Dr. Roger Levin’s August JADA article, "The Purpose of a Business," takes aim at the latest Wall Street news about fraud and cheating, which is laudable.
He starts by asking, "What is the purpose of business?" The first questions for dentistry, a profession, however, are broader: "What kind of community is it, what good does it do, and what responsibilities do its members take on?" These are different from Dr. Levin’s questions, and offer better reflections for solving the underlying problems.
A professional ethics workshop needs a few days to help practices truly answer, not just reflect on, what good they do. This is a very serious issue, so something should be said now about the article’s conflicts with the notion of profession. JADA didn’t, and that isn’t good for patients, society, individual dentists or the profession.
The article’s first absolute claims are wrong-headed: "A dental practice is a business focused on providing high-quality oral care for patients." And the way to evaluate the purpose of a dental practice is to think about it in terms of providing income to the dentist, satisfying employees and servicing customers or patients.
David Ozar, in "Dental Ethics at Chairside,"1 offers a fuller approach to this conflict. Like Dr. Levin’s article, the first question is, "Who is the chief client?" Unlike Dr. Levin’s article, it shows that the patient, all else being equal, has a priority, and not just because of personal practice preference.
"Patient" has different meanings. Is he or she the person being treated, the one waiting, the crying child on welfare outside the office or others? Who has priority, and when? Where does the dentist rank? What are his or her priorities with other dentists, staff and others? We rarely think this out; it happens as a matter of habit over time, sometimes with deliberation, always within the professional community and society. When individual practices reflect on the good, not the purpose, they are not the sole decision-makers.
Combining the chief client question with different ends for each client is confusing. "Providing income" for a dentist is not the same as "satisfying" employees. Both of these ends are also very different from "servicing" customers or patients. This approach points to the wrong direction and the wrong answers. Claiming authority and saying dentistry is first and/or only a business is misleading.
True, dentistry has a business component; true, my wife is an animal. I don’t, however, treat her like one; she even deserves special consideration over other humans. Special consideration is what professions are about in relation to business. Many business practices and theories work within the profession. Others, however, destroy it. As long as professionalism is given a moral priority over business, things work out. Allow business ethics to shape the mission and the strategic plans of the larger profession, however, and it is no longer a profession, just a business with no common good or real community or family.
Providing income is important in a family, but that’s not what families are about. Without first recognizing that each professional is part of a special family with special obligations, we do not nurture a profession, but build a free-for-all, even if we learn to respect each other to survive the competition. Libertarianism and autonomy are great contributions to modern culture, but they are not trump cards—just a few critical values of a great culture, good community and healthy businesses.
Business is about competition; health professions are about collaboration. This helps separate business ethics, professional ethics and even organizational ethics. Dr. Levin’s model, without these other moral frameworks, does not serve the profession. Deciding purpose only within each office is a root cause of the current Wall Street scandals.
There are many companies with great missions. A well-articulated mission tied to an effective strategic plan, however, doesn’t make an ethical or a good business, just an effective one that lasts. Think of the Mafia: church things on Sunday, business as usual during the week.
When the ADA limited what it would say in its Code to settle the "restraint of trade" issue with the Federal Trade Commission, it did not make the whole Code neutral, just its references to the market. Leaving business out of a profession’s ethics isn’t immoral, just amoral. This is not what a moral community wants to be. The JADA editor shouldn’t cop out with an editorial note that "the views expressed" may not reflect the ADA’s.
If a view contradicts the mission and core values of the profession, it shouldn’t be published without an absolute disclaimer. Dr. Levin’s suggestions and the editorial caution are both forms of moral relativism—a cause of the Wall Street scandals. Relativism disguised as pluralism by pseudo-cautions of allowing all voices to have equal weight and priority could either be a coverup, or unawareness of the latest developments in moral education and theory. Without knowing the nature of the community one agrees to join, and the good of its mission, answering questions about making an income, satisfying and servicing has no purpose. Making money, satisfying and servicing also fit an ancient trade that may be illegal, but still a good draw for entertainment.
I hope the situation with this article, and the ADA’s bland comment, is unawareness. I sense that all of us are aware of the problem, and are just trying to find a good way to say what’s in our hearts. If dentistry can agree on its core values in terms of the good it does, it would still need a desire to do it. Then, if all of us see ourselves in positions of moral responsibility to do what needs doing, we may be ready to blend the business of making gold with the value of doing good.
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