In my office we usually will give the patient a list of local possible
referrals and let the patient decide on who to see.  We are fortunate
to not have your situation where an ethics question exists.  I
personally would have a problem with referring exclusively to my
spouse.  I think at least disclosure of the relationship would have
been appropriate.  It certainly is legal to refer to whoever you feel
is competant to perform the procedure.

    Good question.  It's a much bigger one than that--doctors routinely
refer to their buddies.
    IMO there is no ethical obligation to fully divulge the nature of any
extra-professional relationship between the referrER and the referrEE.
However, if the referral is inappropriate CLINICALLY, the referring
dentist carries both an ethical and legal liability if the
inappropriateness could reasonably be known.  The fee business isn't an
issue; I don't know anything about a doctor's fees unless I myself have
been a patient or if a patient comes back and reports.  My obligation is
to make a referral to a highly skilled specialist.
    Many of the risk management courses will recommend you do NOT refer to
a single specialist, esp. if there are several in the area--to avoid the
APPEARANCE of impropriety.  I understand this, and I agree (where it is
possible--it often is not).
    There are of course other ethical issues relative to referral.  One of
the most common I encounter is a patient who comes to me because I
participate in their insurance;  I need to refer to a specialist, but
there is only one endodontist (for example) in Brooklyn who accepts
their insurance, and let's say (for argument's sake) that he's a bum.
The patient wishes to go to a participating specialist.  How do I refer?

Steve