Can the Amish practice dentistry without a license?

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The Pennsylvania State Board of Dentistry recently ordered an Amish man to stop practicing dentistry, and fined him the maximum allowable fine of $1,000 for his former conduct.

The Amish man, a farmer with 10 children, regularly performed tooth extractions on people in his Amish community. When proceedings were commenced against him by the Pennsylvania Bureau of Professional and Occupational Affairs, the man responded in writing that many in the Amish community cannot afford dentists. He raised concerns that if he were to stop providing dental services, Amish people would attempt to attend to their dental problems themselves or would simply suffer without his services. He explained that Amish people are forbidden for religious reasons to have health insurance.

The Board ordered the Amish man to cease and desist from the practice of dentistry without a license. Noting that he had no power to prescribe medication to combat infection or pain, the Board expressed serious concern that he was extracting as many as 22 teeth from a single patient in one sitting. Given the risk of serious hemorrhage or infection, the Board found that he did not have the requisite skill to practice dentistry safely. Moreover, he was simply in violation of clear laws regarding the licensing of dentists.

On appeal, the Commonwealth Court rejected the Amish man’s claims that his activities were religious. Instead, the court found that his reasons were essentially economic. While the Amish community forswears health insurance on religious grounds, the court noted that many Amish use the services of licensed medical professionals who are outsiders to their community. The court also ruled that while the costs of services from a licensed dentist may be burdensome to individual Amish, their religious beliefs do not prevent them from going to dentists. Expressing some reservations about the harshness of the fine, the court nevertheless found that the Board acted within its power in imposing the maximum fine allowed by law.

Religious objections to state regulations or laws are narrowly interpreted by the courts. Because there is no outright Amish ban on the use of professional dentists, the court found no real religious rights at issue. It is of some interest that neither the Amish man nor the court drew any distinction between his practicing dentistry in the confines of his community, on people who apparently realized that he was unlicensed, and the more troublesome prospect of an unlicensed dentist practicing at large on the unwary public. Had the Amish community intervened, or had privacy issues been raised, the result in the case might have been different.