9.1 ADA Principles of Ethics & Code of Professional Conduct
Key Takeaways
- The ADA Code has three components: the aspirational Principles of Ethics, the binding Code of Professional Conduct, and the interpretive Advisory Opinions.
- The five ADA principles are patient autonomy (self-governance), nonmaleficence (do no harm), beneficence (do good), justice (fairness), and veracity (truthfulness).
- Den 501.01(a) incorporates the ADA Code with advisory opinions revised to March 2023, and knowingly or willfully violating it is misconduct under RSA 317-A:17, II(j).
- Under ADA Advisory Opinion 5.B.1, a dentist who accepts a third party's copayment-plan payment as payment in full without disclosing that the patient's share will not be collected is overbilling.
- Under ADA Code 5.G, the name of a dentist no longer associated with a practice may be used for no more than 1 year unless the public is given prominent notice of the retirement.
The ADA Principles of Ethics and Code of Professional Conduct
How the ADA Code works
- Principles of Ethics: the aspirational goals of the profession. They may overlap or compete and sometimes must be balanced.
- Code of Professional Conduct: specific conduct that is required or prohibited. It is adopted by the ADA House of Delegates and binds ADA members.
- Advisory Opinions: the Council on Ethics, Bylaws and Judicial Affairs' interpretations applying the Code to specific facts.
The ADA itself notes that ethics and law are related but not identical, and that ethical duties often exceed legal ones. In New Hampshire, the Code also has legal force. Den 501.01(a) incorporates the version with advisory opinions revised to March 2023, and RSA 317-A:17, II(j)(1) and Den 407.01(l)(1) make knowing or willful violation professional misconduct. Where New Hampshire law is more specific, such as the 20-day record-copy deadline and fee cap, the law controls.
The five principles and their key rules
| Principle | Core duty | Key Code sections and advisory opinions |
|---|---|---|
| 1. Patient autonomy ("self-governance") | Respect the patient's right to self-determination and confidentiality | 1.A involve patients in treatment decisions by explaining proposed treatment and reasonable alternatives. 1.B safeguard records and share information that helps future treatment. 1.B.1 furnish copies of records, including X-rays, free or at nominal cost, whether or not the account is paid. 1.B.2 get written permission before forwarding sensitive information such as HIV status unless certain the law allows it |
| 2. Nonmaleficence ("do no harm") | Refrain from harming the patient | 2.A keep knowledge current. 2.B seek consultation; specialists return patients to the referring dentist. 2.B.1 second-opinion dentists should have no vested interest. 2.C delegate only legally delegable duties to qualified auxiliaries and supervise them. 2.D no practice while impaired; urge impaired colleagues toward treatment; report first-hand knowledge to a dental society's professional assistance committee. 2.D.1 limit practice for disease or impairment. 2.E after a patient's exposure incident, immediately inform the patient and refer for postexposure evaluation; share the dentist's own status and submit to testing if the dentist is the source. 2.F no abandonment without adequate notice. 2.G avoid personal relationships that could impair judgment or exploit trust |
| 3. Beneficence ("do good") | Promote the patient's welfare | 3.A community service (3.A.1 weighs elective care against public risk during a public health emergency). 3.B join and follow a professional society. 3.C–3.D share research; patents may not restrict research or practice. 3.E know the signs of abuse and neglect and report suspected cases as state law requires; respect an adult's wishes where reporting is not mandated. 3.F a respectful workplace (3.F.1 disruptive behavior) |
| 4. Justice ("fairness") | Treat people fairly | 4.A no refusal of patients based on race, creed, color, gender, sexual orientation, gender identity, national origin, or disability. 4.A.1 treat patients with disabilities or bloodborne pathogens on the same basis as others. 4.B reasonable arrangements for emergency care of patients of record, and for non-patients who call in an emergency, returning them to their regular dentist. 4.C report gross or continual faulty treatment by other dentists and avoid unjustified disparagement (4.C.1). 4.D expert testimony; 4.D.1 contingent expert fees are unethical. 4.E no rebates or split fees; 4.E.1 percentage-of-fee marketing and "social coupon" splits are fee splitting |
| 5. Veracity ("truthfulness") | Communicate truthfully | 5.A no false representation of care. 5.A.1 removing amalgam from a non-allergic patient to "remove toxins," solely on the dentist's recommendation, is unethical. 5.A.2 no unsubstantiated cure claims. 5.B no false fee representations: 5.B.1 waiving copayments without telling the carrier is overbilling; 5.B.2 raising a fee because the patient has coverage; 5.B.3 the uninsured fee is the full fee; 5.B.4–5.B.5 no false treatment dates or procedure descriptions; 5.B.6 no unnecessary services. 5.C disclose conflicts of interest in presentations. 5.D use only devices and drugs whose complete formulae are available; 5.D.1 report serious adverse reactions, including to the FDA. 5.D.2 product sales must not exploit patient trust. 5.E–5.F no false or misleading announcements or advertising (5.F.2 examples; 5.F.3 unearned degrees; 5.F.4 per-patient referral fees; 5.F.5 HIV-negative ads need a disclaimer; 5.F.6 websites and SEO). 5.G practice names must not mislead, and a departed dentist's name may be used for up to 1 year. 5.H specialty announcements; 5.I general practitioner announcements |
What "false or misleading in a material respect" means — Advisory Opinion 5.F.2
Avoid statements that:
- (a) contain a material misrepresentation of fact;
- (b) omit a fact needed to keep the statement from being misleading;
- (c) are likely to create an unjustified expectation about results; or
- (d) claim superior quality that cannot reasonably be substantiated.
Subjective quality claims are judged by the impression the whole ad creates. New Hampshire's statute goes further: claims of superiority or painless service are misconduct per se (RSA 317-A:17, II(h)(2)).
Where the ADA Code and New Hampshire law meet
| Topic | ADA Code | New Hampshire law |
|---|---|---|
| Record copies | Free or nominal cost; paid account not required (1.B.1) | Within 20 days; up to $15 for 30 pages + $0.50 per page; paid account not required (Den 501.01(e)) |
| Delegation | Only legally delegable duties; supervise (2.C) | Den 501.01(b)–(c); RSA 317-A:23 |
| Impairment | Report to a professional assistance committee (2.D) | Professionals' health program; society committees may report (RSA 317-A:16-a) |
| Abandonment | Adequate notice (2.F) | Emergency care for up to 30 days or until the patient finds another dentist (Den 501.01(k)) |
| Specialty | 5.H | Den 302.04(b) adopts section 5-H; RSA 317-A:31 requires "general dentist" or "specialist" in ads |
| Amalgam | 5.A.1 | Standardized materials pamphlet (RSA 317-A:38) |
How the ADA enforces its Code
Complaints about a member go first to the constituent (state) or component (local) dental society. A member found to have acted unethically may be censured, suspended, or expelled from the ADA, with a right of appeal. That is membership discipline. License discipline in New Hampshire comes only from the Board under RSA 317-A:17 and Den 407.
A dentist tells an insurance carrier his fee for a crown is $1,200, accepts the carrier's payment as payment in full, and routinely does not collect the patient's 20% copayment, without telling the carrier. Which ADA principle and advisory opinion does this violate?
During an extraction, the dentist's glove tears and the dentist's own blood contacts the patient's open surgical site. Under ADA Code 2.E, what is the dentist's ethical obligation to the patient?
Dr. Allen retired from a group practice 18 months ago. The practice still advertises as "Allen & Brooks Dental" with no mention of the retirement. What does ADA Code 5.G and Advisory Opinion 5.G.1 say about this?