Informed consent is based on the patient exercising autonomy in decision making and has both ethical and legal implications in medicine and dentistry. Informed consent has two parts.
First, it requires that the professional provide the patient with all relevant information needed to make a decision. Second, it allows the patient to make the decision on the basis of the information provided. Informed consent is a process of providing appropriate information to the patient, the process of understanding and assimilating the information, and making the decision.9
Dentists and hygienists must recognize the patient has a right to informed consent as well as a right to make an informed refusal. Respecting the autonomy of individuals as self-determining agents recognizes their right to make their own choices and determine their own destiny. This includes the right for a patient to assess all the information provided by the professional yet still make a choice that is not the one most valued by the professional — informed refusal. Although not as dramatic as life and death decisions made by clinicians in medicine, dental decisions may involve choices that are potentially harmful to the patient.
When patients give their authorization for a procedure or a comprehensive treatment plan, they grant the health care provider informed consent for that treatment. First, the clinician must obtain and document information and disclosure; secondly is the process of interaction and communication, which produces a truly informed decision. Not all individuals have the ability to make informed decisions about their dental health. Children and adults who are mentally disabled typically have a parent or caregiver who assumes that function. Depending on the age and capacity of the child, certain choices can and should be discussed with the younger patient, but actual decisions regarding what types of services are rendered must remain the purview of the legal guardian. Informed consent when the patient does not understand because of a language barrier is not possible, and steps must be taken to remedy the situation. The use of a translator, family member if a translator is not available, or other communication option must be pursued to ensure the patient fully understands the choices and consequences. To do any less is unethical and illegal. The only exception to this would be if the patient’s life was in danger and an immediate procedure was required to save that life.
An issue related to autonomy and informed consent is the determination of decision-making capacity. Capacity is a clinical term used to describe a person’s ability to understand their health care conditions, treatment options and ability to make their own decisions. For an individual to make informed consent, capacity or competence is a prerequisite. This is a growing concern with an aging population as older adults can exhibit a wide range of cognitive function.