Student Spotlight: Emma Paolella DMD 25 and Melanie Thomas DMD AS 24 win Dental Ethics Award
How does a dental professional make ethical treatment decisions that simultaneously prioritize their patients’ well-being with their own legal obligations and professional standards – all within an increasingly commercialized healthcare landscape?
Emma Paolella DMD 25 and Melanie Thomas DMD AS 24 grappled with that question in their submissions for the 2023 Ozar-Hasegawa Dental Ethics Award competition — so successfully, as it turns out, that they were named this year’s sole two winners. As part of their victory, the winning essays will be published in the eJournal of the American College of Dentists.
Catherine Sarkis, GSDM clinical professor of health policy & health service research, served as the faculty advisor for both Paolella and Thomas. When she discovered her two students won this year, Sarkis said she was “really flabbergasted.” GSDM students have previously won this national contest, which is sponsored by the American Society for Dental Ethics and the American College of Dentists — Victoria Chang DMD 23 in 2020 and Luljeta Isedisha DMD AS 21 in 2021 — but this is the first time the school has had two winners in one year.
“It’s always a thrill to see that kind of recognition for your students, and these two students really put in a lot of effort,” Sarkis said. “I was really, really thrilled and I felt it was very deserving because of their hard work.”
When Paolella learned about the Ozar-Hasegawa Dental Ethics Award competition, she wasn’t motivated to enter by a potential victory and publication. She said she enjoyed her dental ethics course and wanted to go through the “enriching” process of creating and analyzing an ethical dilemma. Now, she hopes other dental professionals will be inspired by her rationale in her essay ‘“Do Good’ By Your Patient: An Ethical Dilemma That Extends Beyond Dental Care.”
“It’s important to train our minds to be cognizant and aware of these ethical scenarios that may happen,” Paolella said. “There’s no black and white answer for every ethical scenario; [it’s] training your mind to approach it from an ethical point of view and [to] just be aware that we shouldn’t feel like things will fall out of our jurisdiction because it doesn’t have to do with the physical dentistry.”
For her ethical reflection entitled “For-Profit Dentistry: A Commercial View of Healthcare,” Thomas said she was pleased to have a platform to express her point of view as an internationally trained dentist entering the U.S. dental landscape. She simply wanted to write about something she really believes in and wishes others would be able to relate.
“Ethics is something that you’re going to be practicing every day and how you act and how you behave, [it] speaks volumes about your character,” Thomas said. “It’s important to start talking about this and have these conversations because that’s how change happens. I see a trend that healthcare is becoming more and more commercialized, that dentists are being put under a lot of pressure… If we don’t address this and we don’t talk about the negative implications of something like this topic, the commercialization of healthcare, then nothing is going to change.”
As their faculty advisor, Sarkis worked with the pair to finalize their respective topics and guide them through their writing processes. She noted that Paolella and Thomas picked topics that reflected their personal and professional interests, and it’s clear that their passion shines in their analyses.
“They really put in the hours and communicated with me,” Sarkis said. “Both of them had appointments with me, multiple appointments, and emails. So, it’s always nice, as a faculty member, to have students who both had really interesting topics, and they were just really interested in them. They were curious. They were motivated. They wanted to know more, and they put in the work.”
In Paolella’s essay, a 16-year-old named Jane enters a community health center dental clinic by herself complaining of a painful toothache. After completing an examination, the dental professional finds a draining abscess over a “grossly decayed and infected second molar with a large amalgam restoration,” now with very slim likelihood of restorability. The dental professional believes the best treatment would be to extract tooth #31 but wants to do an x-ray to confirm their diagnosis.
Jane wants to get the x-ray and potential extraction, but due to her age, the dental professional needs her parent/legal guardian’s informed consent. Jane reveals that her mother has a history of substance abuse that has been escalating recently, and she worries her mom is not in a sound state of mind to give an informed consent. The dental provider knows the infection could become life threatening if treatment is delayed for too long – but they must decide how to approach the situation first.
