PERSPECTIVE

There is a renewed sense of urgency forreflection on what the dental profession isand what it ought to be.

Essays of opinion on current issuesin dentistry are published in this sec-tion of/ADA. The opinions expressedor implied are strictly those of the au-thors and do not necessarily reflect theopinion or official policies or positionof the American Dental Association.

liree models of professionalism andjrofessional obligation in dentistry

id T. O/ar, PhD

f :rhe relationship between the dentalnofession and the lay community, bothtthe individual level and more broadly,s, without doubt, undergoing significantGanges. Therefore, the need for membersi. the dental profession to deepen theirmderstanding of their status as profes-fonals grows more and more insistent.»me signs of these changes are obvious:™ success of denturism in Oregon; theMergence of retail store dentistry; and«increase in the number of malpracticeu'ts and the size of awards in such suits.'tt the most important changes taking'«ce are of a deeper and subtler sort thanResurface advances of dental commer-telism. The most important and underly-S8 changes affect the basic relationship"Ween the dentist as a professional andj* Patient as a layperson seeking profes-wal services., hese changes are difficult to under-BaO. and, consequently, will remain dif-^« to affect, without a clear under-going of the nature of professionalismDentistry as it is and as it might be. To

ie A ̂ is understanding, three models ofeti»ental profession and of the relationse. een professional and layperson, and

een the profession and the lay com-are described in this paper. In

case, the model will be describedsinglemindedly to highlight

the differences between the three models.This means that none of the models willdescribe exactly the profession as it istoday or as it ever was or might be. How-ever, a careful development of the threemodels, together with a careful examina-

tion of what is known and what can beenvisioned about the profession, willidentify and illuminate the most impor-tant features of the dental profession as itis, and as it might be. The three modelsare: the commercial model, the guild

Commercial modelGuild model

Interactive model

JAOA, Vol. 110, February 1985 • 173

PERSPECTIVE

model, and the interactive model.1

Commercial model—dental careas a commodity

One possible way to examine dentistry isas a purely commercial enterprise. Fromthis perspective, dental care is simply acommodity that dentists sell and patientsbuy. The dentist is a producer, the patientis a consumer, and the interaction be-tween dentist and patient is simply one ofmany transactions in the commercialmarketplace. On this basis, the entire rela-tionship between dentist and patient con-sists of communications about the com-modity and its price and then the actualexchange of that commodity for the price

is precisely the model that accurately de-scribes the essence of dental practice, orthat will solve dentistry's problems.

In the commercial model, a dentist'sprimary relationship to other dentists isthat of competition. They are all pur-veyors of the same commodity to the pur-chasing public; each is interested in sell-ing as much as is possible and for the bestprice. Dentists will therefore price com-petitively, seeking not only to attract newconsumers to themselves rather than toother dentists, but also to attract otherdentists' patients to then-selves by offer-ing, for example, the :>ame services at alower cost. Dentists will also competewith one another in the quality of basiccare they provide, in special services, in

In the commercial model, no one has obligations ofany particular sort simply because he or she isa dentist

that is agreed on.From the commercial point of view, the

dentist and patient must be considered,first and foremost, competitors. Each istrying to obtain from the other the greatestamount of what is needed while giving upas little as possible of what is being of-fered in exchange. Thus, the criterion bywhich the dentist determines what sort ofdental care to give the patient is not thepatient's need, but rather what servicesthe patient is willing to pay for, andwhich give the dentist the greatest returnfor the least cost in time, effort, and mate-rials.

Need has only an indirect role as a de-terminant of dental care. It functionsabove all as the patient's motivation topart with money for the sake of increasedwell-being or comfort. Consequently, al-though the dentist will offer judgmentsregarding the patient's need for care, thepatient's own judgment of his or herneeds is alone authoritative. For it is es-sentially a consumer judgment in whichthe patient weighs needs and discomfortsagainst the costs of the purchase. Thedentist's comments regarding the pa-tient's need for care must be viewed in thecommercial model primarily as efforts bythe dentist to motivate the patient to pur-chase dental services. They are marketingactivities, similar to the salesperson'scomment that the client will look good inan item of clothing that is being consid-ered.

