IS IT ETHICAL FOR DENTISTS TO TREAT THEIR OWN CHILDREN?

Abstract

My wife and I are going through a divorce. She has petitioned the judge for child support, which includes routine dental care, as well as orthodontic treatment, for our two children, ages 12 and 14 years. I object to this because I am a pediatric dentist and perfectly capable of treating my own children. It just isn't necessary to send them to another dentist or an orthodontic specialist. If my wife and I and the judge can agree, is it ethical for me to treat my own children under these circumstances? No doubt you and your wife want the best care available for your children. Whether it is ethically appropriate for you to treat your children in this instance, unfortunately, could become a highly charged issue compounded by what already may be a decidedly emotional situation. So let us consider some relevant information that may enable you and your family to determine what may be the best route to take. First, there are specific ethical guidelines for physicians regarding the treatment of immediate family members. The American Medical Association Code of Medical Ethics, in its “Opinions on Practice Matters,” states, “Physicians generally should not treat … members of their immediate families.”1American Medical Association Code of medical ethics: E-8.19—self-treatment or treatment of immediate family members.Available at: “www.ama-assn.org/ama/pub/category/8510.html”Google Scholar The rationale underlying this statement is that “professional objectivity may be compromised when an immediate family member … is the patient; the physician's personal feelings may unduly influence his or her professional medical judgment, thereby interfering with the care being delivered.” It further states, “Physicians may fail to probe sensitive areas when taking the medical history,” that “patients may feel uncomfortable disclosing sensitive information or undergoing an intimate examination” and that “sensitive or intimate care should especially be avoided for [a minor child].” Concerns regarding patient autonomy and informed consent also are raised, particularly with minor children who may “not feel free to refuse care from their parents.” A threshold question is whether the practice of dentistry inherently creates the same or a similar level of conflict of interest as does the practice of medicine. Many dentists say it does not. There is no parallel provision in the American Dental Association Principles of Ethics and Code of Professional Conduct (ADA Code).2American Dental Association Principles of ethics and code of professional conduct, with official advisory opinions revised to January 2005. ADA, Chicago2005Google Scholar Consequently, the ADA Code does not prevent dentists from treating their family members. The decision to do so is left to the discretion of the dentist and the family member involved. However, various sections of the ADA Code are relevant when making this decision. The first principle of the ADA Code, Patient Autonomy, tells us that “[t]he dentist has a duty to respect the patient's rights to self-determination … .” Your children, while still minors, are approaching the age at which their wishes about their dental treatment should be taken into consideration. Principle 3, Beneficence, states that the dentist has “a duty to act for the benefit of others” with the primary obligation of “service to the patient.” It further states that “[t]he most important aspect of this obligation is the competent and timely delivery of dental care within the bounds of clinical circumstances presented by the patient, with due consideration being given to the needs, desires and values of the patient.” You also would want to keep in mind your responsibility under Principle 2, Nonmaleficence, which states that dentists should know their own limitations and when to refer a patient to a specialist or other professional when circumstances and the patient's (in this case, your minor children's) dental condition dictate. Section 2.B, Consultation and Referral, adds that the dentist is “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.” The issue here is whether your children's orthodontic needs may require treatment by an orthodontist. With these issues in mind, you and your wife should consider several other factors before making your decision. Equally important points to consider are the sensitive nature of your family's situation (including the needs and emotions of your minor children and their comfort level with you as their dentist), your ability to remain objective in providing your children with the necessary care and the degree to which your financial interests may be influencing your decision. After evaluating the situation objectively, assuming there are no conflicts of interest and that you and your wife determine that you are the most competent practitioner for the job, then you are ethically free, from the ADA Code's standpoint, to treat your children with no obligation to refer them to other practitioners.