Every person has rights when it comes to their medical and dental treatment. In order to receive treatments and care, patients must provide consent to the providers. This is a fundamental part of the medical system. However, it may not always be well-understood. What is consent and who can provide it?
What is Consent?
The basic meaning of the word is that a person allows something to happen or agrees to do something. In terms of medical care, the definition can be expanded in a few key ways.
- Understanding – the patient or person providing consent has to be able to understand the treatment and also the advice to have that treatment performed
- Provision of information- the treatment has to be completely explained including the risks and benefits
- Appropriately provided – the consent may need to be provided in writing or verbally, depending on the circumstances of the situation. More complex and serious situations generally require a written consent
- Legal capacity – the person providing consent must have legal capacity in order to provide consent. This means that children or anyone with a condition affecting their ability to understand the information cannot provide consent. Instead, a legal guardian, a person with power of attorney, and advanced care directives may be used to provide consent.
- Agreement of expenses – if the person receiving treatment is not providing consent or payment for that treatment, then care should be taken to ensure that the person providing payment does understand and agree to pay the treatment expenses.
Ability to Provide Consent
This is an area that can be more challenging to understand. While the person receiving treatments ideally will provide consent, this is not always appropriate. A person who has a mental illness, dementia, or another disability may not be appropriate based on the above criteria.
When this is noted, the medical professional will not provide the treatment until they do receive consent from the appropriate person or party. This does not mean that every person who has a cognitive deficit cannot provide consent. Some procedures may be understood.
It is the job of the person providing treatments to gauge whether the person receiving them can provide consent. For some individuals, this ability may be documented already. For example, some individuals with medical illnesses have been deemed to not have the legal capacity and this will be documented.
When the medical professional is not completely sure whether the person can provide treatment, additional steps should be taken. The dentist could seek assistance from the patient’s authorized substitute decision-maker for assistance with providing consent. If the patient does not have this in place, then a court may need to provide that information.
Every area of the country has legal guidelines in place to allow for consent to be obtained from a legal body when a person cannot provide this for themselves.
When it comes to seeking consent for minors, they can be explained the treatment but cannot provide consent. This must be provided by a legal guardian or a legally authorized substitute.
Implied Versus Documented Consent
For dental practices, consent for an examination is implied. This is not required to discuss or document unless the patient has questions or concerns. Any further work must be explained in addition to the risk factors, materials being used, and the treatment itself. Before starting the treatment, they will need to provide consent. For most of the time, consent can be provided verbally with dental procedures. For complex procedures, information sheets are recommended.
When it comes to more complex procedures such as surgery, a verbal consult will likely not be adequate. In these scenarios, written consent is almost always obtained. For example, consent, where anesthesia is used, will typically require written consent.
Consent by Others
If the patient is not the one providing the consent, then the dentist can explain and obtain consent from the designated individual. This does not mean that the patient cannot be present and it may be a good idea to have both parties present, even if the patient cannot provide consent themselves.
It is highly recommended that the guardians of patients attend consultation examinations to understand the complete treatment plan. While this is not required, it improves the understanding of treatments and reduces room for error or misunderstanding.
Cognitive Status for Consent
The person who provides the consent must be in an unaltered state in order to provide this consent. If a dentist notices any signs of drugs or alcohol use that could impair judgement, it will be impossible to obtain consent from that individual. While this may not be common for all, some people have severe anxiety when it comes to dental offices. They may take medications or use alcohol as a coping mechanism. Although this may help with anxiety, it could also affect a person’s ability to understand and make an informed decision regarding their medical treatment.
If there are any concerns that are preventing appearing at a dentist’s office in-person to provide consent, there may be other options available. Make sure to discuss this with the dental staff prior to an appointment.