The ADA Council on Ethics, Bylaws, and Judicial Affairs addressed the ethical issues that dental professionals may have with treating unvaccinated patients.

The ADA Council on Ethics, Bylaws, and Judicial Affairs said that the ADA Principles of Ethics & Code of Professional Conduct should aid dentists in addressing the ethical issues regarding unvaccinated patients.

During the ongoing COVID-19 pandemic, the ADA and the council have received inquiries and comments about unvaccinated patients and whether dentists have an ethical obligation to treat them, said Robert J. Wilson, DDS, immediate past chair of ADA Council on Ethics, Bylaws, and Judicial Affairs.

“Some feel very strongly that it is not ethical to deny treatment to an unvaccinated patient,” said Wilson. “Against that backdrop, the council decided a statement on the ethics of inoculations was needed, and the revision of the council’s earlier limited statement was an efficient way to proceed.”

The refusal of care altogether or dismissing patients is not per se unethical, according to Wilson.

“For example, a practitioner who treats a population of highly vulnerable patients, perhaps including some for whom vaccination is contraindicated, may conclude that the ethical obligation to those patients outweighs the ethical obligation to those who willingly choose not to be vaccinated and therefore may present a higher risk to the other patients,” said Wilson

“Perhaps a doctor or staff person has a condition that precludes inoculation and renders them highly vulnerable to significant morbidity or mortality. Because of these very specific and unique circumstances, a blanket statement to the effect that dismissing or refusing to care for an unvaccinated patient is unethical would not be appropriate.”

The updated statement proposes that policies respect the Code’s principles of autonomy, beneficence, and nonmaleficence and be fair to all involved.

“Asking patients with active illness to defer appointments until they are no longer contagious, for example, would reflect respect for each of the principles outlined in the code,” according to the statement. “Another possible solution would be to schedule unvaccinated patients at different times than those patients who may be immunocompromised or who may not be able to get vaccinations and therefore depend on herd immunity.”

According to Wilson, dental professionals can feel an ethical obligation to be vaccinated while recognizing that there are some dentists and patients who are not able to be vaccinated.

“The principle of beneficence calls us to ‘do good,'” said Wilson, referencing the Code. “The dentist’s primary obligation is service to the patient and the public-at-large.”

“Dentists are held to a high standard and are expected to be leaders in the community. By receiving a safe and effective vaccine, particularly during a pandemic, the dentist leads by example in promoting public health. The dentist will also be more likely to remain available to provide service to their patients. Further, the dentist will elevate the esteem of the profession by demonstrating their commitment to the welfare of their patients and the larger community.”

A more detailed discussion and analysis of the application of the Principles of Ethics & Code of Professional Conduct regarding vaccinations can be found in the Council on Ethics, Bylaws and Judicial Affairs white paper titled The Ethics of Vaccination.

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