You recommend extracting a severely damaged tooth, but the patient refuses.

This scenario centres on the tension between two of the four pillars of ethics: autonomy and beneficence. As a dentist, you’ve assessed that extraction is the treatment in the patient’s best interests — but once a patient declines your recommendation, the situation becomes more delicate to navigate.

How to approach this situation

Respect their autonomy

Patients have the right to refuse any treatment, even if you believe it isn’t in their best interests. This is a fundamental principle, and overriding it — or pressuring a patient into agreeing — would be both unethical and a breach of professional standards.

Explore their concerns

A refusal doesn’t necessarily mean the patient has made a fully considered decision — it’s possible they’ve misunderstood the treatment plan, or have an underlying fear or concern they haven’t voiced. Asking why they’re refusing treatment opens the door to addressing any misunderstandings or anxieties directly.

Ensure they’re fully informed

It’s your responsibility as a dentist to clearly explain the risks and benefits of both having and not having the treatment. This isn’t just good practice — it’s what allows the patient to give (or withhold) valid, informed consent, as required by the GDC.

Document the conversation

Whatever the patient ultimately decides, the discussion needs to be recorded thoroughly. This protects both the patient and the dentist, and provides evidence that the patient made an informed decision after being given all the relevant information.

Why this matters

This question is really testing whether you understand that respecting patient autonomy doesn’t mean disengaging from the conversation once a patient says no. A good dentist keeps communicating, checks understanding, and ensures full information has been given — but ultimately accepts and respects the patient’s final decision, even if it isn’t the one they’d have recommended.

Suggested structure for this question

• Acknowledge the ethical tension at the heart of the scenario — your duty to act in the patient’s best interests (beneficence) versus their right to decide for themselves (autonomy).
• Explain that you would first seek to understand their refusal, checking for any misunderstanding or unaddressed concern.
• Describe how you would ensure they’re fully informed, covering the risks and benefits clearly and without jargon.
• Confirm that ultimately, you would respect their decision if they still choose to refuse treatment after being fully informed.
• Mention the importance of documentation, showing awareness of both the ethical and legal/professional dimensions of the scenario.