Code of Ethical Practice and Professional Conduct

Introduction

This document is published by the European Federation of Orthodontic Specialist Associations to provide a guide to the ethical obligations of its member societies and their individual members and to describe the role of the EFOSA Council in Ethics. With changes in public expectations and constant developments in clinical techniques and professional requirements, new situations leading to future changes of this narrative will inevitably arise. Members of EFOSA accept the principles of ethical practice and professional conduct expressed in this code and must assume a responsibility to support their individual members in the maintenance of these principles.
Whilst the primary purpose of this Code of Ethical Practice and Professional Conduct is to protect the public and our patients, we must also recognise our responsibilities and obligations to colleagues and other health care professionals. No one principle can stand alone or be individually applied to a situation. In all instances, it is the conglomerate intent and influence of the principles of ethics which shall measure ethical behaviour for the orthodontist. Ethical standards of professional conduct and responsibility may exceed but never are less than, nor contrary to those required by law.

Competent Dental Authority

In all countries in the European Union there exists a national body which administers the dental profession. This body is the same as the “Competent Dental Authority” as defined in the EC Dental Directives 78/686/EEC or the equivalent body in non-European Union States. It is under these bodies that all specialist practitioners of orthodontics are registered and subject to regulation and disciplinary procedures.

Ethical Obligations and Duties of the Members of EFOSA.

  1. EFOSA expects that all member societies will give active concern to the ethical behaviour of their individual members.
  2. All member societies should as a minimum requirement adopt the EFOSA Code of Ethical Practice and Conduct in Orthodontics as set out in this document as well as the ethical guidance of their own Competent Dental Authority.
  3. Any action taken by an individual member relating to quality of care issues as encompassed by these Codes of Ethical Practice and Professional Conduct and which breach guidelines on Professional Conduct and Fitness to Practice of the Competent Dental Authority should be reported to the Competent Dental Authority; and this could ultimately result in suspension or curtailment of the right to practice.
  4. All member societies have an obligation to bring to the attention of the Council of EFOSA any individual suspension or erasure from the register as a specialist in orthodontics by their Competent Dental Authority.

Ethical Obligations and Duties of the Council of EFOSA.

  1. The Council of EFOSA has an obligation to ensure that all Members comply with the ethical requirements and duties.
  2. The Council of EFOSA on behalf of its constituent members shall establish and maintain the Federation’s Code of Ethical Practice & Professional Conduct.
  3. When the Council of EFOSA receives information from a member society that an individual member has been suspended or erased from the register as an orthodontist the Council shall immediately update its file of registered orthodontists of the concerning country for the relevant period of time.

EFOSA CODE OF ETHICAL PRACTICE & PROFESSIONAL CONDUCT IN ORTHODONTICS

An ethical standard of professional conduct demands a level of personal performance at least as high as that required in law and sufficient to conform with the profession’s own generally accepted codes of good practice. The Council and Members of EFOSA have a duty to take action over unethical standards of professional conduct where these might threaten the well being of patients or the good reputation of the profession.

Principles of Ethical Practice in Orthodontics

  1. In the following “Members” means an individual member of any orthodontic society which is a member of EFOSA.
  2. Members shall recognise and uphold the principles regulating the ethical practice of orthodontics as laid down by this ”Code of Ethical Practice & Professional Conduct”.
  3. Members shall ensure that they make no false or misleading statements to patients. This shall include any misleading claims of competence which cannot be supported by the generally accepted standards of orthodontic practice.
  4. Members shall not give false or misleading statements in their professional advertising including any information given on the Internet.
  5. Members should provide basic information on orthodontics to every patient and/or the patient’s parent or guardian. This information should at least contain the scope and reasons for orthodontic treatment, the aims of treatment and the patient and parents’ obligations during treatment.
  6. All treatment planning should follow a full examination and the taking of all necessary diagnostic records.
  7. When planning treatment, members should take into consideration the patient’s and/or parents’ or guardians’ wishes and best interests.
  8. Members should provide the patient and/or parent or guardian with information about the proposed treatment. This information should outline specifics not being dealt with in the basic information, such as professionally determined need and the method, time and cost of treatment.
  9. Members should discuss with the patient and/or parent or guardian the risks and benefits inherent in the possible alternative treatment options including no treatment.
  10. Members do not have to provide treatment that they feel is not in a patient’s best interests. Notwithstanding the right to exercise discretion over the provision of treatment, members shall not refuse to accept any patient for treatment on the grounds of race, colour, creed, gender, age, or disability.
  11. Members should give consideration to the cost of orthodontic treatment. Cost- considerations should include financial cost as well as non-financial cost, such as treatment duration, effort from the patient and/or parents or guardians and discomfort as a result of treatment.
  12. Members shall ensure that they have the full and informed consent of their patients for all aspects of a proposal for treatment. That consent should be accurate and comprehensive and the onus rests with the member to ensure that it is understood and acknowledged by the patient. Written and signed consent is advisable.
  13. Members shall ensure that the standard of treatment they dispense is of the highest quality compatible with individual circumstances of, or the express wishes of, the patient.
  14. Members shall ensure that reasonable arrangements are made for their patients to receive any necessary emergency care and that their patients are properly aware of such arrangements. The duty of emergency care, so far as it is reasonably possible, extends beyond members’ own patients to any member of the public seeking their help.
  15. Members shall, at their own discretion, or at the request of a patient, seek a second opinion on the management of a clinical situation before, during or after a course of orthodontic treatment. Such an opinion should be sought from an appropriate source.
  16. Members shall ensure that continuity of clinical management is maintained for a patient who moves away from the local cover offered by the practice. A written referral is obligatory, and whenever possible this should be made to a qualified orthodontic specialist. Acceptance of the transfer by the receiving practitioner should be confirmed to the referring practice and all relevant clinical records should be made available.
  17. Members should equally be willing to accept transfers from colleagues under financial arrangements that apply in the country of the accepting member and take account of the treatment to be completed and the payments made so far.
  18. The rule of confidentiality in the patient/clinician relationship has been accepted throughout the history of medicine and dentistry. Information discussed in the course of consultation and treatment is confidential and should not be disclosed. This applies not only to clinicians but also to supporting staff. Therefore Members should not disclose information about patients without appropriate consent except to those with a genuine concern for a patient’s welfare, such as other health care professionals or where there is a requirement in law. In the case of minors, information may only be disclosed to parents and/or legal guardians where it is in the interest of the patient. If there is doubt over specific issues, members are strongly advised to seek advice from their national professional association.
  19. “Whistle blowing”. If a Member becomes aware that another orthodontist is performing poorly in a consistent manner to the detriment of patients, whether because of impairment, incompetence, unethical conduct or illegal practice it is the member’s ethical duty to inform the appropriate person and/or authorities with a view preventing continuing harm to others.

June 2005