New Technologies in Health Care - a Legal and Ethical Dilemma

Objective: The purpose of this study was to determine the clinician's legal and ethical obligations to offer a new technology as a therapeutic alternative to patients. Methods: This qualitative study combined a literature review and legal research with key informant interviews. Relevant information was identified through scientific databases: MEDLINE, PubMed; legal databases: Quicklaw, Droit civil en ligne, Justis; and library catalogues: McGill University, Université de Montréal. Interviews with 7 key informants having expertise in the areas of law, ethics and organized dentistry were conducted to clarify aspects unanswered by the literature review. Results: Keywords for scientific databases included legal liability, ethics, moral, diffusion of innovation, practice guidelines, standard of care, informed consent and alternative treatment. Keywords for legal databases included informed consent, alternative and dentist. The search on legal obligations resulted in 36 articles, 6 books and 5 legal cases being more closely examined. The search on ethical obligations resulted in 45 articles, 10 books and 5 websites. The clinician is legally responsible for informing a patient about treatment alternatives as part of informed consent. Practical points of views and personal opinions obtained via interviews highlighted the importance of the clinician having to use personal judgment in order to decide whether a particular technology merits disclosure as a treatment alternative. Conclusion: Deciding whether the technology is a viable alternative requires the clinician to ensure that his/her practice is in accordance with the highest current standards and that he/she is able to evaluate the quality and quantity of the available evidence. Keeping current with significant advances may be accomplished by consulting journals, speaking to respected colleagues and attending continuing education courses and conferences. The addition of an undergraduate course in `Technology Assessment for Clinicians` by dental schools could prove helpful.