Joanie and Jimmy Read are 12-year-old twins for whom you have just initiated treatment to resolve severe crowding. This is a “salt of the earth” family. The twins’ parents are hard-working people. Mrs Read is a registered nurse who works at night so that she can tend to the children by day. Her husband, an iron worker, is a dedicated father and the headmaster of the local Boy Scout troop. They are a storybook family, bonded by a team approach to life, embracing the traditional work ethic with strong love for one another—until tragedy strikes. As you drive home from the office one evening, the local sports report is interrupted by an urgent news bulletin. Apparently, a roof collapsed at a construction site and instantly killed 3 site workers. Mr Read is mentioned as one of the unfortunate. Your jaw drops as you hear his name on the radio, and you picture Mrs Read and the twins in anguish as they learn that Mr Read will never again return home.

As you attend the funeral service, you search inside yourself for some gesture to help this distraught family. You can think of no other way but to forgive the entire balance of both children’s accounts to eliminate at least one of the family’s financial burdens. Your note of condolence to Mrs Read assures them that the children will receive treatment by your service at no future cost whatsoever.

As adults, and more specifically as health care providers, we become increasingly aware of obligations that are incumbent upon us. Reporting child abuse and meeting a patient at the office during the weekend to resolve pain from an appliance are examples of routine obligations. But there are actions that exceed the level of expected and required responsibilities. These acts are called supererogations , meaning “to perform beyond the call of duty” or “to expend in addition.” Supererogatory acts are optional rather than obligatory, exceed common moral standards, promote the good of others, and demonstrate “moral excellence.” Their application is not solely confined to the health care arena.

Supererogatory acts can vary from minimal gestures of benevolence to extreme acts of sacrifice. The boundary between obligations and supererogatory acts can be especially vague for a health care professional because the professional’s routine roles are to relieve suffering and to encourage health and happiness. The general population, in contrast, is neither obligated nor able to perform such services.

Many people who provide supererogatory acts do not see themselves as exceptionally altruistic, but believe that they are merely doing what is appropriate and that which someone else would do for them. Consider the pedestrian who pushes another out of the path of oncoming traffic only to be struck by a vehicle as an extreme act of supererogation. The orthodontist who re-cements a loose band at no fee for an out-of-town visitor demonstrates a supererogatory act. The virtues of generosity, compassion, and kindness manifest themselves in supererogatory efforts, and are more prevalent in some people than in others.

The opportunity to become involved in supererogation is a fringe benefit of professional status, and certainly providers who realize this will be more fulfilled than those who practice purely for financial gain. No fee will remunerate the internal satisfaction of helping a vulnerable person who is in need.

It has now been a month since you last saw the twins and the first appointment since Mr Read passed away. As Joanie and Jimmy’s adjustment visits conclude, your receptionist says that Mrs Read would like a minute alone with you. You meet her in your private office, and she becomes overwhelmed with gratitude for your gesture of altruism toward her and the twins. Neither you nor Mrs Read can muster a word, but from her misty eyes and her subdued tone of voice, you realize once more that orthodontics has given you the ability to do more than straighten teeth.