 Mrs. Gladys Funk is a 78-year-old widow with a history of cardiovascular disease, diabetes, and is a past smoker having quit in her early 50s. She has been a patient of Dr. Tappell for eight years. Although she now lives alone, Mrs. Funk has a granddaughter who lives in the area and who sometimes checks in on her. Oral health, function, and appearance have always been important to Gladys as she has worked with Dr. Tappell. She has maintained routine office visits and received treatments, including dental implants. Dr. Tappell has had growing concerns about her patients' oral and overall health that until now have not risen to a significant level. Mrs. Funk has come in late for her appointment today. What time was my appointment today? I made a couple wrong turns on the way here. Well, you're here now. It's good to see you, Gladys. You're just a little bit late for your 3.30 appointment, but it's fine. Well, what time is it now? It's 4.15, but Dr. Tappell can see you now. I'll walk you back. All right. Hello, Gladys. I'm so sorry. I really don't know what happened. Oh, don't worry about being late. Is everything okay? Yes, I'm okay. Just having a little trouble lately. Can you tell me a little more about the trouble you've been having? It's probably nothing. I just haven't been able to remember things the way I used to. It's been very frustrating, but I don't want to take your time with my stories about getting old. Let's keep going. Do you feel okay to proceed with today's checkup? Yes, I think so. During the exam, Dr. Tappell reexamines a few problems, including root carries and a number of teeth previously determined to need extractions due to progressive periodontitis. She has been monitoring these teeth at Mrs. Funk's four-month periodontal maintenance appointments and has recommended fillings and extractions at each of these sessions, but Mrs. Funk has not followed through. Well, I see some definite problems have progressed since your last visit, Gladys. The lesser problems are some moderate plaque and calculus buildup, but I also see that those dental root carries and loose teeth have gotten worse. It's really time to deal with the cavities and extract the teeth. But I don't have any pain. Why should I have that done? You missed your appointment last month when we were scheduled to take care of the teeth with root carries? I thought you'd already done that. Mrs. Funk's oral health has taken a negative turn, and there are some decisions which must be made to address the conditions that have progressed. Options to replace teeth and preserve oral function will need to be discussed after the immediate concerns are addressed, but Dr. Tappell is worried that Gladys' ability to comprehend the problems she sees has diminished and is surprised by Gladys' changing values of caring for her teeth. A former business owner, she had been known for her engaging personality and sharp style. She had always been concerned about her dental health and appearance. And was motivated to follow Dr. Tappell's recommendations in the past. She always needed to understand what the dentist was doing for her. Now, it seemed as if she had lost a bit of her overall sharpness. Her clothes have appeared to be too large and mismatched, and at times she has appeared a bit confused. Lately, she has forgotten to show up at all for some appointments and has seemed less able to comprehend everything Dr. Tappell has been telling her about her dental health. If it's okay with you, we can start with treating the cavities that are getting larger and then schedule you for the extractions. Well, okay. Just do whatever you think is best. What are the ethical and professional issues raised by this scenario? You may pause the video to consider this question. What are some options for addressing this situation? You may pause the video after each possible solution to consider the implications of each option. Should Dr. Tappell do nothing to address the patient's cognitive incapacity? Proceed with dental care since Gladys has said, do whatever you think is best. Contact Gladys' granddaughter directly and share concerns about Gladys' well-being. Work to help Gladys understand that her long-term oral health depends on accepting the recommended treatments. Pursuade Gladys to bring her granddaughter to her next dental visit. Ask additional questions to better assess Gladys' cognitive function. Refer Gladys to her physician for evaluation. Now let's look at potential contributing factors as you weigh what's important in your decision about an appropriate course of action. Concern about the patient's life and general health. Concern about the consequences of untreated disease. Working to determine the best interests of a vulnerable patient. Reviewing the patient's insurance benefits. Respecting a patient's autonomy while recognizing that their capacity to make decisions about their oral health care needs may be impaired. Balancing the obligation to maintain patient privacy and involve others when concerned about a patient's well-being and safety. Many dental practitioners face ethical dilemmas such as this one on any given day. Anticipating how you might deliberate to find a suitable resolution to any such dilemma is good preparation and can aid each practitioner to find appropriate solutions to the challenges they sometimes must face.