Her inspiration for the essay was two-fold. As part of the National Health Service Corps Scholarship Program (NHSC SP), Paolella will be working in a community health center in an underserved community following her graduation from GSDM. She placed her ethical dilemma in a similar setting to the one in which she will be working in order to test her mindset for situations she might face. Paolella also modeled the scenario after the experiences a friend of hers had with a mother who was not competent to make healthcare decisions.
“I was inspired by the thought of just what would I do if a patient or a family dynamic was presented to me,” Paolella said. “Like how would I respond to that? What would be my obligation and my responsibility?”
For the patient in her fictional situation, Paolella decided it was best to speak with Jane’s physician, if permitted by Jane and her mother, to help form a full opinion about Jane’s overall healthcare and to speak with a social worker within the community health center.
“Doing right by your patient is not just limited to the physical dentistry that we provide,” Paolella said. “The patient deserves the regard and care that extends beyond that. I think that that is the obligation, the responsibility that we have as dental professionals.”
In Thomas’s essay, she analyzed the commercialization of healthcare, which is pressing doctors and dentists to increase productivity at any cost, potentially leading to compromises on ethical and professional standards. In her scenario, which she based on a true story but took artistic liberties to expand the situation, a recent dental school graduate, Dr. KT, starts her first job as an associate working at a private practice with her beloved family dentist. While working there, she forms a close friendship with JC, the dental assistant, who was formerly a dentist from KT’s native country, but had left his residency program to come to the U.S. to obtain his dental license.
It was only after getting to know each other that JC confessed to KT, saying he had misled the practice owner into thinking he was a specialist in his home country. He formed an arrangement with the owner, allowing him to handle the implant cases within the office to gain valuable experience and a supplementary income while he waited to get his dental license. In return, the practice owner was relieved of the financial burden associated with hiring a certified specialist by having JC place implants without a formal contract and with minimal compensation.
Appalled by this knowledge, KT was faced with a difficult dilemma between loyalty and ethical responsibility. On one hand, she didn’t want to betray a close friend and colleague, but she also didn’t want innocent patients to be treated by someone who is purposely misleading them about being fully qualified.
The story goes on to explore KT’s internal struggle to decide whether to report the situation, confront her family dentist/the practice owner, or address the assistant’s actions, while also addressing the complex interplay of relationships, professional integrity, and the broader ethical implications of dishonesty in the medical field.
“I didn’t make the story up, unfortunately,” Thomas said. “It is a true story that has happened to people that I know and that’s particularly why I wanted to write about it because I’m sure that others can be put in this position. When you don’t have a lot of experience and suddenly, you’re in this difficult situation, how do you address it when you find out that your boss, maybe the clinic owner, or your friend in the office is doing something unethical to the patients. You have to ask yourself. What is your role in this? How do you act? And are there consequences of not taking any action? It’s not as easy as one might think.”
In her essay, Thomas had KT address the issue by informing the practice owner that she has a duty to report to the state licensing board, which would lead to an investigation into how many patients were involved and the extent of the damage done. Thomas wrote that prioritizing patients’ well-being while upholding professional ethics is critical for healthcare practitioners.
“As an international dentist and as someone who has had dental assisting experience, I feel every day is a test of ethics in practice,” Thomas said. “Every day you’re put in difficult situations, and you have to know how to act. You have to know that your actions can have really important or difficult implications for everybody around you.”
After taking part in this essay competition, Thomas said she wants her fellow GSDM peers to be inspired to think ethically in everything they do.
“I feel that there’s so much more to [ethics] than people understand and that it’s our responsibility as healthcare providers to just really learn to educate yourself, to train yourself on how to be an ethical dentist,” Thomas said. “And if you don’t do it from now while you’re in school, while you have mentors and people who can help you, once you graduate, the stakes are going to be much higher.”