In response to the opinion expressed by Dr. Terri Tiersky in the August JADA Ethical Moment, "What Ethical Considerations Arise From Acting as a Mediator?" (
JADA 2008;139[8]: 1128–1129[Free Full Text]
), I most heartily agree that dentists who volunteer their time to serve as mediators are "performing a necessary and admirable service for [their] local dental society." However, I differ with her conclusion regarding the ethical appropriateness of subsequently accepting a patient encountered in this context as a patient within one’s practice.
Aside from providing an informed professional opinion, the highest obligations of a dentist providing a forensic opinion or serving as a mediator are impartiality and objectivity. There can be no doubt of anything other than the patient’s best interest as the overriding principle in such encounters. A mediating dentist who subsequently begins treating a patient undermines that principle, regardless of his or her innate ability to maintain objectivity.
A dentist assuming the position of mediator is automatically cloaked with an implied mantle of expertise and clinical insight, which may or may not be deserved. Furthermore, to be effective, the mediator must assume the posture of a sympathetic listener and confidant, building rapport and trust. Hence, it is almost impossible for the patient to determine the genuine capabilities of the consulting dentist or eliminate the implied aura of exceptional expertise.
I would assert that, after introductions and the customary obligations of greeting the "new patient," the first order of business should be to establish an explicit understanding between the mediator and patient that if the dentist is to undertake the role of expert, such action would preclude providing dental treatment in the future. The decision then rests with the patient, and the quandary is thereby averted.
As with most ethical dilemmas, there can be extenuating circumstances that affect the subsequent relationship between mediator and patient. Dentists who practice in isolated communities and specialists who practice where there is limited access to other specialists of the same discipline are indeed placed in an awkward situation in which their involvement may produce hardship with regard to future dental care. In such circumstances, dentists would do well to consider alternatives.
