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Alyssa Cardinal
Professor Nagel
21 May 2012
Professional Code of Ethics
Providing beneficent care and advocating for the patients autonomy should always be
the primary goals of any health care contributor. Unfortunately, alternative motives predominate
todays health care systems. A 39-year-old registered dental assistant (RDA), by the name of
Michelle, has been working at the same office for the past fifteen years. She shares her
experience with this common unethical behavior. In an interview she stated the following:
I am often asked to do work that does not correlate with my RDA license issued by
the state of California. Dentists, hygienists, extended function assistants, registered
dental assistants, and unlicensed dental assistants all have different jobs they are
allowed to do, which differ from state to state.
Although entirely uncomfortable with practicing such illegal activity, Michelle claimed to have
been especially uncomfortable when her boss asked her to repair his own crown.
I am not allowed to numb, prepare a tooth for a crown or even cement a permanent
crown on; in which I did all of the above. I first told him no, but he was persistent
so I eventually gave in. I have watched him do it for years so I wasnt that nervous;
however, I was afraid that if I did screw up he would be pissed. Its not like you can
grow another tooth!
When asked how this made her feel in regards to her own personal ethics she
responded:

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I feel if I dont follow Doctors office procedures I would be let go and there are
one hundred people waiting in line for my job. That just cant happen. Although I
know it is unethical, I justify it by knowing it is a very common practice for dentists
to have their employees perform duties they arent allowed or licensed for. It is
becoming more and more common practice for dentists to save where they can by
having lower paid assistants do the work of higher paid hygienists or dentists. This
means more patients are being treated in a day with greater amounts and levels of
care, thereby resulting in a higher cost to the patient or insurance company [] If I
hurt a patient while doing a job out of my scope of practice, both Doctor and myself
could lose our licenses, be sued, and potentially go to jail.
Two major problems exist in this situation. First, employees are feeling obligated
to act unethically and illegally in order to maintain their careers. Second, caregivers are
no longer advocating for patient autonomy, but rather their personal gain. Through
analysis of two articles correlated with maintaining a code of ethics and preserving
patient autonomy, Michelles unethical obligations will be addressed and an appropriate
resolution will be established.
On January 27, 1986, Robert Lund, vice-president of engineering for Morton
Thiokol, was the last individual to approve the launch of the Challenger. He had earlier
presided over a meeting of engineers than unanimously recommended against the
launch (Davis, 151). The Space Center, a profit and publicity driven company, rebuked
the committees apprehensions and persuaded Thiokol to reconsider. Eventually Lund
was the only engineer who had not given his approval. His boss, Jerald Mason, told Lund

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to think like a manager rather than an engineer (Davis, 152). The following morning
the shuttle exploded during lift off and everyone on board died.
Every profession has an implied or written code of ethics. The code is not
provided in hopes of over regulating, but rather to prescribe how professionals are to
pursue their common ideal so that each may do the best she can at minimal cost to herself
and those she cares about (including the public, if looking after the public is part of what
she cares about) (154). Lund initially paid respect to his code when refusing to give
approval for launch. However, through persistent peer pressure, Lund retreated and
conformed, resulting in several fatalities.
The same concept applies to Michelles situation. When Michelle communicated
with her employer that she was uncomfortable performing a procedure she was
unqualified to do, she was exhibiting her knowledge and awareness of the Dental
Associations code of ethics. By not only encouraging her, but emotionally obligating her
to disregard the code, her employer put his personal desires above the professions ethical
responsibility. Davis makes a powerful distinction in that ethics is not a matter for
majority vote but for private conscience, or if not for private conscience, then for experts
(Davis, 153). Michelles employer was utilizing this majority vote tactic to persuade
her, which put the Doctors personal desires over the ethics of herself and the profession.
When elaborating on the unethical habit of her employer, Michelle also
mentioned the following:
Often the Doctor will not explain all of the patients options so they are
mislead in to thinking they have only one or two. The options provided are
usually the most expensive and not always the best for the patient [] By

