A 74-year-old male presents with his wife, who states 'He is here for his extractions.' The patient has hypertension, hyperlipidemia, a stroke 2 years ago, is wheelchair-bound, and his wife is the court-appointed legal guardian. Medications include lisinopril, atorvastatin, and warfarin. Non-restorable teeth #30 and #31 are planned for extraction. By using which principle of ethics can the patient's wife sign the consent form?

Correct answer: A. Autonomy

• A. CORRECT. Autonomy is the ethical principle of self-determination and the right to make one's own decisions. Since this patient had a stroke 2 years ago and can no longer consent due to residual cognitive deficits, his wife (as court-appointed legal guardian) exercises substituted decision-making on his behalf, which is an extension of the autonomy principle — the guardian acts as the patient's autonomous agent to give informed consent.
• B. INCORRECT. Beneficence is the principle of 'do good' — acting in the patient's best interest. While this principle guides the treatment plan, it does not specifically address the mechanism of who can legally sign the consent form.
• C. INCORRECT. Veracity is the principle of truthfulness and honesty — being truthful with patients about diagnoses, risks, and alternatives. It does not address who may provide consent.
• D. INCORRECT. Justice refers to fairness and equitable distribution of dental care and resources. It does not address the legal basis for surrogate decision-making.