The Dental Council Code of Practice relating to professional behaviour and ethical conduct (section 7) sets out the requirement that “informed consent” must be obtained before treatment is provided.
But what does “informed” mean and what is meant by “consent”? How could there even be “consent” if it was not informed?
Increasing numbers of complaints and legal claims involve a failure to obtain valid consent. This is often a source of surprise and frustration to dentists who have acted in good faith when providing care. It is all too common to presume that consent has been given when there is very little to support this.
In many cases, patients and their parents and carers do not have any real understanding of what the treatment actually entails and simply put their trust in the dentist to do the necessaries. On one level this means that the dentist can be seen as having the freedom to get on with the job.
The problem with this view however is that when a previously unexpected aspect of treatment becomes clear to the patient and / or parent / carer – for example post-operative pain, the number of appointments required, the time taken to complete treatment etc. - it can be an unwelcome surprise.
All of a sudden there is a question of consent; if this was not expected but it has now happened then how could the patient (or the person who consented on his/her behalf) be considered as having agreed to this?
To avoid difficulties of this sort it is appropriate to ensure that the patient, or the party consenting on behalf of the patient, is taken through a consent “process” which includes not just the provision of information but the careful explanation of what is involved and the double-checking of the other parties understanding.
Having done this, it is also important that the dentist can demonstrate that this process took place. This is where making good, clearly detailed notes is critical.
In terms of consent the twin considerations are process and documentation.