Practicalities of Consent Flashcards
What is definition of autonomy?
Every human being of adult years and sound mind has legal right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient’s consent commits an assault, for which he is liable in damages
Name 3 types of consent
- Implied
- Express - Verbal / Written
- Limited
What is implied consent?
- Patient coming into surgery and sitting in the chair with their mouth open
- Wise to have conversation and gain verbal consent also
Name 2 situations where verbal consent is not adequate
- Sedation
2. GA involvement
What is limiting consent?
Consent which specifically limits what the dentist can do e.g examination but not treatment
What is limiting consent?
Consent which specifically limits what the dentist can do e.g examination but not treatment
Name 4 groups of patients who have the authority to consent
- Competent adults of 18+ years old
- Competent young adults of 16 and 16 years old
- “Gillick Competent” minors
- Adults who have parental responsibility
Why are young adults separated from adults in terms of giving consent?
Responsible adults retain the right to overrule competent young adults in life saving or major treatment but not over competent adults of 18+ years
What are 3 principles of valid consent?
- Capacity
- Informed
- Voluntary - No Undue Influence
Name 3 components of capacity
- Understand, retain and weight the information provided
- Make a decision
- Communicate that decision
Describe 2 features of capacity
- Assumed unless proven otherwise, and up to clinician to determine
- May fluctuate e.g intoxication
Describe the information which should be provided to the patient during the consent process
- Options of treatment, and risks and benefits
- Clinician’s opinion on necessary and appropriate treatment
- Consequences, risks and benefits of proposed treatment
- Likely prognosis
- Cost of treatment
- What may happen if treatment is not carried out
- Whether treatment is guaranteed and how long for
What is material risk, according to Montgomery v Lanarkshire Health Board 2015?
A reasonable person in the patient’s position is likely to attach significance to risk, or the clinician is or should be reasonably aware the particular patient would be likely to attach significance to it
What 3 types of risks should be discussed with a patient?
- Significant risks in professional view
- Risks that a reasonable person would attach significance to
- Material risks
What is shared decision making?
Collaborative process whereby the patient is supported by health professional to reach decision about their care which is right for them
Name 3 things which SDM considers?
- Evidence-based research
- Patient autonomy
- Patient values
Describe the practicalities of SDM
- Earns patients trusts
- Detailed discussion with all alternatives, pros and cons of treatments
- Double checking patient understands information
- Make reasonable efforts to address various communication needs
- Reasonable amount of time
- Valid consent as an ongoing process
- Documenting discussions
Describe 4 components of autonomy
- Consent needs to be ongoing and revisited and can be withdrawn at any time
- When competent patient refuses treatment, unlawful to administer treatment
- Best interests are not just dental interests
- Patients cannot force clinicians to carry out treatment the clinician does not believe is in their best interest
What is a potential issue with consent being withdrawn at any time?
Problematic if the patient is mid treatment - Safety issues may override the consent issues
Describe 4 stages of consultation pre-examination
- Establish why patient is attending
- Expectations of their appointment / treatment
- Always explain what will happen next
- Gain consent to examine patient
Describe a consultation following gaining permission to carry out an examination
- Discuss findings with supervisor and establish diagnosis
- Explain diagnosis to patient and provide all necessary information
- Establish patients wishes, expectations and answer questions
- SDM to formulate treatment plan
- Valid consent before commencing treatment
Describe what the BDA say about consent
The aim of an effective consent process is not to overwhelm the patient with so much information that they are left unable to process it all
