4: Importance of informed consent

What is valid, informed and implied consent?

Prior to providing any care to a patient in the dental setting, you need to obtain formal consent or permission from the patient. This could take various forms, such as asking if you can examine them, or take a radiograph and they consent verbally or they open their mouth to allow the non invasive process to continue. The consent is implied if a patient has specifically booked an appointment for general oral examination but it is always good practice to verbally check.

Why obtain consent?

• Adequately informing patients and obtaining consent in regard to treatment is both a specific legal requirement and an accepted part of good medical practice.
• Failure to obtain consent could result in legal action for assault and battery.

Valid informed consent

For more invasive or restorative procedures, written consent is important and this can be via a consent form.  Simply signing the form however, will not make it “valid”.

The patient should have sufficient information so that they can understand and make an appropriate decision about that proposed treatment or procedure. The patient should also be allowed time to understand what the procedure or treatment involves and what to expect before, during and after a procedure or treatment. Ideally, this is in written format but also explained chairside, along with the risks and benefits and any alternative options available. This assists active involvement in their own health care decision making.

Remember that consent acquired is only valid if:

• the patient has capacity to give consent  i.e. capacity to understand the implications of having the treatment
• the consent is freely given, with no coercion from staff or other family
• the consent is specific i.e. it is valid only for the treatment or procedure for which the patient has been informed and agreed to
• the patient must be informed in a way they can understand the procedure which is intended.

It is very important to spend some time educating the patient about the problems identified after an initial examination and diagnostic test results. Careful attention should be paid to the chief complaint. The advantages and disadvantages of the individual options should be discussed. The dentist should clearly describe the short- and long-term prognosis for each type of treatment and what can be expected if no treatment is provided (Stefanac & Fontana, 2017).

The patient must also be able to:

• ask questions and be satisfied with the responses provided
• ask for more time (if needed) to seek the opinion of their family or other advisors, often utilised for larger treatment plans
• have all relevant  information and be able to comprehend costs and payment plans for treatment
• use the information provided so they can decide what they think is in their own best interest, with no influence from the clinician or health care provider.

In special needs situations, the consent may not be valid if the patient cannot legally and voluntarily provide consent. In this case, the legal guardian or a power of attorney that has been assigned is consulted instead.

Zhao (2013) lists the type of Information that must be provided to carers or individuals with capacity to consent: