A 64-year-old with dementia and a blood pressure of 166/95 consents to an MO composite on the mandibular left second molar. After caries excavation the dentist discovers deep caries on the DISTAL and proceeds to restore that surface too, without further discussion. Which pair of ethical principles is in conflict?

Correct answer: A. Autonomy and beneficence

• A. CORRECT. The dentist acted in what he judged to be the patient's best interest — treating disease he found, sparing the patient a second appointment and a second injection. That is BENEFICENCE. But he did so without obtaining consent for the additional surface, overriding the patient's right to decide what is done to her body. That is a breach of AUTONOMY. The conflict between these two is the classic definition of PATERNALISM, and the presence of dementia sharpens it considerably: it raises a genuine question of capacity and of whether a health care proxy or surrogate decision-maker should have been involved.
• B. Justice concerns the fair allocation of resources and non-discrimination in access to care. Nothing in this scenario turns on fairness of distribution.
• C. Non-maleficence is engaged if the extra treatment caused harm, but the fundamental defect here is the absence of consent for a procedure that was itself clinically indicated — an autonomy problem.
• D. Confidentiality is not at issue; no information was disclosed.

Note: On the legal question the file also asks — yes, this is a viable claim. Treating beyond the scope of consent can constitute BATTERY (unconsented touching) as well as negligence. The correct course was to complete only what was consented to, then discuss the additional finding and obtain informed consent, involving a legally authorised representative if capacity was in doubt. The elevated blood pressure and dementia are also documented, and both bear on capacity and on how the discussion should have been conducted.