ETHICAL MOMENT | Patient autonomy : Cancer
Suppose Sarah ’ s prognosis is as dire as indicated by the family . In that case , the dentist should consult with the patient ’ s physician and , perhaps , schedule a conversation with the patient and her physician to discuss options and to ensure that she has a full understanding of her diagnosis and prognosis . As oncology requires special skills and knowledge , the dentist ethically should consult with the oncologist . 1 Failing to disclose the patient ’ s health status to her , if she has capacity , is a violation of her autonomy and inhibits her ability to make decisions based on her own goals and values .
Once the dentist and patient clearly understand her health , that may influence how they discuss treatment options . Even if all disagree with the patient ’ s choice to pursue veneers , for example , owing to her limited life expectancy and the cost of such a procedure , she is free to make such a choice if she is an adult with capacity .
If , however , this may pose a danger to her already failing health , the dentist may find that her request is not “ within the bounds of an accepted treatment .” 1 Thus the dentist may refuse to proceed . This , however , should not be determined by the family . Her family ’ s role in making the decision should be dependent on whether the patient has capacity and , if so , how involved she wishes her family to be ; and if she does not have capacity , the family ’ s role should be dependent on whether she has named a durable POA for health care .
“ The ethical dentist strives to do that which is right and good .” 1 This is not always easy , especially when more than one course of action may be appropriate . But the dentist has a relationship with the patient first , and , therefore , her “ rights to self-determination and confidentiality ” should be the focus in addressing the complex circumstance described .
References
1 . American Dental Association Council on Ethics , Bylaws , and Judicial Affairs . American Dental Association principles of ethics and code of professional conduct , with official advisory opinions revised to November 2020 ; https :// www . ada . org / - / media / project / ada-organization / ada / ada-org / files / about / ada _ code _ of _ ethics . pdf ? rev = 86aeaa6fb0d- 0467f8a380a3de35e8301 & hash = 89BAA88FB9305B- 8F134414E337CAE55A , Accessed 14th Aug 2022
2 . J . V . Welie Living wills and substituted judgments : a critical analysis ; Med Health Care Philos , 4 ( 2 ) ( 2017 ), pp . 169-183
3 . J . V . M . Welie , S . P . K . Welie Patient decision making competence : outlines of a conceptual analysis ; Med Health Care Philoso , 4 ( 2001 ), pp . 127-138
4 . A . Mukherjee , A . A . Livinski , J . Millum , et al . Informed consent in dental care and research for the older adult population : a systematic review ; JADA , 148 ( 4 ) ( 2017 ), pp . 211-220
About the Authors
Dr . Himmelberger is a retired general dentist , a past chair of the ADA Council on Ethics , Bylaws and Judicial Affairs , and served as our ADA Third District Trustee from 2017-2021 . Dr . Himmelberger was PDA president in 2006-2007 .
Dr . Clark is a member of the American Dental Association Council on Ethics , Bylaws and Judicial Affairs and a supervising dentist , California Department of Corrections Health Care Services , Marin County , CA .
Disclosure . Drs . Clark and Himmelberger did not report any disclosures .
Ethical Moment is prepared by individual members of CEBJA or guests of CEBJA , in cooperation with The Journal of the American Dental Association . Its purpose is to promote awareness of the ADA Principles of Ethics and Code of Professional Conduct . Readers are invited to submit questions to CEBJA at 211 E . Chicago Ave ., Chicago , Ill . 60611 , e-mail ethics @ ada . org . The views expressed are those of the author and do not necessarily reflect the opinions of the American Dental Association Council on Ethics , Bylaws and Judicial Affairs or official policy of the ADA .
22 MARCH / APRIL 2023 | PENNSYLVANIA DENTAL JOURNAL