For years, dentists have provided free clinics and
screenings for underserved and low-income populations. Free cleanings,
procedures, treatments – how could any of these be considered harmful to a
patient? After all, we’re discussing people who would otherwise not receive any care.
The ADA’s recently published paper, The Ethics of Temporary Charitable Events, addresses possible
adverse outcomes that many would never even consider regarding short-term
volunteering. Nonmaleficence is an ethical principle that states dentists have
a duty to refrain from harming a patient. One major concern involves the lack
of follow-up care. Patient abandonment is a definite possibility at these
temporary outreach events, and providers should ensure that the patient has
been treated well and has the opportunity to have all work completed (Raimann
et al., 2015). A temporary fix may result in greater harm if proper patient
education and follow-up care isn’t provided.
Similar to nonmaleficence is the principle of beneficence.
It’s the duty of the dentist to service the patient and act for the benefit of
others. These temporary charitable events are a great opportunity to increase
access to care as well as provide oral health education. However, lack of
training and coordination, possible language or cultural barriers, and the lack
of sustainability are important things that need to be taken into
This was a major issue in the aftermath of the 2010
earthquake in Haiti. So many health agencies tried to dispatch workers to the
same area, leaving other areas with no access to care. Many patients were left
without follow-up care for amputated limbs, wounds, or fractures because referrals
weren’t well established (Langowski & Iltis, 2011). Similarly, a language
or cultural barrier could significantly impede delivery of proper care. If a
patient doesn’t fully understand why a cavity is being filled, what the
possible dangers are, or how to prevent another one from occurring,
establishment of a long-term dentist-patient relationship is more challenging.
After all, one of the goals of these short term volunteering projects is to
stress the importance of having a dental home and maintaining dental health on
a regular basis (Raimann et al., 2015).
This brings me to the point of sustainability. Large
organizations like Medecins
or Operation Smile receive significant funding and support for their endeavors.
They have enough money to train volunteers and develop a plan for working with
local communities. But what about regular local health agencies who just want
to help? Is setting up a free clinic worth it if there’s no foreseeable
long-term plan? (Langowski & Iltis, 2011)
Finally, veracity and transparency are other concepts that
should be considered. Dentists should honestly educate their patients about
treatment options and the limitations of a temporary charitable event. A dental
disease can’t be cured or prevented at a single outreach event, and the patient
should be made aware of this. Even though the care provided today is free,
there may be potential follow-up fees to consider. Patients should also
understand who exactly is providing care – students, specialists, or general
dentists? (Raimann et al., 2015) Patient education is arguably the most
important aspect of any service a dentist can provide. It increases the chances
a patient will return for follow-up care and decreases the chances of treatment
complications secondary to noncompliance.
Free clinics and screenings – are they good or bad? It’s
hard to say; nothing is wrong with wanting to help people. But we should ensure
that execution of such community outreach events meets the standard of care
that’s expected of us as dentists.
Langowski M, Iltis A. (2011, June 15). Global Health Needs
and the Short-Term Medical Volunteer: Ethical Considerations. HEC Forum, pp.
71-78. Retrieved May 10, 2016, from http://link.springer.com/article/10.1007/s10730-011-9158-5
Raimann T, Reynolds E, Ishkanian E, et al. (2015). The
Ethics of Temporary Charitable Events. Retrieved May 10, 2015, from
http://www.ada.org/~/media/ADA/About the ADA/Files/ADA-Charitable-Event-White-Paper
define this acronym