Obtaining consent from patients has become a particularly topical issue amongst medical and dental professionals. Following a recent decision of the Supreme Court on this very issue, dental practitioners, as well as with their medical counterparts, are looking at ways to deal with the increased burden of seeking to identify the nature of the consent required and said to constitute informed and lawful consent.
The General Dental Council’s (GDC’s) guidance on this issue, defines the main ethical principles in obtaining consent as comprising of consent being informed, voluntary and made by a patient with capacity. According to the GDC’s guidance, the key questions for practitioners are thus
- does the patient have enough information to make a decision;
- has the patient made the decision; and
- does the patient have the ability to make an informed decision?
But is this the whole picture? Is there more to obtaining consent than meets the eye?
Informed consent varies from patient to patient
In a recent ruling (Montgomery v Lanarkshire Health Board  UKSC 11), the Supreme Court has put patients squarely at the centre of any discussions about consent to treatment. Although the case itself concerned medical practitioners, the principles are likely to apply to the discussion of treatment options in the field of dentistry.
The correct approach to consent after this case will require dentists to ensure that patients are aware of “material risks involved in any recommended treatment and of any reasonable alternative or variant treatments”. This means that practitioners can no longer rely on their professional judgment when making decisions about treatment. There now appears to be an expectation that professionals will go further and discuss treatment alternatives with patients and the risks of injury that may be involved.
Dental professionals need now to ensure that patients are given both the information they want as well as the information they need. This changes the patients role in the consent process from a more passive listener, to that of an active questioner; the professional is required to make an assessment of what level of information a particular patient will require.
Dental practitioners are now also encouraged to be satisfied that the patient has understood the information given to them.
All of this means that practitioners will need to adapt their practices when obtaining consent to suit the needs of their (potentially) diverse patient base.
Getting it right
Given that every patient is different and comes to the chair with differing levels of understanding of the medical jargon involved in their treatment, practitioners should consider using visual aids to provide clearer information. Patients should always be informed of the treatment plan and costs estimate (in writing where appropriate). Of particular importance is the need to ensure that patients know whether treatment is private, under the NHS or mixed. This information should be communicated to the patient and knowledge should not just be assumed. These changes can make a real difference to the extent to which a patient will feel involved in the consent process.
An on-going discussion…
Another area that is often overlooked is the need to explore consent again where the treatment plan changes. At this stage, similar discussions about options, risks and costs need to be clearly communicated to the patient regardless of how limited the options may appear to be.
Where dental practitioners are able to view consent as an on-going discussion between themselves and the patient, they stand themselves in good stead for dealing with, and responding to, any concerns later raised about the treatment provided.
There is now more than ever a greater need for practitioners to actively engage in the consent process. As the balance of power appears to be shifting towards the patient, there is a greater onus on the dental professional to ensure that patients are involved in decisions relating to their treatment and any associated risks.