Ethical behavior transcends legal implications, and represents the level of professionalism, humanity and morality a physician should possess in order to address his/her patient’s care.
If a physician upholds his/her ethical responsibility to a higher standard than a legal obligation, the patient’s best interests may be addressed.
The Hippocratic Oath may not address specific ethical problems unique to the utility of lasers, therefore many professional associations have devised tenets to follow.
The simple acronym, “E-T-H-I-C-A-L” may help guide a physician to uphold the highest ethical standard when performing a laser procedure.
Financial gain may entice a physician to not optimize care for a patient.
It is ethical for a physician to remain honest about their experience and training.
Full disclosure of pertinent information to the patient may be sensible so he/she may remain the autonomous decision-maker without physician biases.
Unreported interests may not only be financially unethical but also may promote biased research and conclusions based on false pretenses.
A patient should not be discriminated against except when laser treatment may negatively alter treatment for that patient.
Advertising techniques are suitable as long as they are not fraudulent or misleading.
A physician may report to peer-review authorities about unsafe laser practices of another practitioner if he/she presents a clear danger to the public.
A practitioner’s lack of action of not reporting inappropriate conduct taken by another physician may be considered unethical and unlawful.
In general, ethics can be considered the science of moral duty, of ideal human character, and of the ideal ends of human action.1 Ethics is closely tied to morals, and it can be said that ethics is the science of morals, and morals are the practice of ethics.1 The legal standard of care is usually the minimum required, while ethics usually pertains to a higher standard. If a physician upholds his/her ethical responsibility to a higher standard than a legal obligation, the patient’s best interests may be addressed. It is a physician’s ethical commitment to the patient, himself/herself and the profession of medicine that may guide a successful laser procedure.
Laser treatments in dermatology may create an ethical dilemma for physicians since some procedures are elective. Clinical endpoints for laser therapy can be difficult to objectively quantify, and patient satisfaction often becomes the cornerstone of treatment efficacy. Furthermore, cosmetic patients may have unrealistic expectations, and instilled in the public, is a media-driven mentality that lasers are generally safe devices without complications.
The continued, heightened controversy in recent years is the result of one looming question: is aging a physical illness?2 Whether the aging face needs rejuvenation may spark dead-end debates even among colleagues in dermatology.3 The Hippocratic Oath may not address specific problems unique to the utility of lasers, therefore many professional associations including the American Medical Association (AMA), American Society of Dermatologic Surgery (ASDS), American Academy of Dermatology (AAD), American Osteopathic College of Dermatology (AOCD), and American Society of Laser Medicine and Surgery (ASLMS) have established tenets in terms of patients’ best interests, professionalism, and personal conduct. These guidelines serve to establish standards for non-medical care in an ever-changing, cosmetic world. In addition, physicians’ ethical responsibilities sometimes differ from their legal ones.4 They are not solely limited to clinical practice, but also include the moral treatment of human subjects in laser medicine and surgery research. Multiple issues may be encountered between a practitioner’s moral duty and the patient’s best interests. A simple acronym, “ETHICAL” (Economics, Training, Heart to Heart Discussion Between Physician and Patient, Interests, Contraindications, Advertising and Libel versus Letting Authorities Know of Misconduct) can serve as a guide to help remind physicians of their ethical responsibilities to patients.
Economics
Financial gain may entice a physician to not optimize care for a patient. It is wise and ethical for the physician to uphold the dignity of the patient, and not exploit or abuse the relationship for financial matters. Gifts, kickbacks and other financial gain received in exchange for operating one laser brand over another may be considered unethical without the consent of the patient. The definition of equipment tampering is any safety bypassing allowing the unauthorized reuse of the product.5 Approved equipment with replacing equipment that is not approved for use may result in negative outcomes for the patient. Furthermore, the resale of lasers to non-physicians is not advocated and may be subject to penalties under the labeling requirements of the Food Drug and Cosmetic Act.5 This action may contribute to non-medical workers operating lasers on patients without the proper training. Moreover, economic bias may sometimes be difficult for physicians to preclude, when they may feel obligated to endorse a product because they receive monies for company lectures and/or research.
Training
It is ethical for a physician to remain honest about their experience and training. Formal procedural dermatology training can assist in demonstrating competency in selected laser procedures, including their proper use and management of complications. It is prudent to disclose to a patient when medical personnel and extenders will be part of the treatment, since some clinics have nurses or physician assistants operating lasers or light devices. A recent survey conducted by the ASDS showed that nearly 41% of responding dermasurgeons reported an increase in patients seeking treatment due to injury caused by untrained, non-physicians performing laser and light rejuvenation techniques.5 Depending on the state, non-medical personnel may perform treatments provided that a physician is on site should a complication or issue arise. Non-physicians must have appropriate documented training in the physics, safety, and surgical techniques for each procedure performed.5 The ASMLS recommends physician extenders complete a basic training program devoted to the principles of lasers, their instrumentation and safety issues.6 A minimum 8–10 h is suggested by the American National Standards Institute (ANSI) standards.6 Furthermore 40% of the time should be allocated to practical sessions.6 It is also recommended that such medical personnel spend time in a clinical setting or preceptorship.6 It is encouraged for the novice to first perform procedures with the supervision by the expert if state law permits.6
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