Patient autonomy as a necessary but limited ethical principle in shaping the dentist-patient relationship.

Today, the ethical and legal organization of the therapeutic relationship is determined in large extent by the principle of respect for patient autonomy or self-determination. From it, the patient derives important legally enforceable rights, most notably the right to consent to (or refuse) any proposed dental treatment. And yet, historically and indeed by its very nature, this principle is actually foreign to the health care context. Patients do not seek to defend themselves against their dentists in the same way that citizens need protection against a potentially tyrannical government. We will argue that the principle of patient autonomy sets important legal boundaries to the therapeutic relationship. But it does little to cement the relationship itself. Rather, it is the ethical principles of beneficence and non-maleficence that structure the dentist-patient relationship.