8: Informed Consent for the Geriatric Dental Patient

Chapter 8
Informed Consent for the Geriatric Dental Patient

Jessica De Bord

Children’s Village, Yakima, WA, USA; Department of Pediatric Dentistry, University of Washington, Seattle, WA, USA

Informed consent

Informed consent is a concept that recognizes that individuals have the right to make decisions about their health care. The idea of informed consent is rooted in autonomy. Autonomy is the notion that individuals have a right to self-determination (Eyal, 2011). In the context of health care, autonomy means that people have the right to adequate information in order to understand their condition and treatment choices, and the right to use that information to make healthcare decisions (Eyal, 2011). These rights create corresponding obligations on the part of the healthcare provider to provide such information to patients, and to respect their patients’ healthcare choices. If healthcare providers do not uphold these obligations, they have violated patients’ rights. Informed consent is a necessary factor in providing quality care (Brody, 1989).

Background

Informed consent is a relatively new concept. Historically, health care was more paternalistic, in that healthcare providers decided the best course of action or treatment, and their patients complied. However, under the auspices of healthcare research, many inappropriate and unethical medical studies were conducted. A prototypical example is the Tuskeegee Syphilis Experiment, in which African-American men with syphilis were neither treated nor even informed of their condition so that researchers could observe the progression of their disease (Coleman et al., 2005). Another example of an ethical violation in research was a study conducted at the Jewish Chronic Disease Hospital in which elderly patients were injected with live cancer cells without their knowledge to study that disease (Coleman et al., 2005). Ethical violations such as these, that dramatically infringed on the rights of people participating in healthcare research, illustrated the pressing need to have potential research participants understand what the research was, along with any potential risks and benefits. Armed with this information, individuals could then decide in an educated manner whether they wanted to participate in a given study. This concept then migrated from research to health care in general (Beauchamp, 2011). The application in general health care for patient permission to perform health services became known as “informed consent.” It recognized that people are autonomous, have the right to receive information, to make decisions, and deserve to have their values, beliefs, and priorities honored when receiving health care.

Informed consent is important because patients have a right to make choices about themselves and their health care. For patients to make educated/informed choices, it is necessary that their provider gives them the adequate and appropriate information with which to do so. If a provider makes unilateral decisions about a patient’s health care, does not provide the patient with adequate information to make an informed decision, or proceeds with the assumption that the patient has consented, the provider has violated the patient’s right to autonomy and to make his or her own healthcare decisions.

In clinical practice, it is not uncommon for practitioners to think of informed consent as simply a piece of paper to be signed prior to treatment; however, true informed consent is a process that involves an ongoing conversation between the provider and patient (Brody, 1989). It involves the provider giving the patient adequate information with which to make an informed decision. Ideally, the patient understands the condition requiring treatment, the benefits and the risks of the proposed or recommended treatment, as well as the alternative treatment choices and their risks and benefits. Of particular note is that part of a patient’s understanding necessarily includes understanding the risks and benefits of declining treatment entirely. Additionally, providers should communicate to their patients, in clear and appropriate terminology, the provider’s thought process that led to the recommended treatment (Brody, 1989). The patient ought to have the opportunity to ask questions and have to have them answered (Brody, 1989). For example, if a patient has an odontogenic infection, the provider should explain, in understandable terms, that the infection exists and what caused it. Then, if the recommended treatment is root canal therapy, this should be explained to the patient, including information about why preserving the tooth is the treatment of choice; what would be involved with the therapy, including facts such as the need for a crown following the treatment; and an explanation of the chances that the root canal therapy could fail. The provider would also be obligated to inform the patient that extraction, with or without placement of an implant, would be an alternative method of treatment, and explain both the risks of extraction and the implications of tooth loss. Again, declining treatment is an option, and the risks of that choice – in this case the risk of leaving an infection untreated – also need to be explained. With this understanding, the patient would be able to make a choice that is informed and would be able provide knowledgeable consent for treatment.

When the informed consent process has taken place, it is critical to adequately document the process in the dental record. Having the document that the patient signed providing consent is important, but is, in and of itself, inadequate documentation. The chart note should document the relevant facts of the provider’s conversation with the patient, including the explanation of the condition, the recommended treatment, i/>

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Jan 4, 2015 | Posted by in General Dentistry | Comments Off on 8: Informed Consent for the Geriatric Dental Patient
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