Transcript Patient Abandonment - University of Kentucky

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