Q&A: What are your ethical obligations if another dentist dies before completing treatment?
A recent news report described financial challenges faced by patients who had prepaid for treatment before their dentist unexpectedly died.
The ADA News spoke with Jill Burns, D.D.S., a former member of the ADA Council on Ethics, Bylaws and Judicial Affairs, to discuss ethical considerations associated with situations like this, including how other dentists can appropriately assist the patients and help prevent similar issues from occurring in their own practices.
Dr. Burns previously wrote about this topic in The Journal of the American Dental Association in April 2020.
ADA News: If a dentist with an active practice dies before completing treatment already paid for by patients, what obligations do other dentists in the area have to complete that treatment? How do legal and ethical obligations differ in this situation?
Dr. Burns: Under the ADA Principles of Ethics and Code of Professional Conduct, other dentists in the area may have an ethical obligation to assist these patients based on the principle of Beneficence ("do good"). The most straightforward way to help would be delivering finished prosthetics, such as crowns, bridges and dentures, to the patients. I have done this myself for patients caught in a bind after the dentist unexpectedly passes away. I believe most dentists would donate this service gladly.
It's a different question when there are large treatment plans that have not been completed. Most dentists would not be comfortable finishing a treatment plan generated by another dentist, especially if their plan would be different. Legally, the dentist must stay within the boundaries of a state dental practice act. The dentist must do their own diagnosis and treatment plan, or it may fall under a failure-to-examine rule. Beneficence does not require a dentist to treat a patient in a manner that would endanger their license to practice.
Within organized dentistry, some components have taken the next step and formalized a plan to help their fellow dentists if they become disabled or their practices if they pass away. Dentists in Stark County, Ohio, have a program called the In-Office Aid Group within their component of the Ohio Dental Association. This group wrote a contract detailing the assistance that area dentists could provide. The dentists take turns donating care for the patients in their colleagues’ offices if the dentist is unable to practice. The program has been a wonderful success for both patients and dentists in the area.
ADA News: What steps can dentists take to help prevent their own patients from being left with prepaid but unfinished treatment in the event something unexpected happens to them or their practices? How should ethical obligations factor into these preparations?
Dr. Burns: Requiring patients to pay large sums before the case even starts can lead to ethical issues regarding Veracity ("truthfulness") and Justice ("fairness"). Having the patient sign an agreement that addresses negative outcomes and outlines the practice's remedies is helpful. Planning for the unimaginable is always wise, especially considering patients and their continuing care. Many times, a patient must file a claim against the dentist's estate to recover the funds. Two steps that may save patients from having to sue are succession or setting up an escrow account for this purpose. Having another dentist prepared to take over or purchase the practice — succession — is the most seamless option and fulfills the obligation of Beneficence to the patients. This dentist would honor the arrangements and perform the work after completing their own treatment planning.
Dentists could start a dedicated escrow account for patients who prepay for procedures. It would be an independent bank account just for this purpose. Once the patient completes treatment, the dentist can withdraw funds from the account to cover the cost. If the dentist becomes unable to continue, the remaining funds stay in the escrow account and can be refunded to the patient for any unfinished treatment. The accounting for this is beyond me and the scope of this question, but it might be an innovative way for patients and dentists to feel comfortable with large case prepayments.
ADA News: What ethical obligations do dentists need to consider when offering prepaid plans and associated discounts to patients?
Dr. Burns: This is an interesting question. Both Veracity and Justice come into play with prepaid plans and their discounts. The dentist must be truthful about the services included in the prepaid plan, and the fees must be fair. These plans can include two exams, two prophylaxes and bitewing radiographs for a calendar year. The plan can provide discounts on treatments needed outside of these services. These treatments would be handled like any other fee for service, only with a discount attached. The dentist may want to consider including a clause specifying financial arrangements if the dentist cannot provide services, such as in the event of the dentist's death. Fees are nonrefundable unless the dentist cannot complete the treatment. It is very important for the patient to feel comfortable with the arrangements and the contract and to trust that the dentist has their care foremost in mind.
