A patient states that he does not want to lose any more teeth. He has 1–2 non-restorable teeth. Regarding management, all of the following would be appropriate EXCEPT:

Correct answer: D. Refusing to treat the patient unless he agrees to extraction ('I cannot treat you if you won't let me extract these teeth')

• A. Incorrect. Explaining the consequences of keeping non-restorable teeth IS appropriate informed consent and falls under beneficence/non-maleficence.
• B. Incorrect. Suggesting a second opinion is appropriate and even encouraged in complex situations where the patient is hesitant.
• C. Incorrect. Offering time to consider respects patient autonomy and is ethically appropriate.
• D. CORRECT — this is the EXCEPTION. Threatening to refuse all dental treatment unless the patient consents to extraction is coercive, violates patient autonomy, and may constitute patient abandonment. The dentist cannot withhold necessary care as leverage. The appropriate approach is to inform, discuss consequences, respect autonomy, and document.