Honoring Autonomous Decisions
Kevin I. Reid, DMD, MS, MA, HCEC-C, FACD
Miao Xian Zhou, DMD, MS
Kevin I. Reid is the Director of the Clinical Ethics Consult Service at Mayo Clinic, Rochester, Minnesota and Consultant in Orofacial Pain, Department of Dental Specialties, Mayo Clinic, Rochester, Minnesota. Miao Xian Zhou is the Senior Associate Consultant in Periodontics, Department of Dental Specialties, Mayo Clinic, Rochester, Minnesota.
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ental referrals between general dentists and dental specialists do not often produce moral conundrums. Typically, general dentists have a significant role in referral of patients to dental specialists.1 There are instances in which dental specialists may need to refer to a general dentist if patients do not already have a general dentist. The ADA’s “General guidelines for referring dental patients” states the following:2 “ Dentists shall be obliged to seek consultation, if possible, whenever the welfare of patients will be safeguarded or advanced by utilizing those who have special skills, knowledge, and experience. When patients visit or are referred to specialists or consulting dentists for consultation: 1. The specialists or consulting dentists upon completion of their care shall return the patient, unless the patient expressly reveals a different preference, to the referring dentist, or, if none, to the dentist of record for future care. 2. The specialists shall be obligated when there is no referring dentist and upon completion of their treatment to inform patients when there is a need for further dental care.”
Journal of the American College of Dentists
Referral dynamics are rarely problematic. However, there are ethically compelling instances in which a patient will ask the specialist to refer to a colleague to complete a procedure previously planned by the referring general dentist. There is little in the way of guidance to navigate this challenging situation. It has been hypothesized that shared decision making plays an important role in dentistry.3,4 Here, we present a hypothetical but representative scenario to underscore pertinent ethical issues and particularly those related to the obligation to respect patient autonomy. Further, we consider ways to navigate this potentially awkward situation while still meeting the ethical and professional obligations inherent in the role of a Dental professional. We refer to the dental specialist as the “consultant” and the referring dentist as the “referring dentist.” 52
