Obtaining a valid informed consent requires the patient understand his or her health condition, the treatment options, the risks and benefits of the treatment options (including cost and prognosis), and the consequences of deferring treatment. When a patient diagnosed with AD progresses to late stage disease, their decision-making capacity is diminished. This can make it problematic for the patient to provide valid informed consent if they are still consenting for their own care. When given the opportunity, dental providers should discuss informed consent alternatives with the patient prior to the patient reaching this stage. Unfortunately, this is not always an option. If a patient is unable to provide valid informed consent, and a surrogate has not been identified, routine treatment procedures should not be initiated. However, in emergency situations, such as being in acute pain, dental providers may legally act in the best interest of the patient without having informed consent.98 The rules regarding emergency care may vary from state to state. The dental provider should reach out to the patient’s family and physician to see if a decision making surrogate has been appointed. Patients who are unable to make their own medical decisions will need a decision making surrogate or an individual with a medical power of attorney to make decisions and provide informed consent on their behalf.74,89 This individual should be present at planning and treatment appointments, and a copy of pertinent legal documents should be placed in the patient’s chart. Dental providers should still attempt to include the patient in the decision process and respect patient autonomy.
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