Some clinicians believe that patients must be provided with every last detail of the evidence base, in order to enable them to assess the information objectively and to compare alternative treatment options. Not only is this another onerous prospect for the clinician, it also fails to recognise two important aspects of the consent process. Continue reading
In an Australian case (Rogers v. Whitaker), the High Court of Australia ruled that a 1 in 14,000 risk of blindness associated with a procedure, should have been disclosed to a patient. In this example, the patient was already almost blind in one eye and the doctor should have warned of the possible risk of blindness to the other eye no matter how slight in these circumstances, regardless of whether the patient had expressly asked the question or not. Continue reading
An individual’s capacity must be assessed specifically in terms of their capacity to make a particular decision at the time it needs to be made.
This means that a person may lack capacity to make a decision about one issue but not about others. Care must be taken not to judge an individual’s capacity merely by reference to their age, appearance or medical condition. Continue reading
Most children eventually reach an age where they can grasp relevant facts about their body and about proposed treatment to it. They can give consent to treatment, but the degree of understanding can vary in relation to the complexity of the treatment envisaged. A few children are never, even when adulthood is reached, capable of properly understanding the information given to them and must therefore be considered incapable of giving consent. Continue reading
In order both to understand the information provided, and to give the necessary authority for consent, a patient must be competent. “Competence†in this context means the patient’s ability to understand the explanations given, about:
We can influence patients consciously or subconsciously by the way in which we communicate with them. For example
Whether the words are written or spoken, a patient’s perception can easily be influenced by the words that we choose to use. Some patients will be particularly reactive or sensitive to the use of certain words (eg. “cutâ€, “drillâ€, “injectâ€, “bleedingâ€, “painful†etc); when you are discussing a procedure face to face you can usually see this reaction, and deal with it there and then. But when you use the same words in a letter, you don’t get this opportunity. Continue reading
A landmark legal case involving a medical practitioner (a surgeon) broke new ground just a few years ago and demonstrated just how far the UK courts would go in order to uphold patient autonomy, even in the face of well-established legal principles:
“I start with the proposition that the law which imposed a duty to warn on a doctor has, at its heart, the right of a patient to make an informed choice as to whether, and if so when and by whom, to be operated on†Continue reading
A patient’s informed consent to investigations or treatment is a fundamental aspect of the proper provision of dental care. Without informed consent to treatment, a dentist is vulnerable to criticism on a number of counts, not least those of assault and/or negligence – which in turn could lead respectively to criminal charges and/or civil claims against the dentist. Furthermore, the question of consent arises increasingly at the heart of complaints made under the NHS Complaints Procedure, and complaints to the General Dental Council on matters on professional ethics and conduct. Continue reading
Children with OI and dentinogenesis imperfecta need the same basic care as discussed in Part 1, but they also need to be monitored for cracking, chipping and abrasion of the teeth. Special care will be needed even with the baby teeth. All of the teeth may not be affected by DI, and primary teeth usually are affected to a greater extent than the permanent teeth. Restorative treatment may be needed at some point. Continue reading