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Language models deployed in high-stakes professional settings face conflicting demands from users, institutional authorities, and professional norms. How models act when these demands conflict reveals a principal hierarchy -- an implicit ordering over competing stakeholders that determines, for instance, whether a medical AI receiving a cost-reduction directive from a hospital administrator complies at the expense of evidence-based care, or refuses because professional standards require it. Across 7,136 scenarios in legal and medical domains, we test ten frontier models and find that models frequently fail to adhere to professional standards during task execution, such as drafting, when user instructions conflict with those standards -- despite adequately upholding them when users seek advisory guidance. We further find that the hierarchies between user, authority, and professional standards exhibited by these models are unstable across medical and legal contexts and inconsistent across model families. When failing to follow professional standards, the primary failure mechanism is knowledge omission: models that demonstrably possess relevant knowledge produce harmful outputs without surfacing conflicting knowledge. In a particularly troubling instance, we find that a reasoning model recognizes the relevant knowledge in its reasoning trace -- e.g., that a drug has been withdrawn -- yet suppresses this in the user-facing answer and proceeds to recommend the drug under authority pressure anyway. Inconsistent alignment across task framing, domain, and model families suggests that current alignment methods, including published alignment hierarchies, are unlikely to be robust when models are deployed in high-stakes professional settings.