Dr. Kenneth Jones’s response in March JADA’s "Ethical Moment: Extreme Makeovers" seems to embrace the idea that, as long as patients have been informed of all risks, it is ethically permissible to give them anything they desire. This could not be further from accepted ethical practice.
The duty to do no harm (non-maleficence) does not mean that we merely have to fully inform the patient, it specifically demands that when we have determined that the risks and costs of a procedure outweigh the benefits, we have a moral duty to say no.
This is not a choice at the discretion of the dentist. It is a duty, and it is the very thing that makes dentistry a profession and not just a business. Weighing risks, costs and benefits is, admittedly, not a science, and it often involves conflicts between the values of the patient and those of the dentist. Nonetheless, a conscientious estimation of risks, costs and benefits, with the values and preferences of the patient well in mind, is every dentist’s duty. And when he or she has determined that the benefits are outweighed by other factors, he or she should decline to treat.
We should be proud that we are part of a profession that still has concerns about the patient’s right to dictate "treatment" that we know or suspect will cause them harm.