For some dentists, this model may al-ready sound appalling. But it needs to bedeveloped fully to learn from it. Otherdentists, of course, have argued that this

174 • JADA, Vol. 110, February 1985

ambience, and in any other features ofdental practice that might attract dentalconsumers to themselves and away fromother dentists. If one dentist discovers anew mode of diagnosis, therapy, or pa-tient management, he or she keeps thediscovery secret from competitors.2 Inthis model, the proper measure of a den-tist's practice is not how well it meets thepatient's needs, but the performance ofthe package of goods and services, to-gether with the price commanded in thedental marketplace.

Dentists, of course, have interests incommon as they deal with various centersof power in the larger community, espe-cially with government agencies. Con-sequently, although they are primarilycompetitors, dentists will have sound,self-interested reasons for forming tradeassociations to perform functions such aslobbying and public relations in behalf oftheir common concerns and interests. Inthe commercial model, these are the pri-mary functions of the American DentalAssociation and its constituent societies.Dentists join such organizations not tocompete with one another less, but tocompete more effectively as a group withother sectors of the economy and othercenters of power in the society.

In the commercial model, then, thereare no obligations or commitments be-tween individual dentists and individualpatients, or between dentists, or betweenthe profession and the lay community as awhole, except those obligations andcommitments for which the individualsinvolved have deliberately bargained andcommitted themselves. Therefore, there

is absolutely nothing about the professionof dentistry that would provide a basis forsaying to a dentist: "You have an obliga-t ion to do or r e f r a in f rom doing

because you are a dentist."

;cholentielie

iiroullleie

ie orlentesunIf CO]

In this model, no one has obligations of Fs

any particular sort simply because he or ;neilt

she is a dentist. It is arguable, of course,that there are obligations that all bargain-ers have toward one another whether theyagree to them or not, namely, obligationsto speak truthfully or to keep their con-tractual commitments. But these are notobligations which dentists would have asdentists or as professionals. Althoughimportant in practice, obligations of thissort do not specifically help us under-stand dentistry as a profession.

Some people may object that this modelfails to describe dentistry because in ac-tual practice dentists cooperate with oneanother much more than they compete.The ADA, it might be argued, is not atrade organization of the sort just de-scribed. It is important to note, however,that producers are always interested inagreements with other producers if they |will strengthen bargaining positions inrelation to consumers. The risk amongcooperators is that one will break out ofthe pattern, underselling the rest of thegroup or offering a product of signifi- j-conicantly higher quality than the rest and '. In tlattracting a high volume of business away but. Ifrom the rest of the group, who are refrain- fine;

"oex;)rro\

-\cliu

ing from competition for their mutualbenefit. But if the benefits of cooperationsignificantly exceed those of competi-tion, there will be little motivation to

Jowl-rrniridth«om

break ranks in this way. As dental care is rrtifi.something that most consumers value fit ashighly, and as dentists have won, throughtall astate licensing laws, a legalized "mono-pea,poly" on their product, the value of coop- ?om jerating rather than competing is in fad edie1

great. This means that the fact that dentists 'i owiactually cooperate more than they com- iperspete does not in itself invalidate the com- kis tiimercial model as a description of the den- Thetal profession and current dental practice !ance,

