Patient Abandonment

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 societys 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 patients
  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 patients 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.

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• 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)