Importance in Daily Practice
Rebecca S. Wilder, RDH, MS
Informed consent is the legal term describing the process of acquiring patient consent. It is based on the theory that an adult of sound mind has the right to decide when treatment is necessary and advisable.1 Informed consent is also a process by which a dialogue occurs between the oral healthcare professional and the patient. During such dialogue, the professional educates the patient--in layman's terms--about recommended treatment, alternative options, and the benefits, risks, and consequences of each.
Written or Verbal Consent?
There are two appropriate methods of consent, and both can be received in various forms. Implied consent is based on the actions of the patient. It is given when the patient enters the office and sits in the dental chair. Implied consent is limited to examination, diagnosis, and consultation. Subsequently, the oral healthcare provider may not assume anything regarding the patient's consent without further conversation. Expressed consent is an affirmative statement that is communicated either through verbal or written methods.2 Many dental offices use written consent forms for a more complete documentation. The written form is useful in several ways. First, it can initiate and guide the conversation regarding treatment while reducing the chance that important information will be omitted. Second, the patient can take a copy of the form home to review prior to signing. This will ensure that the patient has ample time to think of possible questions. Last, when signed and dated by the patient or his or her representative, it can provide evidence that the patient was informed of the diagnosis, treatments, benefits, risks, and consequences of the treatment procedure.3 Samples of consent forms may be obtained from the American Dental Association as well as many dental practice management organizations.
The forms can be amended by the practice to meet specific state law requirements.4 Informed consent documentation is essential to record keeping as well as risk management strategies. Documentation may take various forms--from a note on the record with or without the patient's signature, to a signed form with attending witnesses. If a lawsuit is filed, documentation such as a consent form as well as progress notes will likely help the defense. Regardless of the method, clear concise records showing that a patient was given not only the opportunity to participate in the treatment decision, but that the patient understands the discussion is vital. In addition, once consent is obtained, the practitioner should not go beyond what the consent has authorized unless additional consent is obtained.
The Importance of Communication to Informed Consent
Communication is extremely important when obtaining consent from a patient. The professional should use simple terms that can be easily understood. For example, most patients may better understand the use of the word "gums" rather than "gingiva." It is also important not to guarantee treatment results. Statements such as "I guarantee this procedure will make your gums heal" or "All of my patients have had success with this treatment" will lead the patient to believe that a positive outcome is assured. A more realistic choice of statements might be "This procedure may help your gums heal" or "Many of my patients have had successful outcomes with this treatment." Some dental procedures carry risks such as gingival bleeding, hypersensitivity, and irreversible gingival recession.” These risks should be fully disclosed so a patient can provide consent to the treatment recommendations.5 When obtaining consent, patient questions should be welcomed and answered completely. If a patient needs additional information, it should be provided without delay. The requirement of informed consent is that the patient be provided with information about:
- Recommended treatment.
- Explanation of procedure.
- Benefits and risks.
- Alternative treatments.
- Consequences of inadequate treatment.
It may be beneficial to provide the patient with educational materials including pamphlets, written handouts, and preprocedural and postprocedural instructions. These materials will help familiarize the patient with the procedures and therefore comfort him or her when proceeding with recommended treatment. Any discussion regarding misconceptions and expectations about the outcome of the procedure would be appropriate at this time.
The oral healthcare professional has an ethical and legal obligation to inform patients about their conditions and treatment possibilities. All professionals should review their informed consent procedures to ensure they are providing patients with all relevant information and thus protecting themselves against legal liability.
Note: Information provided herein should not be interpreted as legal advice. Since each state is different, practitioners are advised to seek personal legal representation in their legal jurisdiction.
*Associate Professor and Director, Master of Science Degree Program in Dental Hygiene Education, University of North Carolina School of Dentistry, Chapel Hill, NC.
- Fiesta J. The Law and Liability: A Guide for Nurses. 2nd ed. Albany, NY: Delmar Publishing; 1988.
- Davison JA, Davidson JA. Legal and Ethical Considerations for Dental Hygienists and Assistants. St. Louis, MO: Mosby; 2000.
- Available at: http://www.ada.org/liability/articles/informed/icvsct.html. Accessed December 1, 1998.
- DeVore CH. Legal risk management for the dental hygienist. J Prac Hyg 1997;6(4):59-61.
- Zarkowski P. Legal issues in the practice of dental hygiene. Seminars in Dental Hygiene 1990:2:1-7.