1. Patient Abandonment

2. Ethics and Law As has been emphasized previously, while ethics and law are not the same, there are areas of similarity and overlap. Laws are society’s way of attempting to appropriate justice, which is a principle of ethics. “Ethics is beyond the law, but not above the law.” A primary moral rule is “obey the law.” This discussion of abandonment considers not only the ethical but also the legal, which is also the ethical.

3. Ethics The concept of ethics basic to thinking about abandonment is fidelity, that is, faithfulness. The establishment of a covenantal / contractual relationship with a patient is, in fact, to profess (promise/vow), to care for the patient’s oral health. (Thus is dentistry as a ‘profession.’) The promise must be kept until formal dissolution of the relationship.

4. Law From the legal perspective, contractual agreements, such as which occur in the dentist / patient relationship, must be managed fairly by both parties. Justice requires such. Thus laws addressing patient abandonment are laws designed to ensure that patients are treated fairly by their dentist.

5. Essential Elements in Abandonment 1. an established dentist/patient relationship, 2. a reasonable reliance on the part of the patient that care will be provided, 3. a need of the patient of such a nature that lack of care will cause injury; and 4. a lack of care that actually causes injury.

6. The dentist / patient relationship may be created by minimal contact, even by a single telephone conversation scheduling an appointment.

7. Abandonment May Be Present When: A dentist expresses refusal to treat a patient without giving the necessary and proper notice with the opportunity for the patient to secure other dental care. A dentist removes self from operatory during a procedure, or fails to attend to the patient immediately after treatment. A patient is not observed often enough to recognize potentially harmful developments in time to treat the patient safely. A dentist fails to give proper instructions as to the patient’s care subsequent to leaving the office.

8. Grounds For Terminating Relationships The dentist / patient relationship may be terminated when there is: lack of cooperation by the patient lack of agreement on appropriate goals or methods of treatment. intervening illness of the dentist. lack of payment by the patient. mutual consent.

9. The patient must be given sufficient notice so that he or she can procure other dental attention elsewhere, and must not be abandoned at a critical course of treatment.

10. When a dentist wishes to withdraw from the care of a patient, retires, or relocates the practice, proper notice must be given. Notification of termination of the dentist/patient relationship is best accomplished by certified letter, return receipt requested. No reason for the termination is legally required, but is morally encouraged. Adequate and reasonable time for the patient to procure another dentist must be given.

11. The dentist must make reasonable arrangements for seeing patients during hours the dentist is not in the office, e.g., evenings and weekends. The dentist must make reasonable arrangement for patients being seen by colleagues during periods of absence, e.g., illness, professional meetings, or vacation.

12. Referral If a dentist lacks the requisite skill to treat a patient, the dentist must inform the patient and effect a proper transfer to one who has the necessary competency. If the patient refuses to pursue the treatment/referral, the dentist must warn the patient about the risks of not being referred and treated. (Informed Refusal)