An older patient is frustrated after a long-standing restoration failed and now demands that all of his teeth be extracted. What is the BEST initial approach?

Correct answer: A. Use motivational interviewing to explore his concerns and goals before any treatment decision

• A. CORRECT. A demand driven by acute frustration is not the same as an informed decision. MOTIVATIONAL INTERVIEWING — open questions, reflective listening, exploring ambivalence — uncovers what is actually driving the request (fear of repeated failure, cost, pain, a sense of losing control) and lets the patient articulate his own goals. Only then can informed consent be meaningful, and the discussion often reveals that a restorative option is acceptable after all.
• B. Autonomy requires INFORMED decision-making. Acting on an impulsive demand without exploring alternatives and consequences fails the informed consent standard, even though the final decision does belong to the patient.
• C. Dismissing the patient abandons him and destroys the therapeutic relationship.
• D. Sedating a patient to perform irreversible full-mouth extractions he may regret is a serious ethical failure.

Note: Autonomy is not the same as compliance with every request. The clinician's duty is to ensure the choice is informed and considered.