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Richard Masella's "Renewing Professionalism in Dental Education: Overcoming the Market Environment" reveals why professionalism is nearly dead in America; it also shows the good of commerce and the excesses of commercialism in the market. More importantly, it collects and summarizes most of the relevant forms of education currently available to teach professionalism and professional ethics in dentistry; it then briefly examines whether those forms of education are used and if they are effective. Masella also asks some key challenging questions. His select and limited references lead to deeper studies about the nature and definition of professionalism and how it might be learned and presented. His suggestions for renewing professionalism are minimal; this sets the stage for proposing and selecting other ideas that need attention and development. Some of those ideas and suggestions, such as competition and collaboration, four types of dentistry, understanding two conflicting meanings of desire and need, and universal patient acceptance were recently explored in a workshop, "

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This article reviews the history and future good of acceptance ethics and helps frame the publication of papers presented at the workshop on Professional Promises: Hopes and Gaps in Access to Oral Health Care. Discovery and development of Universal Patient Acceptance (UPA), a practical application of acceptance ethics, is key to systematizing access to oral health; UPA expands partnerships among professional volunteerism, culture, and economic structures. A Veterans' Administration health services preventive dentistry research project and a West Virginia school children's preventive dental program raised awareness of acceptance. A state insurance crisis revealed an underlying systems ethics problem that was not purely legal, political, educational, economic, or scientific in nature. Key players were identified for dialogue, and questions were ranked. UPA was articulated and proposed as a unique, practical, and positive professional promise.

There is an unnoticed step that occurs before a person becomes a patient, that is, every prospective patient must first express his or her need for care to a health professional who responds by describing how the patient might access that care. When the health professional accepts the patient as someone to talk with at the outset, this is termed “acceptance.” Acceptance has been defined as the hidden ethic and core value underlying the applied ethical tool of universal patient acceptance (UPA). Acceptance impacts access to care. Published reactions to acceptance and UPA have so far ranged from thoughtful and constructive, to emotionalized and reactive. As the practical applications of acceptance and UPA are discussed in national forums on access to care, some general trends have emerged. This paper is a status update on UPA and speaks to those proposals and recommendations. The ethical basis of UPA is expanded upon, and the attempt is made to more effectively operationalize the concept and further justify its relevance to the allied-health professions. A clearly articulated notion of acceptance is needed to protect professional conscience from secular interests of patients. It is only after broader multi-disciplinary review and debate, however, that UPA can become less hidden or presupposed, and actually find expression in the ethics codes and training curricula of all the health professions. Once expressed within these professional forums, it will likely gain more relevance in the critical evaluations of acceptance as it is more broadly used in the conversations of economics, politics, and secular (non-professional) society.

Acceptance" is an often presupposed, hidden core value and ethic focused on how dental and other health practitioners first accept people as possible patients. The three basic styles of patient acceptance are random, selective, and universal. Reduced public access to care results from the practice of random and selective acceptance. Only universal acceptance creates a potential pathway for improved access to care. The notion of Universal Patient Acceptance (UPA) is discussed here as one kind of applied ethical tool or clinical practice that allows for the ethic of acceptance to be more effectively pursued in daily practice. We suggest that health providers falsely surmise that they already understand and practice Universal Patient Acceptance. That myth and perspective are partly what keeps Acceptance hidden as an ethic and overlooked as a potential way to foster dialogue and indirectly promote better access to care. Without Universal Patient Acceptance, dental and health providers will continue to silently engage in practice patterns that adversely affect public access to care. The actual benefits of Universal Patient Acceptance are the subject of ongoing review and debate. Whatever those benefits might be will not likely be realized until Acceptance and Universal Patient Acceptance are included as part of dental and other health professional codes of ethics and training curricula. That is what we argue for here. Dr. Corsino is President