in any one healthcare professional’s scope of practice. Because Botox is not healthcare. And that may be why so many states have refused to directly control who can administer Botox. Dentists with appropriate training are certainly capable of administering Botox as safely as nurse practioners or gynecologists.

Welcome To Ethics with a Bite

Welcome to Ethics with a Bite!
The Ethics with a Bites goal is to become a resource for ethics for the practicing dentist. Practicing dentistry has never been more exciting or more challenging. Technology is changing the way we diagnose and treat patients. Our concepts of ethical treatment must change with technology. But we can’t abandon ethical principles along the way.
New business models are also changing our relationships to patients and staff. These new business models require us to look at ethical relationships with patients and staff in new ways.

The tremendous influence of cosmetic procedures had re-defined dentistry.Our code of ethics must keep pace with the rapid expansion of the types of treatment available to patients from dentists. Where does healthcare end and personal enhancement begin? How does this affect the doctor patient- relationship?

Healthcare law is changing too. How will this affect our ethical relationships with patients? Does the intrusion of the insurance industry create new ethical dilemmas? Do dentists in corporate dental offices have the same obligations and duties to patients as practice owners?

Ethics with a Bite will address these questions and more. I encourage dentists at all phases of their careers to participate in the discussion on how to be an ethical, practicing dentist.