ETHICAL MOMENT
Patient autonomy : Cancer
By Alma Clark DDS , MSHCE , and Linda K . Himmelberger DMD
( Reprinted with permission from the Journal of the American Dental Association , January 2023 ; Volume 154 , Issue 1 , pages 94-95 )
QUESTION :
Several months ago , a colleague received an emergency call from a new patient regarding pain in her left maxilla . Although Sarah was not a patient of record , her husband , sisters , and other extended family members were all patients within the practice . My colleague agreed to see Sarah but soon learned through a phone call from Sarah ’ s husband that she had metastatic cancer , which had spread to the maxilla , and he did not wish his wife to know . Sarah ’ s husband requested to “ slow walk the treatment .” The dentist saw the patient , obtained a periapical radiograph , told Sarah she did not see anything on the radiograph indicating pain that could be caused by a tooth problem , and suggested the patient contact her oncologist to rule out any other causes . According to the patient , the oncologist did not address her concern , nor did he tell her about the spread , suggesting instead that the patient not “ worry about little pains here and there , and just continue to live her best life .”
Sarah again contacted the dentist . A cone-beam computed tomographic scan was obtained , clearly showing the cancerous lesion in the left maxillary sinus . The dentist reviewed the cone-beam computed tomographic image with the patient and her sister , a nurse , noting there seemed to be “ something ” in the sinus . The sister recognized the lesion as cancer and suggested Sarah see her oncologist for another opinion .
In addition , the patient is interested in having veneers placed and a new nightguard fabricated ( an expensive dental treatment ). Unfortunately , my colleague has avoided Sarah ’ s requests , unsure if the patient would still opt for these treatments if she knew the source of her pain .
What are the dentist ’ s ethical obligations regarding disclosure of the information that is known ?
20 MARCH / APRIL 2023 | PENNSYLVANIA DENTAL JOURNAL