Salvatore J. Durante, DDS, FAGD

 Family Dentistry & Orthodontics

    Phone 718-486-9076      Email SalDurante@gmail.com
     326 Leonard St., Brooklyn, NY 11211
3 blocks from the Metropolitan Ave./Lorimer stop on the G & L trains       

 326 Leonard St., Brooklyn, NY 11211
3 blocks from the Metropolitan Ave./Lorimer stop on the G & L trains       

Copyright Salvatore J. Durante, DDS, FAGD, 1993. Published in GP: The Journal of the New York State Academy of General Dentistry, September 1990.

Many people believe that regulators simply want to protect them from their own ignorance and stupidity. Not only is this proposition insulting to anyone with self-esteem, it is absurd on its face. It is contradictory to assert that people, in general, cannot be expected to act rationally and make informed decisions, and then assert that they are wise enough to appoint a few men--regulators--to decide what course of action would be best for all. The proposition is illogical, yet it alone could not lead to the coercive governmental agencies that one must obey today: IRS, FDA, DEA, EPA, OSHA, the State Education Department and its Office of Professional Discipline (licensing), etc. At worst, it would lead to some inefficient advisory bodies that people could choose to ignore.

No, what leads to the coercive nature of governmental regulatory agencies is the notion that one is not, and should not be, responsible for oneself or the consequences of one's actions. Put differently, your life is not your own; your decisions--good or bad--are not your own; your wealth, or lack of it, is not your own. Sounds ridiculous in America, doesn't it? Yet this is one of the ugly premises behind much of today's governmental action, including governmental regulation of physicians and dentists.

"Good intentions" notwithstanding, over a long enough period of time, regulatory authority cultivates and attracts people who simply lust for power. Today, we are witnessing the climax of such a process in medicine. The government is steadily instituting the means of controlling all medical decisions. For example, those in control of the Health Care Financing Administration (HCFA), the agency that oversees Medicare, no longer deny that they seek to control health-care decisions; those in control of state-run Medicaid programs, which are beginning to implement rationing schemes, openly state that they hope to provide models for bureaucrats who could then ration all health care. This is a power-luster's paradise.

Those who still claim that regulators are only trying to do what they think is best should note that "the road to hell is paved with good intentions," as the author of a letter to the editor on page 4 reminds us. In simplest terms, adults have the inalienable right to be left alone in their voluntary associations, regardless of the "good intentions" of any third party--no matter how large or "wise" that third party may be. Violating this right by granting regulatory authority to impose one particular set of "good intentions" on adults, who would otherwise make their own voluntary contractual arrangements, is a blueprint for tyranny.

One may be tempted to ignore the law, at least those regulations that one regards as particularly absurd. You may wonder what could be the real harm in letting your assistant perform prophylaxes when you know she is capable; or, why shouldn't you allow your hygienist to use nitrous oxide since you are confident she knows what she is doing?; or, why can't you rewrite a prescription for your mother's heart medication, since you would only be doing what her physician would do if he were not away on vacation? You may think, "I and those directly concerned are adults; we understand the risks and benefits of our actions, so why should we observe some absurd governmental edict?"

The main reason you should obey these and all other regulations is that if you do not, you risk punishment. Make no mistake about it: those in power stay in power and justify their roles by prosecuting offenders. That is the nature of regulatory bureaucracy.

Another reason for toeing the government line is that one cannot effectively fight an unjust law or regulation while simultaneously violating it. Respect for the law is a requirement of civilization. Furthermore, claiming that one wishes to improve the law while willfully violating it is hypocrisy. One needs the support of one's peers to change laws, and hypocrisy does not instill confidence nor inspire potential allies. Violating the law can be justified if one intends to make one's action a "test case," or if all methods for changing the law have been nullified--that is, if censorship has been imposed. (A form of censorship has been imposed under anti-trust legislation, but such laws do not yet forbid agitating for legislative changes.)

A much more effective and safe approach is to obey the law, while educating those it affects adversely. For instance, if you believe that the limitations on nitrous oxide use by hygienists are especially ridiculous and costly, and if your patients are upset by the regulation, then educate them and make them your allies. You could display a simple notice in your reception area and hygiene room to let your patients know that this legal requirement exists, and tell them whom to contact if they object. Then start a campaign to have the NYSAGD and Dental Society of the State of New York (DSSNY) fight to change the law. Who do you think is responsible for many of the laws and regulations that affect dentists, anyway? Chances are that one of the dental groups wrote the legislation you dislike in the first place.

On a broader scale, one can write letters to editors of dental publications to assure others who are equally outraged that they are not alone. One can display strength in numbers and demand accountability from politicians through letter-writing campaigns. (This seems to have worked well for the ADA and AGD in fighting the more ridiculous provisions of recent OSHA regulations.) One can use the same methods to change policy in the ADA and AGD, which can then lobby for change in Congress and the state legislature--a nebulous, but our only real, link to the regulators, who are not elected to their positions of power. This is a slow process of education, but its effectiveness has been demonstrated repeatedly.

In summary, question the actions of government bureaucrats, but obey the law! You can and should oppose the power-lusters by using the educational powers of the press and by directing the professional organizations that you pay to represent you, but you should not volunteer to be the regulators' next victim.

For information on your legal scope of practice, contact the State Education Department at 518-474-3838.  

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