Silveira Marushka Leanne, Chattopadhyay Amit
Division of Biostatistics & Epidemiology, University of Massachusetts, Amherst, MA.
Office of Science Policy and Analysis National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD.
Ethics Biol Eng Med. 2011 Apr 1;2(2):115-136. doi: 10.1615/EthicsBiologyEngMed.2012004545.
Testing for systemic diseases in dental clinics is a potentially attractive avenue for oral health professionals and may be viewed as an opportunity to increase professional reach, expand practice, and improve financial returns. However, several ethical questions arise that must be addressed before such activities are adopted. (1) What should be the level of training dentists must acquire to deal with challenges associated with testing? (2) How well are dental practices aware of and compliant with the Health Insurance Portability and Accountability Act and procedures related to informed consent? (3) What is the evidence regarding acceptability and effectiveness of testing? (4) What should be the acceptable standard of practice for conduct of invasive and noninvasive tests? (5) What is the boundary delineating "testing" and "reporting" vis-à-vis counseling? (6) What is the value of testing without counseling? (7) What assurances need to be in place to ensure voluntariness of testing? (8) How would data from testing be used in "research," especially with the growth of practice based research networks? and (9) Does the American Dental Association Code of Ethics need to incorporate guidance for practicing dentists? We discuss how ethical principles can be used to develop a framework of guidelines for potential testing for systemic diseases in dental clinics..
在牙科诊所进行全身性疾病检测，对口腔健康专业人员来说可能是一条颇具吸引力的途径，并且可能被视为增加专业影响力、扩大业务范围以及提高经济回报的契机。然而，在采用此类活动之前，会出现几个必须解决的伦理问题。（1）牙医为应对与检测相关的挑战必须获得何种程度的培训？（2）牙科诊所对《健康保险流通与责任法案》以及与知情同意相关的程序了解程度如何且是否合规？（3）关于检测的可接受性和有效性的证据是什么？（4）进行侵入性和非侵入性检测的可接受的执业标准应该是什么？（5）在咨询方面，界定“检测”和“报告”的界限是什么？（6）不进行咨询的检测有何价值？（7）需要有哪些保障措施来确保检测的自愿性？（8）检测数据将如何用于“研究”，尤其是随着基于实践的研究网络的发展？以及（9）美国牙科协会道德准则是否需要纳入针对执业牙医的指导意见？我们讨论如何利用伦理原则为牙科诊所潜在的全身性疾病检测制定一套指导方针框架。
