A dentist believes a patient will not be able to afford implant therapy, so she presents only the removable partial denture option and does not mention the alternatives. Which ethical principle has been violated?

Correct answer: D. Autonomy

• A. Veracity is the duty of truthfulness. It is closely related and is arguably strained by the omission, but nothing false has been stated. The principle that names the harm precisely is autonomy: the patient's capacity to choose was removed.
• B. Beneficence is the duty to act in the patient's interest. The dentist may sincerely believe she is sparing the patient embarrassment — which is exactly why this scenario is instructive. Well-intentioned paternalism is still a violation of autonomy.
• C. Non-maleficence is the duty to avoid harm. A removable partial denture is a legitimate restorative option and delivering it competently causes no direct harm — the breach is in the decision-making process, not in the treatment itself.
• D. CORRECT. AUTONOMY is the patient's right to self-determination, and that right is meaningless without complete information. By pre-judging what the patient can afford and filtering the options accordingly, the dentist has made the decision on the patient's behalf. This is PATERNALISM — the classic autonomy violation. Every reasonable alternative, including the option of no treatment, must be disclosed with its risks, benefits and costs; the patient then decides. A patient may have savings, financing, family assistance or priorities the dentist knows nothing about.

Note: Distinguish three related items that recur on this exam. Presenting all options and letting the patient choose = AUTONOMY respected. Withholding options because you assume the answer = AUTONOMY violated (paternalism). Refusing to treat someone because they cannot pay = JUSTICE violated. The distinguishing question is always: what exactly was taken from the patient?