Another Ethics Q!

[The Candidate]

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what do you guys think?

A mother of a 24 year old with trisomy 21 (who is under his mother’s care) says she wants the dentist to replace her son’s amalgam fillings, but the patient strongly objects. The dentist should:

1. listen to the mother,
2. listen to the patient,
3. call the father,
4. call a pediatric dentist

 

[MrPerfect]

Who cares. The kid has trisomy 21. He won't care. He has bigger things to deal with like having trisomy 21.

what do you guys think?

A mother of a 24 year old with trisomy 21 (who is under his mother’s care) says she wants the dentist to replace her son’s amalgam fillings, but the patient strongly objects. The dentist should:

1. listen to the mother,
2. listen to the patient,
3. call the father,
4. call a pediatric dentist

 

[molarsmile]

May be call a pediatric dentist since the pt. has down's syndrome

 

[Dan3223]

I would just tell her that replacing the amalgam isnt neccessary and that it would be in the patient's best interest to leave them be.
If she still wants to have them replaced, she could go somewhere else.
Just sounds like it would be a pain in the butt case that i'd rather not deal with.

 

[Cold Front]

I would just tell her that replacing the amalgam isnt neccessary and that it would be in the patient's best interest to leave them be.
If she still wants to have them replaced, she could go somewhere else.
Just sounds like it would be a pain in the butt case that i'd rather not deal with.

What do you mean by "it would be in the patient's best interest to leave them be"? Dentists replace amalgams with tooth-colored (composite) restorations all the time (if there is no risk of harm).

So, trisomy 21 = down's syndrome = impairment of cognitive ability (especially if the condition still exits in adulthood) = lack of understanding and trying to make sense of things (can patient understand and decide his options?) = no? parent or legal guardian provides the consent = parent or legal guardian decides everything for the patient during treatment plan (while the dentist keeps in mind his/her nonmalificence limits).

Parent in this case is the mother, not the father! 😀

 

[myocardial]

What do you mean by "it would be in the patient's best interest to leave them be"? Dentists replace amalgams with tooth-colored (composite) restorations all the time (if there is no risk of harm).

So, trisomy 21 = down's syndrome = impairment of cognitive ability (especially if the condition still exits in adulthood) = lack of understanding and trying to make sense of things (can patient understand and decide his options?) = no? parent or legal guardian provides the consent = parent or legal guardian decides everything for the patient during treatment plan (while the dentist keeps in mind his/her nonmalificence limits).

Parent in this case is the mother, not the father! 😀

well i still didnt get the point .
Is the decision made by parent in case of disabled patient ??or do the patient if adult has consent?

 

[Varna]

But he is not a child, he(she) is 24 year old.

 

[Dan3223]

What do you mean by "it would be in the patient's best interest to leave them be"? Dentists replace amalgams with tooth-colored (composite) restorations all the time (if there is no risk of harm).

Right... but if there is no problem with the current restorations, then there is no need to replace them. Plus, the patient does not want them... and forcing a patient in to a procedure dosnt seem right to me. An unwilling patient (especially a trisomy patient) wouldnt likely sit very still for a procedure.... which could lead to harm.

 

[Cold Front]

But he is not a child, he(she) is 24 year old.

By physical age, the patient is adult. However, doctors also go by mental age. Adult DS can usually reach a mental age level of a 3-7 year old normal child. How often do you see 7 yr olds strongly objecting their parent's wishes in a dental setting, and the dentist goes ahead and treats the patient anyways (using restrainers). If this sounds shocking, google a place called SMALL SMILES... they do exactly that! and have been on national news few times.

I still think this is a tricky question, and an issue of Autonomy versus Paternalism... The further a person is, in a particular situation, from being a rational self-ruler, the more paternalistic behavior is morally appropriate.

 

[VEERA007]

hey doc.. where didu get the ethic qs from.....

 

[shibab]

btw do v have ethical questions like this for nbde 1????plzz guide .i am not aware of it though

thanks

 

[gte1974]

well it does not state if the restorations are needed, but lets ignore this one, the question says that he is under the mother's care, so she is the caretaker and decision maker.

out of the options:
correct answer would be based on the availability to care based on disabilities act- listen to mother

now in a practical manner if the patient is objecting, the patient would probably need to be sedated to be able to receive care and quality needed.

a referral could be interpreted as not being properly prepared to handle patients with disabilities, a clear ethics violation i believe.

i think most people would read the question and answer: call a pediatric dentist, as he would be more suited for this type of procedure and capable of handling the case, due to the fact the 24yr old will act like a child, but i feel this would be incorrect from an ethics standpoint.

 

[myocardial]

well it does not state if the restorations are needed, but lets ignore this one, the question says that he is under the mother's care, so she is the caretaker and decision maker.

out of the options:
correct answer would be based on the availability to care based on disabilities act- listen to mother

now in a practical manner if the patient is objecting, the patient would probably need to be sedated to be able to receive care and quality needed.

a referral could be interpreted as not being properly prepared to handle patients with disabilities, a clear ethics violation i believe.

i think most people would read the question and answer: call a pediatric dentist, as he would be more suited for this type of procedure and capable of handling the case, due to the fact the 24yr old will act like a child, but i feel this would be incorrect from an ethics standpoint.

even i think so that dentist should listen to parent [mother in this case] coz the patient is disabled and under parent's observation ...if this is not the case patient has right to decide.