Q. I have a 17-year-old patient with learning difficulties with a marked orthodontic problem. I have assessed his need as 4A on the index of treatment need (IOTN) but I have not yet started the treatment. The father wishes his son to receive treatment however; I am concerned about the patient’s uncertainty about the treatment in the first place and also a potential lack of compliance. I am not sure about the father consenting on behalf of his son so how should I proceed?

You have quite correctly identified that informed consent is required from all patients over the age of 16 and the starting point should be to presume that your patient has capacity to make his own decisions.  You should explain the father that without his son's consent, you cannot proceed with treatment. 

However, I would advise that you try and reach a solution with both the father and the son, discussing with them the risks and benefits of orthodontic treatment and your concerns in respect to patient motivation and compliance and the effect that this would have on the orthodontic outcome.

The Mental Capacity Act 2005 applies to this situation so technically, the father could make the decision for treatment on his son's behalf whilst he is under the age of 18, providing the patient himself lacks capacity. Over the age of 18, a Lasting Power of Attorney (LPA) would need to be made; allowing adults who lack capacity to have another make decisions about their personal welfare, including healthcare and medical treatment, as well as their property and affairs.