Autonomy is the principle that embraces respect for persons, the ability to be self-governing and self-directing. An autonomous person chooses thoughts and actions relevant to his or her needs, independent from the will of others. In health care autonomy gives rise to the concept of permitting individuals to make decisions about their own health, which is the heart of many ethical dilemmas that occur in dentistry.7 All health care professionals must respect the autonomy of patients and properly inform them about all aspects of the diagnosis, prognosis, and the care being provided. Because dentists and dental hygienists have a wide range of knowledge and skills, they must fully and adequately explain the parameters of the services that can be performed as well as the consequences of performing or not performing those services.
Unlike nonmaleficence and beneficence which arise from the Hippocratic traditions, autonomy concerns arose much later in the 20th century. The application of autonomy is based on respect for persons which holds that the health care professional has a duty to allow patients to make decisions about actions that will affect their bodies. This also includes the duty to provide patients with all the unbiased information they would need to make a decision about treatment options.
Conflict can arise around this concept when what the dentist and/or hygienist believes is in the best interest of the patient differs from what the patient desires. Sometimes what the professional believes is best for the patient is not what the patient elects to do. As long as the patient selects from treatment options that are consistent with accepted standards of care, the professional may ethically act on the patient’s choice. However, the professional practitioner also has the autonomy to not provide a service requested by the patient if that service is in conflict with the standards of patient care. For example, refusing a patient’s request to extract all healthy teeth would be ethical even though that decision would conflict with the patient’s autonomy. Dentists and hygienists will avoid doing harm to a patient even if the patient is exercising autonomy by asking to receive a potentially harmful treatment or service.