An Ethical Critique of the AAO Principles of Ethics and Code of Professional Conduct

Abstract

The American Association of Orthodontists(AAO) adopted its Code of Ethics and Code of Professional Conduct in May of 1994. This document is meant to provide guidelines for ethical behavior amongst orthodontic professionals. Its main purpose is to protect the public from ethically unsound actions that could be committed by members of the AAO. All members of the AAO agree to abide by the Code, as stated within its preamble: "By accepting membership, all members assume an obligation of self-discipline above and beyond the requirements of laws and regulations, in accordance with these Principles." This study represents a critique of the AAO Code. As the field of medical ethics evolves, so must the documents that govern ethical behavior. The last revision took place in May of 2009 and the wording of the current document can be misinterpreted or abused. The current code leans heavily towards an Agent/Commercial model of practice, where the Orthodontist's role is influenced greatly by patient request and business ambitions. The purpose of this study was to utilize accepted schools of thought in ethical literature to do the following: (1) Point out ethical flaws and weak points in the AAO Code. (2) Present corrections for the Code in order to clarify potential points of contention. These corrections will articulate rules that promote a partnership between practitioner and patient. To accomplish these goals, the Code will be analyzed, line by line, for redundancies, faults, or potential misinterpretations. Principles and Advisory Opinions which can be improved upon will be labeled as "weak." All weak statements will be reformed in a manner where the weak aspects no longer play a role in the Code. The reformed statements will promote the Partnership model of practice in favor of Agent and Commercial models. The Conclusions of the study are as follows: (1) Principle I can be improved by changing it to the following phrase: Members shall be dedicated to providing the highest possible quality orthodontic care to his/her patients within standards commensurate with the accepted science and techniques of orthodontics, the clinical aspects of the patient's condition, and with due consideration being given to the needs and desires of the doctor and patient within a relationship based on partnership. (2)Advisory Opinion IE. should be changed to the following: A second opinion should include a diagnosis and treatment plan recommended to the patient. It must be honest and focus on the facts presented. It is unethical to propound a specific technique, philosophy, training or ability as superior without presenting scientific literature, at least summarized or simplified, to the patient to support claims made. A second opinion must disclose to the patient any conflict of interest of the member providing the opinion. (3) The phrasing of Advisory Opinion IF. is made stronger with the following wording: Patients should be informed of their oral health status without disparaging comments about the patient's prior treatment.(4) The phrasing of Advisory Opinion IG. is made stronger with the following wording: Members should inform their patients of their prognosis, any proposed treatment, and any reasonable alternatives, so that the patient understands their treatment decisions.