Consent Across Three Patients

Correct answer: A. Informed consent

• A. Correct. Informed consent requires disclosure of the diagnosis, the proposed treatment, its risks and benefits, the reasonable alternatives including no treatment, and an opportunity for the patient to ask questions and demonstrate understanding. Every element is present here.
• B. Incorrect. Proxy or surrogate consent is given by an authorized person on behalf of a patient who lacks capacity. Patient A has full capacity and consented for himself.
• C. Incorrect. Emergency consent is the doctrine permitting treatment of a patient who cannot consent when delay would cause serious harm. Nothing here is an emergency and the patient is fully able to consent.
• D. Incorrect. Implied consent is inferred from conduct rather than stated — a patient opening their mouth for an examination, for example. It never suffices for a surgical procedure.

Correct answer: B. Autonomy

• A. Incorrect. Justice concerns fairness in the distribution of care and resources, and equitable treatment of patients. It is not the principle engaged by an individual consent discussion.
• B. Correct. Autonomy is the patient’s right to self-determination. Informed consent is the practical mechanism by which that right is honored, ensuring decisions about his own body are made by him on the basis of adequate information.
• C. Incorrect. Nonmaleficence is the duty to do no harm. It governs technique, competence, and avoidance of unnecessary risk rather than the decision-making process.
• D. Incorrect. Beneficence is the duty to act for the patient’s benefit. It underlies the recommendation itself, but the consent process specifically protects his right to accept or refuse that recommendation.

Note: The five principles in the ADA Code: autonomy (self-governance), nonmaleficence (do no harm), beneficence (do good), justice (fairness), and veracity (truthfulness).

Correct answer: D. Risk of bleeding related to his anticoagulant medication

• A. Incorrect — this should be included. Postoperative infection is a standard disclosable risk of a surgical procedure.
• B. Incorrect — this should be included. Delayed healing and alveolar osteitis are recognized risks of any extraction and must be disclosed.
• C. Incorrect — this should be included, and it is particularly important for #17. The inferior alveolar and lingual nerves lie in close proximity to mandibular third molars, and paresthesia is the most significant specific risk of this procedure.
• D. Correct — this is the exception. He takes no anticoagulant or antiplatelet medication, so a medication-related bleeding risk does not apply to him. Consent must be individualized to the actual patient rather than recited generically.

Correct answer: A. His wife, in her capacity as court-appointed legal guardian

• A. Correct. Once a court has adjudicated a patient legally incompetent and appointed a guardian, that guardian holds the legal authority to consent to health care on the patient’s behalf. Her authority derives from the court order, not merely from marriage.
• B. Incorrect. He has been legally adjudicated incompetent, which means he cannot provide valid consent regardless of age.
• C. Incorrect. Family relationship alone does not confer authority when a guardian has been formally appointed. The court order determines who may consent.
• D. Incorrect. A treating clinician cannot consent on behalf of a patient. Doing so removes any independent safeguard and is a clear conflict of interest.

Correct answer: D. His mother, as parent and legal guardian

• A. Incorrect. A witness attests that the signature was made; a witness does not authorize treatment.
• B. Incorrect. Consent is always required. The only question is who holds the authority to give it.
• C. Incorrect. A 5-year-old lacks legal capacity to consent. His assent is valuable and should be sought, but it carries no legal weight.
• D. Correct. A minor cannot provide legal consent, so a parent or legal guardian must consent on the child’s behalf. Good practice adds assent from the child — an age-appropriate explanation and agreement — alongside the parent’s legal consent.

Note: Recognized exceptions to parental consent vary by jurisdiction and typically include emancipated minors, married minors, and specific categories of care such as pregnancy or substance use treatment. True emergencies also permit treatment without prior consent.