Finally, we should mention the place of Sa ghdental schools in the commercial model ttitistA dental school is, in this view, simply' ill anmarketplace where dentists sell tht >eprcknowledge and skills needed to provide Uorhdental care. The consumers of that com- sisvitmodity, the students, are simply persons Hotewho would themselves like to sell dental entiicare to patients. Here again, the relatioiship between the two parties consists Ktirely in bargaining the terms of, and thecarrying out, contractual commitment'in this case, to exchange dental kno*edge and skills for an agreed on prl* "e otLuckily for those who sell this produsdentists currently hold a legalizej *'ft"monopoly" on dental knowledge ̂ ^'id-skills, so that the only place that would* «*n hdentists can acquire them is in the derf lrtse]

trfessionbasis fori obliga-

do ingdentist."itions ofise he orf course,bargain-'.hertheylegationsleir con-J are not1 have asJthoughis of thiss under-

schools. Consequently, those who selldental knowledge and skills are in an ex-cellent bargaining position in relation towould-be dentists who want to buy them.Here, again, neither student nor teacherjjgs any special obligations or commit-

nts "because he or she is a dentist"beyond the contractual commitments thathe or she deliberately undertakes. Thus,dental students should not be thought ofas undertaking any particular obligationsor commitments as they assimilate dental

own person.This model postulates a different ideal

of dental education than that describedunder the commercial model. In the guildmodel, a code of duty and obligations tothe profession are instilled in the dentalstudent. Of course, the student must mas-ter the knowledge and skills of dentistry,but these are not mastered as a commod-ity to be offered for sale. They are mas-tered because of the dentist's ethicalcommitment to provide expert care. They

In the guild model, the dentist's-obligations derivefrom his or her membership in the profession not fromany moral status of patients.is model

se in ac-vvith one:ompete.is not ajust de-mwever i^owledge and skills from their teachers.

Guild model—dental careas a privilege

Toexamine dentistry in a different light, anarrow focus is placed on the professionexclusively from the perspective of our

ested in •,s if they |itions inc umongik out ofst of the

signifi- j'second model, the guild model.rest and '. In this model, the profession is domi-ess away inant. It is the profession that endures overe refrain- 'lime; that is the guardian of dental• mutual bowledge, wisdom, and skills; that de-iporation iermines appropriate forms of therapy;:ompeti- «nd that certifies new approaches as they•ation to Become available. It is the profession thatal care is certifies the competency of each new den-rs value jiist as he or she graduates from school as.through well as the adequacy of each school'sI "mono- educational program. The profession,i of coop- worn this perspective, resembles the

Medieval guild. It has, as it were, a life ofits own; it is more than just the collection°f persons who are practicing dentistry at

is in factt dentistsioy com-the corn- listiime.

F the den The individual dentist is simply an in-practice stance, a representative of the profession3 place of *U given time and place. The individualil model Dentist's job is to represent the professionsimply3

sell theand to carry out the tasks and the role

*e profession has defined to the best ofi provide nis or her ability in a given situation. Withhat com- ""s view, "You have an obligation to do' persons r to refrain from doing—because you are;li denta'-T dentist" means a great deal. Indeed, be-relatio"' J^ng a member of the profession meansisists en- idertaking the obligations by which theand the" j ™fession defines its role both in societyijtrnen'S' large and in relation to particular pa-

<n Hi n'S' ^^e individual dentist may alsopr'Ce (ft °bligations fr°m other sources; but

prqduc'j^ °r her primary obligations as a dentist^e from the profession and from thellvidual dentist's commitment, made

,6Den ̂ e or sne entered the profession, to

[ Present the profession well in his or her

are not sold to the student for money: theyare given to the student as a trust. In re-ceiving the knowledge and skills, thestudent accepts the obligation to guardand use them properly and with care, andto fulfill his or her other obligations to theprofess ion wi th s imilar conscien-tiousness. The tuition compensatesteachers for their time and efforts in help-ing the students become worthy to bemembers of the profession; it is not theprice of a marketplace commodity.

When the student first arrives at dentalschool, he or she is no more than a layper-son. The dental school transforms thatstudent into an expert, and into a profes-sional, for it is not enough to merelycommunicate expertise. The teachers are

PERSPECTIVE

care at the center of this model of thedental profession. If this image isadopted, this center is viewed, in general,as utterly passive, receptive, and inactivebecause it is untrained and, therefore, un-skilled and uninformed.

