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A dentist, now divorced, asked his office receptionist to let him know "if any eligible women come into the office." In addition, the dentist asked the receptionist to screen those she deemed might be eligible to ascertain whether they might be "interested in dating" the dentist. Is this dentist creating a potential ethical dilemma in seeking a date from among his pool of patients?
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The dentist clearly is looking for someone to date, possibly leading to a romantic relationship with either a present or a potential female patient.
Knowing many dentist colleagues over the years who have successful marriages with former patients, this does present a question that is difficult to answer. Certainly, it is clear that for these dentists and patients, one might be hard-pressed to persuade them that there could be a potential downside when a dentist seeks to date a patient, much less that the dentist may be creating an ethical dilemma. This could be viewed the same as any other romantic relationship between consenting adults.
However, the short answer to the posed question is that yes, the dentist may be creating an ethical dilemma in seeking a dating relationship with a patient.
The ADA Principles of Ethics and Code of Professional Conduct ("the Code") is our starting point. Section 2.G, "Personal Relationships with Patients," states, "Dentists should avoid interpersonal relationships that could impair their professional judgment or risk the possibility of exploiting the confidence placed in them by a patient." This section is under the Principle of Nonmaleficence ("do no harm"). Could dating a patient be harmful to that patient?
In any professional interpersonal relationship, such as the dentist-patient relationship, the professional (dentist) has two interests to consider: the patient’s and his or her own. Under another ADA Code principle, Beneficence (do good), the dentist has a duty to place the patient’s interest (welfare) before his or her own interests. The profession and society expect dentists to exercise their superior knowledge and expertise and their professional judgment to promote the best interests of their patients. If a dentist is looking at the patient as a possible date, are the patient’s interests being placed ahead of the dentist’s interests? Ethicists agree they are not.
While it may be difficult for a dentist to ascertain objective differences in his or her own thought processes in the exercise of professional judgment from one patient to another, this dentist’s thought processes regarding this patient likely may be different if his dating interest is foremost in his mind. Therefore, the necessary objectivity present with other patients may be lacking in this situation. One understands, then, that professional judgment could be impaired if objectivity is lacking in the dentist-patient relationship. And the dentist likely would never suspect or certainly would not admit to such impairment. So, while professional judgment may not necessarily be impaired in such circumstances, it certainly could be, which means that a dating relationship between a dentist and a patient is one that the ADA Code recommends dentists should avoid.
This dentist may say, "OK, maybe my professional judgment might be impaired, but the patient still receives excellent treatment meeting the standard of care, right? So, no problem, right?" That is only part of the issue. Could such a relationship exploit the confidence the patient places in the dentist? Such confidence is related to trust. For example, the patient trusts that his or her dentist places patients’ interests above his or her own interests; holds confidential information confidential; will refrain from intentionally harming patients; and does not abuse or misuse any information gathered in the course of the patient-doctor relationship. Patients’ relations with their dentists often put them in a relative position of dependence in which they are easily persuaded or led, and the trust patients have in their dentists allows them to disclose personal information that they likely never would disclose to other people outside such a relationship. If information gathered from the patient during discussions within the dentist-patient relationship is used for a nontreatment purpose, such as discovering that the patient is available for a dating relationship, one could not seriously argue that this dating relationship with a patient could not create circumstances that "risk the possibility of exploiting the confidence placed in [the dentist] by a patient." That loss of confidence may constitute a patient harm. So, yes, the patient could be harmed.
Dental practitioners should not be led to believe that dentists themselves are not also at risk in a dating relationship with a patient. Some professionals have been sued for malpractice by jilted patients who become angry toward them. At least one court has decided that a sexual relationship between a doctor and a patient could undermine the patient’s ability to make an informed decision regarding treatment, rendering the doctor potentially liable for failure to obtain a patient’s informed consent to treatment.1 Patients also file complaints with licensing agencies, some of which have disciplined their licensees for having consensual sexual relationships with their patients. Some dentists, too, are known to require counseling regarding such relationships.
Like all ethical conduct, the more knowledge one has of the issues involved, the better the ethical choices will be. Dentists should balance the fact that there may be much more at risk than stands to be gained by entering into a dating or romantic relationship with a patient. If such a situation is contemplated, the dentist should terminate the dentist-patient relationship.
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