A 23-year-old transgender patient's chart records the pronouns she/her, but the dental assistant repeatedly addresses the patient as 'Mr'. Which ethical principle is most directly compromised?

Correct answer: A. Autonomy — the patient's right to self-determination and to be recognised as they identify

• A. CORRECT. AUTONOMY, understood as respect for persons, encompasses the right to self-determination — including gender identity. Persistently using a name, title or pronoun the patient has not chosen overrides that self-determination, disregards information the patient explicitly supplied, and undermines the trust on which the therapeutic relationship rests.
• B. JUSTICE concerns fairness in access and the distribution of care. It becomes the operative principle if the patient is treated DIFFERENTLY or denied care because of gender identity — but the failure described here is one of respect for the person rather than of allocation.
• C. BENEFICENCE is the duty to act in the patient's interest; the failure here is more specific than a general omission of benefit.
• D. NON-MALEFICENCE is the duty to avoid harm. Misgendering does cause real psychological harm, so this is a defensible secondary answer — but the principle first violated is respect for the patient's self-determination.

Note: Autonomy (respect for persons) is the strongest answer. Practically: record chosen name and pronouns prominently in the chart, use them consistently across the whole team, apologise briefly and move on if you slip, and remember that the legal name may still be needed for insurance and records.