The focus of the dentist's professionalobligations is indeed the patient's needfor dental care. However, because the pa-tient is a layperson, the need for care is tobe determined by the dentist. Dental careis a privilege, a gracious response by theprofession, through the person of the in-dividual professional, to the needs of thepassive, uninformed, and needy layper-son.

Thus, while dentists have powerful ob-ligations to their patients, it is not by rea-son of any special moral status of the pa-tient that this is so. The dentist's obliga-tions derive from his or her membershipin the profession and from the commit-ments which he or she makes when ac-cepted into it. They derive from the factthat patients' needs are the reason that theprofession exists and the fact that this par-ticular patient has such needs. The den-tist's obligations do not derive from anymoral status of individual patients orfrom the collective moral status of the laycommunity.

In addition, the profession does nothave any other sort of prior obligations tothe lay community as a whole (for exam-ple, based on some contractual model ofrelationships between the profession andthe larger community). The relation ofprofession and community is a one-wayrelationship in this model, a relationshipin which the profession, as guardian ofdental knowledge and skills, graciouslyresponds to the dental needs of the com-

In the interactive model, the dentist and the jpatienthave equal moral status but their status derives fromdifferent factors on the two sides.

professionals, representatives of the pro-fession and models for the students ofwhat they are now obligated to become.On this model of the profession, then,there is a very special relationship be-tween teacher and student; and there arespecial obligations for each, to respectand imitate on the one side, and to be amodel and to represent the profession inan exemplary way for the sake of the stu-dents on the other.

In the guild model there is little to sayabout the patient except that he or she hasneeds and these needs provide the reasonfor the profession's existence. This placesthe patient and his or her need for dental

munity. The reason for this deep inequal-ity of status in the guild model is that thepractice of dentistry depends on exper-tise, and the lay community is made up oflaypersons, untrained in the knowledgeand skills of dentistry. Therefore, the laycommunity is simply unable to determinethe tasks and proper role of the dentist.

Thus, in the guild model, the dentalprofession is viewed as a self-standingmoral entity. The profession must createand define for itself, because it alone hasthe relevant knowledge and skills, the ob-ligations of its members with its properrole and relationship to the lay commu-

,nity. The agencies of power within the lay

Ozar : THREE MODELS OF PROFESSIONALISM . 175

PERSPECTIVE

community may strive and even succeedin restricting and regulating the dentalprofession as it carries out this task, butsuch actions on the part of the lay com-munity can be viewed only as intrusionson the proper role and tasks of the dentalprofession.

In reflecting on this second model, ason the first and the third to come, thereader should remember that each modelis somewhat extreme so that the contrastsbetween them can be highlighted. Therelevant question with regard to eachmodel is to what extent the model accu-rately describes the dental profession as itis and helps us see what the dental profes-sion ought to be.

Interactive model—dental careas a partnership of equals

The interactive model will take a littlelonger to describe because historicalexamples are not as easily found. Certainprofessions (for example, law and archi-tecture) can provide partial examples ofthe interactive model in operation; andmany dentists who read this descriptionmay recognize in it certain elements oftheir own professional practices. As far ascan be determined, this model has notbeen carefully explored in the generaltheoretical literature on the professions,3

and even less has been written about thismodel in relation to dentistry specif-ically.4

In this model, the dentist and the pa-tient are equals in that they have roles ofequal moral status within the decision-making process in dental care. But thismodel differs decidedly from the com-mercial model, in which each party issimply a self-interested bargainer dealingwith another self-interested bargainer.For in the interactive model, the equalmoral status of the dentist and the patientderives from different factors on eachside. In a similar way the dental profes-sion and the larger community are alsoviewed as having roles of equal moralstatus in this model; and again their equalstatus derives from different factors oneach side. For the moment, however, letus concentrate on the one-to-one relation-ship between an individual dentist andpatient.

