I am writing in response to the February JADA "Ethical Moment" by Dr. Nicholas Fontana, "How Do I Respond to My Senior Partner’s Unprofessional Demeanor?" (
JADA 2006;137:243[Free Full Text]
).
I have been teaching ethics to dental residents at the University of Florida College of Dentistry for seven years. One of the problems in teaching ethics is relating principles with real-life ethical dilemmas. Separating principles from real ethical dilemmas can lead to a misleading answer. I believe this is the case in the February "Ethical Moment."
Common sense would lead one to believe that a person who acts in the manner of the senior dentist in the scenario would not be open to advice about his or her behavior from a junior dentist in the practice. There is a much greater likelihood that the writer would receive the same rude, unprofessional behavior that this individual exhibits on a daily basis.
There is no reason to exclude common sense in a deliberation on ethical dilemmas. Every dentist has some ethical obligations to patients, as laid out in the ADA Principles of Ethics and Code of Professional Conduct, or ADA Code. But surely the junior dentist’s obligation is considerably less than that of the senior dentist or any other senior member of the group.
The junior dentist has obligations to the patients under his or her care, but unless he is the practice owner, I don’t believe he has an obligation to all the patients in the practice. As for obligations to the employees, unless they are the junior dentist’s employees, there is no obligation. The junior dentist is also an employee in this scenario.
If one of my former residents came to me with this ethical dilemma, my advice would be to terminate his or her employment. I would advise the junior dentist to make very clear to the group the reasons for terminating employment.
Relying solely on interpretation of the principles in the ADA Code tremendously overestimates the junior dentist’s ethical obligation to both the patients and the employees. The fact that the junior dentist is an employee, as well as a provider, changes the dynamics of the situation.
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