Thank you to Drs. Glenn and Mayer for sharing their insights in response to my Ethical Moment column. As I mentioned in the column, being asked to treat a patient first met during peer-review mediation raises some "sticky issues;" some of those issues have been further highlighted in their letters.
The column attempted to convey that both the patient and the former treating dentist were adamant in their respective positions, and that the patient’s approach regarding subsequent treatment was made well after mediation efforts had ceased. Thus, a reopening of the mediation and the possibility of an undermining of the mediator’s impartiality is remote.
Furthermore, I indicated that if there was any appearance of acting as the patient’s advocate or using the mediator position to entice the patient into seeking further treatment from the mediator, the better course might be to decline to accept the patient, as the mediating doctor’s impartiality and integrity could be questioned. The column also raised a cautionary flag about the potential for difficulty with the patient; that question must certainly be examined. But involvement in a failed mediation attempt does not necessarily make the patient unreasonable or troublesome, and to brand the patient as such may itself raise an issue of impartiality.
In the end, as with many thorny situations with ethical components, there exist areas where we can differ. There will be instances in which the mediator should decline to accept a patient after peer review. But, as I indicated in the conclusion to the column, in some circumstances, accepting the patient may be done without abrogating the ADA Code. Whether the patient is accepted into treatment in those instances must be left up to the judgment of the dentist involved.
