Professional conduct: when patient requests exceed the boundaries of dental care.

This discussion began with a question regarding the possibility of defining the elements of unprofessional conduct. It is likely that the many elements that may be intrinsic to this definition are, in part, temporally situated--that is, unprofessional behavior is defined somewhat differently today than in 1940. The three cases presented underscore this point. It is not likely that dentists of two or three decades ago were confronted with patients desiring pierced tongues, radio stations that saw dental offices as ideal participants in publicity stunts, or individuals admitting their dentist was an instrument of erotic pleasure. Despite this dynamic nature of new challenges to professional conduct, many elements are constant. Certainly the ethical obligations of beneficence, nonmalficence, respect for autonomy, and justice have remained since the time of Galen. We have proposed that one modern-day element of defining professional conduct is the performance of a professional action for a nonprofessional purpose. These types of actions can be harmful to patients and embarrassing to the profession. Finally, it is likely that the dentist who cooperates in any of the scenarios presented could be held to violation of malpractice standards and/or be reprimanded by state dental boards. In addition to these legal entanglements, it is clear that knowingly and willingly participating in any of the presented cases comprises unethical behavior.