Cosmetic treatment, autonomy, and risks: "if you don't do it, I'll go to a dentist who will"

Patient requests and treatment goals may exceed the limits of professional practice and may have an adverse effect on health. When doctors encounter these types of requests, they first must decide whether the patient has the capacity to consent to such care. In the case of child patients, no such capacity exists and surrogate consent to care must be, in the opinion of the doctor, in the child's best interests. Parents who request potentially harmful procedures for a child with no hope for any health care benefit should be refused politely. Adult patients who request harmful elective procedures for themselves also should be educated and helped to fully understand why the request represents substandard treatment. The long-term consequences of these requests must be detailed clearly for these patients. Elective cosmetic treatment that will lead to long-term adverse effects on function and health raises serious ethical concerns in which the principle of nonmaleficence likely will trump the patient's autonomy.