Ethical and legal issues in special patient care.

Dental professionals encounter a number of challenging ethical and legal dilemmas when caring for special patients. Questions may arise in securing consent for treatment; using restraints; overcoming economic, social, and physical barriers to care; and dealing with patient abuse. These concerns generally stem from underlying conflicts between any of the fundamental ethical principles of autonomy, nonmaleficence, beneficence, justice, veracity, and fidelity. When securing consent for treatment, practitioners must consider both legal competence and decision-making capacity. If decision-making is impaired, input should be solicited from others to arrive at treatment decisions in keeping with the patient's values concerning dental care. To guard against the inappropriate use of restraints, 10 guidelines are presented for consideration. Providers should strive not to allow economic considerations to influence their care unduly either by failing to offer a full range of options or by providing care that is below usual standards. Services must be made available to disabled individuals on the same basis that they are available to others without disability. This principle forms the basis of the Americans with Disabilities Act, which stipulates what accommodations must be made to ensure that physical and social barriers do not impede access to dental care. Finally, special patients, particularly the frail elderly, are at increased risk to become victims of abuse. Dental professionals should be familiar with the warning signs and symptoms of such abuse and their obligation to take actions to end it.