In the interactive model, the moralstatus of the patient in dental decision-making derives from the fact that it is thepatient's mouth, health, and functioningat stake. The high value attached to theautonomy of every person requires thatmatters of such vital interest to the patientbe determined by the patient in accordwith his or her own values, priorities, andpurposes.

But when human beings experiencepain and disease, the condition is itself alessening of autonomy, and a loss of abil-

ity to control our own lives on the basis ofvalues. Even when our condition is a con-sequence of our own negligence, forexample, inadequate oral hygiene, westill experience the disease process itselfas something which happens to us ratherthan something we are doing. For the dis-ease process becomes something whichis, or at least which has now passed, be-yond our control.

This experience of not being in controlis made even more acute when the diseaseprocess involves significant pain becausepain depletes a person's ability to func-tion fully and with full control. Peoplecome to dentists, then, because dentistsunderstand the processes that are lessen-ing or threatening to lessen their au-tonomy, and dentists have the skills nec-essary to subject these processes tohuman control by reversing or preventingthem, or minimizing their undesirableconsequences. Patients come to dentistsnot only for relief of pain and restorationof function, but also to regain and pre-serve autonomy.

One consequence of the fact that pa-tients come to dentists without their fullautonomy is that the patient is thereforeunable to be a coequal bargainer with thedentist in the dental marketplace. Thekind of equality stressed in the commer-cial model is simply not available; for thedentist enters the relationship with thecapacity to control the processes thatafflict the patient and limit autonomy.This unavoidable inequality means thatthe commercial model cannot possiblyrepresent the dentist-patient relationshipadequately.

Because patients do come to dentists topreserve and regain their autonomy, theguild model, which views patients aspassive recipients of informed choices ofthe dental professional, must also be setaside. For the autonomy of the patientdoes not have a significant place withinthe guild model. If the dentist's role is notone of choosing for the patient becausethe patient cannot reasonably choose, butrather of enhancing and supporting thepatient's capacity to make choices, thenthe guild model must be set aside in favorof an alternative account of the dentist-patient relationship, the interactivemodel.

In this model, the dentist's statuswithin the dentist-patient relationshipderives from the dentist's expertise. Thisexpertise is significant because of thedentist's ability to restore and preservethe patient's health and function and tofree the patient of pain and discomfortand because it enables the dentist to re-store and support the patient's autonomy.The patient's status derives from the factthat it is the patient's mouth and healthand functioning that are at stake and be-cause practitioners place great value on

controlling these matters according to ourown values, goals, and priorities.

Thus, in this model the dentist and thepatient have equal moral status in the re-jilationship that binds them; but their,'1status derives from different factors onthe two sides. Or more precisely, while i|derives from the same underlying valuesnamely, the value of health, comfort, andfull human functioning and the value ofautonomy, it nevertheless derivesthe two parties' differing functional rela-tionships to these values. The two partiesroles are distinct, but they come togetherin this relationship as moral equals be-cause neither can carry out a role in theachievement of these values without theother being able to do so as well. /r'd tht

This means that the decisions made byfc sjondentist and patient together involve a ramisubtle meshing of the expertise of the pro-fessional with the choice of the patient,based on the patient's own values,priorities, and purposes. Because of thepatient's lack of expertise and experienceof self as diminished in autonomy in relation to dental disease, the burden of ac-fcomplishing this subtle meshing of tworoles falls significantly on the dentist. Itisprecisely this subtle partnership in deci-sion that is the dentist's first professionalresponsibility, not simply the provisionof technically competent dentistry.