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overcharging and doing unnecessary work, patients cannot afford to receive

all the care they need, and are forced to return at a later time. Usually by this
point, the condition has worsened and the patient is now paying way more
than they initially needed to. Its killing their wallets and their health.
Through this we can see that ethics are no longer playing a factor in this Doctors
facilitation of care, or his desire to advocate for patient autonomy. Without respect for
patient autonomy, medical practice would be through and through paternalistic, and
would treat patients as persons only if beneficence so required (ONeill, 173). With that
said, paternalism in patient care is not always a poor course of action, but should not be
the primary instinct in providing care. John Stuart Mills On Liberty expresses that each
person is the best judge of his or her own happiness and that autonomous pursuit of goals
is itself a major source of happiness (ONeill, 173). Misinforming patients in order to
seek greater funds defies this principle. Obligating employees to perform duties outside
of their scope of practice defies this principle. Exposing patients to harmful and
unnecessary radiation defies this principle, (Michelle). Unfortunately, gaining patient
consent is not always a sure sign that the patient is making autonomous decisions.
ONeill claims that when we consent we do not necessarily 'see through' to the
implications of what we consent to and consent to these also (ONeill, 175). It is then
the responsibility of the professional to better inform their patient. Nowhere in this model
of conduct does dishonesty or disloyalty to the patient emerge. Michelles employer,
along with many others doctors in the nation, have lost sight of what it means to provide
care. Unfortunately, she has been caught between sustaining a stable career and providing
dependable, loyal, and beneficent care.

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In a situation such as this, Michelle has a few different possible courses of action. First,
she can continue to follow the orders of an unethical, egotistical dentist, prolonging her position
as a registered dental assistant. As a result, Michelle is now held equally accountable for her
unethical actions. Assuming she has a high standard of personal ethics and desire for patient
wellness, Michelle should reconsider her current situation. Second, Michelle can communicate
her negative feelings toward the offices standard operation. She can choose to dissent the
doctors choice of practice, and offer a more suitable, ethical approach. According to an article
by Narsin Shahinpoor and Bernard F. Matt, dissent cannot be covered up or disguised as public
conformity with private reservations. It is a public act of conscientious or principled
disagreement, of voice (Shahinpoor and Matt, 39). Speaking out means full exposure. Michelle
claimed to have remained silent in order to keep her job; therefore, executing this step may prove
difficult to her and other employees in her position. Succeeding in her dissent, however, would
potentially improve her work conditions and the profession as a whole.
Third, Michelle can blow the whistle on her employer. If she followed through with her
attempt at dissent and her employer still failed to listen, it now becomes her ethical responsibility
to report the acts to a higher power. This is a very serious form of action, and causes risk of
retaliation either from the immediate boss or from the next level of management (Shahinpoor
and Matt, 41). Because termination is typically the response to this level of action, it is not as
commonly taken. When asked if whistleblowing had ever been considered, Michelle responded:
I have never really considered it. Ive heard of situations where people speak up and
lose their jobs. In todays economy, I cant afford to take that risk [] I understand
my ethical duties as a caregiver, and so I have considered speaking to Doctor
personally about his method of practice in hopes of making a change, but definitely

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not to higher management. I have worked with [my employer] far too long.
Although I wish I could act one hundred percent ethically in this situation, a socalled friendship keeps me from doing so.
Although we do not always act ethically, it is evident that taking the next step and
notifying higher officials (if and only if the act is worth fighting for) is the appropriate
course of action.
After closely analyzing the unethical occupational duties of a specific Registered Dental
Assistant, it has become clear that abiding to a code of conduct and striving to advance the
autonomy of the patient population is the most ethical method of practice, regardless of the
consequences.

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Works Cited
Davis, Michael. "Thinking Like an Engineer: The Place of a Code of Ethics in the
Practice of a Profession." Philosophy of Public Affairs 20.2 (1991): 150-67. JSTOR. Web.
9 Jan. 2007.
Jacobson, Michelle. "Unethical Behavior in Dental Work." Personal interview. 12
May 2012.
O'Neill, Onora. "Paternalism and Partial Autonomy." Journal of Medical Ethics
10.4 (1984): 173-78. JSTOR. Web. 13 Jan. 2012.
Shahinpoor, Nasrin, and Bernard F. Matt. "The Power of One: Dissent and
Organizational Life." Journal of Business Ethics 74 (2007): 37-48. JSTOR. Web.