A patient wants teeth whitening done, you tell them this is not in their best interest, and they've offered you extra money to do it regardless, what do you do?

In this situation, you should respectfully refuse providing treatment. You've recognised that this is not in the best interests of the patient and teeth whitening would cause potential harm, which would be against the non-maleficence ethical pillar.

Not only this, but the patient has offered extra money in exchange for treatment that is not advised. It would be unethical for you to accept the money and carry on with the treatment, as you would have blurred the lines between a good patient-dentist relationship.

As a dentist, patient safety is your responsibility. If in the future, there was disease progression had you done the whitening, you would be accountable. This puts your job on the line. Refusing treatment here not only protects the patient, but it also protects your job, and the reputation of the dental profession.

Suggested structure for this answer:

• Respectfully refuse treatment, explaining your reasoning-remember to be empathetic, the patient may be insecure with the colour of their teeth
• Communicate your concerns with what the patient is proposing
• Document the events of the appointment as evidence of your reasoning
• If the patient is non-compliant, escalate the situation and get a superior involved
• Reflect on the situation and understand the long-term consequences if you were to go through with the teeth whitening