There is another element

y corcquisional ;rofespssurc I

tween the interactive model and the othenLfess j(

iion) arhe intetip betarger cffine in

two models. This concerns the patient'sneed for dental care within the dentist-patient relationship. In the commercialmodel, the dentist has no obligation, in-dependent of the actual agreements withthe patient, to give the patient'sspecial moral status. In both the inter*live and guild models, the dentist hasmoral commitment to serve the patient':need: health, comfort, and full functiing. In the interactive model, howeverthe dentist's commitment to serve the patient's need does not derive from the denlist's membership in the profession odentistry, but from a relationship b£

tween the individual dentist and tbcommunity at large. It is the communil)1

rather than the guild, which confersthe dentist the status of a professiThis special status granted by the coimunity, after the profession has certifithe dentist's expertise, is a response tocommitment to serve the commufl1'well.

Individually, and as a group, dentihave mastered a body of information ara set of diagnostic and therapeutic sk"that the ordinary member of the cofflfljnity grasps only distantly and sup*cially, if at all. This special knowMgives dentists the ability to affect peophealth, comfort, and ability to functi"'The community cannot reasonably acc'jsuch an exclusive acquisition and con®

The profildual hfee to pis comnirafessio

jie comrdenti

ie prof os'id men'hich ac

statusormally iractice ;quiesce)' thesu

istributeJu-er, to

teracprof

'Perly u"PPort t.

ftm»6r§er. con

•enlist.

'aree'fobl

eqJga

176 • /ADA, Vol. 110, February 1985

PERSPECTIVE

-ding to oties.list and th,is in the n; but theiifactors o:

;ly, while rring valuesomfort, amhe value ol3rives fronjsjzable power over people's lives on theitional relaL of experts without assurances thattwo parties s power will be used in the interests of

jL_The reason for describing these three models is to develop tools by which. j the members of the dental profession can understand better who they are

%and who they want to be.

ne togetheequals 1role in th(

without thiveil.ns madebi

e of the prothe patientvn values;ause of thexperienc

omy in relairden of acaing of twidentist. It ihip in deciarofessiona,e provisioitistry.'contrast bend theothe.he patientthe dentiscommercia'ligation, insments will,t's need anthe intera

lentist hasthe patientill function3l, howeveserve the p•om the denrofessionionshipist and thcommuniti confers °jrofossion'by the co«has certifieespouse tocomrnun'

•up, delirmation a"peutic skithe corn"1

and supef1 knowl<*feet peop1

to functi"nably ac'i and con

nmunity, a relationship in which the

who are affected by it.'his is why, as sociologists have longed, the mark of every profession is aationship between the professionalIthe community, and between the pro-sional's group of co-experts and the

community accepts and affirms theuisition of this power by the profes-nal and the group, and in which thefessional and the professional groupure the community that the power willbe misused.

Vhereas the guild model dictates a re-onship between superior (the profes-i) and inferior (the lay community),interactive model creates a relation-

p between equals. The profession and]er community in equal partnershipine and specify the obligations and re-msibilities, as well as privileges, of theofession and of its individual members,e profession certifies that a given indi-iial has acquired the requisite exper-3to practice dentistry. In dischargingcommitment to the community, theifession holds its members accounta-for actually practicing in accord withcommitments undertaken in becom-

! dentists. But it is the community, not^profession, that makes people dentists

members of a profession: that is,'ich accords to an individual person* status of being a profession—eitheraially as in licensing laws and dentaljrtice acts, or informally by positiveWiescence in the exercise of this powerthese specific individuals and this

?dfic group. Only the community, not"Profession, has the moral authority toMbute power, especially exclusive*er, to social roles within it. Thus, ininteractive model, the individual den-s professional obligations—to dealPerly with each patient and to activelyJport the profession—derive from

fundamental obligations to thecommunity that are voluntarily

•tertaken when he or she becomes a1st."lally, the particular character of den-education in the interactive model

sionals. Each acquires status as a profes-sional, not from the profession as in theguild model, but from the larger commu-nity in response to the individual's au-tonomous commitment to the communityto use his or her acquired power well. Theteacher has already made this commit-ment and the student aspires to it. Thus,the teacher is rightly studied by the stu-dent as a model, but the teacher has noauthority to give or withhold from thestudent the professional status he or sheseeks. In this respect they are equals inrelation to the larger community, and allthe more so because the student, in ac-cepting the burdens and sacrifices of den-tal school, has already begun to make thiscommitment, and because the teacher, asa fallible human being, would probablydescribe him- or herself more often as onewho strives to live out this commitmentrather than as one who lives it and modelsit in unswerving perfection.

