I would like to comment on “Well begun, half done” in the July issue of the Journal (Greco PM, Grubb J, Vaden JL. Am J Orthod Dentofacial Orthop 2016;150:11-2).

The essay presented a hypothetical ethics case study that sought to demonstrate the importance of a full battery of diagnostic orthodontic records before the initiation of treatment and emphasized the orthodontist’s ethical duty to separate clinical decisions from practice management considerations. Although the article was well intentioned, how it was written was less than collegial. Two ethics articles previously published in this Journal describe more pertinent ethical and legal concepts using a less condescending tone.

In the “Litigation, legislation, and ethics” article in the January 2006 issue of the Journal (Jerrold L. Models and the standard of care. Am J Orthod Dentofacial Orthop 2006;129:78-80), the author discussed the 1-visit consultation and the ethical and legal implications of this mode of practice. One conclusion offered was that the need to take models or any other diagnostic record is largely a risk management decision and not necessarily an ethical decision as far as standards of orthodontic practice are concerned. Without a more complete clinical picture of the hypothetical patient, which even the hypothetical narrator doesn’t have in the article by Greco et al, orthodontic treatment may be de minimis as Jerrold describes. So to impugn the 1-step consultation from an ethical and legal standpoint is a dubious argument.

In the “Ethics and orthodontics” article in the June 2015 issue of the Journal (Greco PM. A difference of opinion. Am J Orthod Dentofacial Orthop 2015:147:653), the author discussed the importance of teaching the patient about the specifics of his or her orthodontic problems and placing the patient’s best interests above any professional difference of opinion. The clinical theory espoused in the article is that “ideal” treatment that produces “ideal” occlusion (comprehensive treatment) may be preferable to a limited intervention (improving the esthetics of the social 6), and this must be communicated to the patient. Without verifiable facts supporting the concept of “ideal” in orthodontics, the patient’s desire for enhancement of the smile must be appreciated. Practitioners who are uncomfortable with this notion do not have to treat the patient. However, they must respect patients’ autonomous decisions to elect a course of treatment that fits their needs after weighing the risks and benefits and the alternatives.

In the end, the “Well begun, half done” article does not present an ethical argument and instead presents a series of trenchant opinions.