CASE 2: GRATEFUL GABBY
Gabby cannot recall how many times she had to visit Dr. Talbot on an emergency basis for issues related to a childhood accident that left her with several severely damaged teeth. She is grateful for every time Dr. Talbot was able to accommodate her into his busy schedule to provide necessary treatment. Fortunately, Gabby has always had the financial resources to pay for her treatment. Her parents’ insurance initially covered the costs. Now she has a good job and pays for her own treatment. Last spring a new problem occurred. Gabby developed a large and very painful sore on her gum tissue in the upper right posterior region. It was the Friday before Memorial Day at 5:00 p.m., and Dr. Talbot had closed his office for the holiday weekend. Because of his good nature and dedication to his patients, Dr. Talbot came in later that evening to examine Gabby and treat the problem. It was an easy fix. Gabby had lodged a large popcorn kernel sheath into the gingival sulcus of tooth #3, and the area had a small abscess. Dr. Talbot removed the kernel, drained the abscess, and assured Gabby that she should be fine in a day or two. Gabby was not only embarrassed but also upset for making Dr. Talbot come in on the holiday for something so
trivial. She paid her bill and as she left the office, she decided she would do something nice for him in return. In mid-July, Gabby arrived at Dr. Talbot’s office with a gift of appreciation for all he had done for her over the years, especially during the latest incident. She had thought long and hard about the gift. She wanted to give Dr. Talbot something he could always keep, as opposed to something like flowers or a food basket. She also thought it fitting to buy something nice because she had been his patient for so long. Gabby settled on mahogany bookends with a nice card of appreciation. She spent $155 on the gift, thinking that it was not too much money for so many years of care. She gave the wrapped gift to the office manager and left feeling satisfied that she had done something nice for Dr. Talbot. She could not wait to hear how he liked it. When Dr. Talbot opened the gift, he was quite surprised. He did not know if it was appropriate to accept the gift or not. Something told him the gift might be too expensive to come from a patient. Conversely, he did not want to insult Gabby by not accepting it because she was a long-standing patient, and
he hoped she would remain his patient. What should Dr. Talbot do (see Table 8)?
Table 8: Case 2 Solution Step Procedure
Working up the Case (fill in below)
1 • Identify the problem and the professional relationship(s) affected . • Gather all relevant facts: ○ Dental. ○ Medical. ○ Social. ○ Identify stakeholders.
○ Examine potential personal biases. ○ Additional necessary information.
2 • Identify the ethical principles and central values involved: ○ Identify those that conflict. ○ Identify those that should take priority. • Identify any professional obligations involved:
○ Refer to relevant professional codes of ethics (ADA, ADHA) as necessary. • Identify legal issues (civil, criminal, and administrative). 3 • List the possible courses of action available. • Answer the question, “What action could be taken?” • Rank the courses of action in light of information gathered in steps 1 and 2. 4 • Select the best solution from the list of possible actions and be willing to act on it. ○ Answer the question, “What action should be taken?" 5 • Prepare a defense for the chosen course of action: ○ Complete the sentence, “I chose this course of action because …” Note . Adapted from American College of Dentists. (2016). Ethics handbook for dentists . Gaithersburg, MD: Author. Retrieved from https://www. dentalethics.org/ethicshandbook.htm Discussion
at stake. The ADA Code does not provide guidance on this topic; however, Dr. Talbot has two choices: ● Graciously accept the gift. ● Decline the gift. Balancing the dominant principles involved here (autonomy vs. nonmaleficence), it appears that more harm will be done if Dr. Talbot refuses the gift. Since Gabby is excited about being able to thank Dr. Talbot in this way and does not expect anything in return, it will be best if Dr. Talbot accepts the gift and thanks her for her generosity. Chances are that this is a onetime event and Gabby will be a happy, loyal patient for many years to come. You may also decide that a better decision would be to accept the gift this time, but also to tactfully explain to Gabby that other gifts will not be accepted in the future. If Gabby’s intentions were suspect – for instance, if she were expecting preferential treatment in return for the gift – Dr. Talbot should consider declining the gift.
The dilemma here is between the professional, Dr. Talbot, and patient, Gabby. Dr. Talbot and Gabby are also the stakeholders in this case. The major issue is whether or not Dr. Talbot should accept his patient’s gift, which he feels is a bit extravagant. Gabby is grateful for the exceptional care Dr. Talbot has given her and has no ulterior motives in giving the gift. Gabby can afford the gift and her intentions are good. Dr. Talbot’s biggest concern is that declining the gift would hurt Gabby’s feelings. Patient autonomy is a relevant ethical principle and central value that is in conflict with the principle of nonmaleficence . The ethical principle of justice is relevant as well, if the gift was given with the expectation of preferential treatment, as this would be unfair to other patients. A major professional obligation that is at risk is respect for boundaries in the provider-patient relationship. Another relevant central value is the dentist’s preferred patterns of practice . There are no legal considerations evident in this case. Respecting boundaries in the provider-patient relationship is the major professional obligation
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Book Code: DHFL2624
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