This model is the interactive model,then, for three reasons. The relationshipbetween dentist and patient is a partner-ship of equals, who make differing con-tributions to the partnership, but whohave equal moral status in the relation-ship and who thus owe each other equalrespect as they work together in makingdecisions about treatment and about theother aspects of their relationship.

This whole interaction between patientand dentist has, as its context, and in acertain sense as its presupposition, theinteraction between the community atlarge and the dental profession. This, too,is a relationship between equals with dif-ferent but complementary roles if theirrelationship is to achieve its goals.

The model is called interactive becausethe relationship of dentist to dentist isalso that of equal partners in the project ofmastering the knowledge and skills ofdentistry and of providing patients withthe highest quality of dental care. Practic-ing, teaching, and learning; modeling intheir own lives the fulfillment of thecommitments to the community that eachhas made, and growing under oneanother's influence; and striving to dobetter—there is no other profession ofdentistry: they are the profession.

members of the dental profession can un-derstand better who they are and whothey want to be. My interpretation ofthe history of the dental profession in theUnited States is that it has developed formany years in the guild model, but that inrecent decades it has slowly shifted itsunderstanding of itself towards the inter-active model. But, that process is by nomeans complete. Perhaps it should not becompleted. My own judgment that theinteractive model is preferable andshould be actively adopted in practice isdefensible; but it is not infallible, and allthe evidence is not yet in. What I propose,in submitting these models for considera-tion, is that the relationship between thedental profession and the community atlarge is in a process of change. I proposethat dentists reflect, with a renewed senseof urgency, whether using these threemodels as tools for reflection or followingsome other method, on what that rela-tionship is and ought to be, and on whatthe dental profession is and what it oughtto be. Only by such reflection will themembers of the profession gain under-standing of the processes affecting den-tistry at present and be able to shape theiroutcome.

|ld already be clear. Although teacher Conclusionstudent are not equals in expertise,

y are equals in regard to the basis of[* obligations and privileges as profes-

The reason for describing these threemodels is to develop tools by which the

These models were developed in course lectures onprofessional ethics in dentistry at Loyola Universityof Chicago's School of Dentistry during the past 4years. The author thanks many junior dental studentsfor their advice and comments on various formula-tions of these ideas, especially C. Shimizu, DOS, whosuggested the term "interactive" to describe the thirdmodel, and Leo Click, DOS, for helpful advice.

Dr. Ozar is associate professor, department of phi-losophy, and associate clinical professor, School ofDentistry, Loyola University of Chicago, 6525 NSheridan Rd, Chicago, 60626. Address requests forreprints to the author.

1. Ozar, D.T. Patients' autonomy: three models ofthe professional-lay relationship in medicine.Theoretical Med 5:61-69, 1984.

2. American Dental Association. Principles ofEthics and Code of Professional Conduct, section 4-A:"Dentists shall have the further obligation of notholding as exclusive any device, agent, method ortechnique." Examining the requirements of profes-sional codes of conduct in the light of models ofprofession such as the three models discussed here ishelpful.

3. Freidson, E. Profession of medicine. Chicago,Aldine Publishing Co, 1970.

4. The best bibliography of contemporary litera-ture on dentistry as a profession and professionalobligations in dentistry is The PEDNET Bibliography,Ozar, D., and Hockenberry, C, eds. Chicago, LoyolaUniversity of Chicago, Professional Ethics in Den-tistry Network, 1984.

Ozar : THREE MODELS OF PROFESSIONALISM • 177