In the March JADA Ethical Moment, "Is It Unethical to Offer Incentives for Patient Referrals?," (JADA 2007;138[3]: 393–4), Dr. James Antoon writes about "incentives" for patient referrals. He cites "Section 4 of the American Dental Association Principle [sic] of Ethics and Code of Professional Conduct." Dr. Antoon notes the Principle of Justice: "the dentist’s primary obligations include dealing with people justly ...". He then cites ADA Code Section 4.D, "dentists shall not accept or tender rebates or split fees."
Section 4.D refers to Expert Testimony, according to the ADA Web site’s published Code of Ethics.1 Section 4.E states, "Dentists shall not accept or tender ‘rebates’ or ‘split fees.’ "
The topic of fee splitting is also mentioned in the ADA Code Section 5.F.4, while discussing false or misleading advertising. This reference is not included in Dr. Antoon’s "Ethical Moment."
When a patient is not fully informed of financial arrangements between referring dentists or referral services, it would appear impossible for that patient to render truly informed consent, in my view. Treating patients without first obtaining fully informed consent may have legal consequences, I suspect. Dentists who mislead patients about fee arrangements gain a financial advantage over honest dentists who are completely truthful to patients.
The practice of fee splitting or dentists offering incentives is a serious matter in my opinion2,3 and deserves more careful consideration than a few paragraphs containing typographical errors and omissions.
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