Consent

1. Consent 4th September By : Lydia McGowan

2. GDC Standards for the Dental Team 2. Communicate effectively with patients 3. Obtain valid consent

3. FGDP Guidelines : Clinical examination and record keeping The Basic requirements for obtaining valid consent are : • The patient must be given sufficient information from which to form a balanced judgement. This means that the patient must be given reasonable and appropriate treatment options, along with their risks and benefit. This includes the option of having no treatment • The patient must have sufficient mental capacity to understand whether he or she is consenting • The consent must be freely given, and can be withdrawn at any time

4. Autonomy ‘’the right of competent adults to make informed decisions about their own medical care’’ • Choice The right of the patient to make a clear choice The ‘right’ choice for each person is totally individual, depending on their personal values, 2. Free will Decisions should be made fairly, voluntarily and without coercion

5. Who can give consent? • An adult of over 16 years with capacity • A person under 16 who is deemed to be ‘Gillick competent’ • What about for children? • All mothers have automatic parental responsibility • The father, if his name is on the birth certificate.. BUT • For children born BEFORE 1st Dec 2013 (Eng&Wales) and 4th May 2006 (Scot) the father would only have consent if he was married to the mother at the time of conception, birth or sometime after. Or if the unmarried father has a parental responsibility agreement registered with the High Court.

6. Assessing capacity In order to have capacity, the patient must be able to • Understand the information given • Make a decision • Communicate a decision • Retain information in order to make a decision If a person lacks capacity, they may have a ‘Lasting Power of Attorney’ (welfare guardian) who can also make decisions regarding the individual’s personal welfare where necessary

7. Incompetent Adults England, Wales and NI : The Mental Capacity Act 2005 • A presumption of capacity • Every adult has the right to make his or her own decisions unless proven otherwise. A patient may have capacity to consent for some things and not others • Individuals being supported to make their own decisions • Unwise decisions • People have the right to make decisions that other people may think are unwise • Best Interests • A decision made on behalf of someone who lacks capacity must be in their best wishes • Less restrictive option • Anything done for or on behalf of a person who lacks capacity should be the least restrictive of their basic rights and freedom

8. What information should be given to a patient in order to consent? • Nature of the procedure • Why it is necessary • Risk vs benefit of the proposed treatment • Risks of not having the treatment • Alternative options (and risk vs benefit of these) • The likely outcomes of treatment - is the treatment gauranteed, and for how long? • Cost (if any) • Printed treatment plan detailing all treatment, whether its NHS/private and any costs incurred

9. Verbal consent vs Written consent • Verbal consent is sufficient for most dental treatment provided it is informed consent • Written consent is necessary for sedation and general anaesthesia, and recommended for more advanced treatment such as implants • A treatment plan and estimate in hard copy should be given to all patients • Consent forms should be tailored to the specific patient and not generic as these are insufficient • It is important to note, a signature does not automatically imply consent, the conversation surrounding the consent is of the most importance • Discussions must be recorded in the notes

10. How is consent documented? GDC Standards 4.1 ‘You must make and keep contemporaneous, complete and accurate patient records’ • The record should set out : • How the decision about the patient’s best interest was reached • What the reasons for reaching the decision were • Who was consulted to help work out best interests • What particular factors were taken into account

11. Bolam Test vs Materiality • The Bolam Judgement • Very much weighted on the views and opinions of the medical professional ~ What would a reasonable practitioner have done in their shoes? If no different, the practitioner is not negligent • No longer acceptable within the court of law • The Montgomery Case (UK, 2015) • Material risk must be tailored to the specific patient • ‘A reasonable person in that patients position would • be likely to attach significance to the risk’

12. What is a material risk? • ‘A risk is material if in the circumstances of a particular case, a reasonable person in that patient’s position - if warned of the risk - would be likely to attach significance to it - or where the medical practitioner is (or should reasonably be) aware that the particular patient is (or should reasonably be) aware that the particular patient - if warned of the risk - would be likely to attach significance to it.’  • The GDC standards encourages us to get to know our patients and find out what matters to them. We must find out what information they want to know and also discuss anything we think may impact their decision

13. References • GDC Standards for the Dental Team : Principle 2 and 3 • Faculty of general Dental Practice (UK)- Clinical Examination and Record-Keeping Good Practice Guidelines • Dental Protection : Dental advice booklet on Consent (excluding Scotland) • The Mental Capacity Act 2005 Thank you for Listening!