A Change in Consent

A good article in the BDJ by Messrs D’Cruz and Kaney from Dental Protection about the change in the law regarding consent following the judgement in Montgomery v Lanarkshire in March 2015.

The link to the full piece is here for BDA members.

I advise any dentist to read it in its entirety but here are some excerpts from the piece:

“…Legally, clinicians, including dentists, must now take reasonable care to ensure that patients are aware of any material risks involved in proposed treatment and of reasonable alternatives. This case now brings the law in relation to the disclosure of risks when obtaining consent to treatment in line with the guidance issued by regulatory bodies, that is, the GMC and GDC…”

“…What the judges in Montgomery said was that the extent of information given to a patient about the risks of a proposed treatment is not to be determined by the clinician or what other clinicians in the same situation would do. Rather the test is what the particular patient sitting in front of the clinician wants to know. Patients must be told of material risks. The test of materiality is whether, in the circumstances of the particular case, a reasonable person in the patient’s position would be likely to attach significance to the risk, or the clinician is or should reasonably be aware that the particular patient would be likely to attach significance to it…”

“…The requirement is that a dentist, in respect of consent, should tell the patient everything they want to know as well as everything the dentist thinks they might need to know…”

“Conclusion
The Montgomery case clarifies that clinicians must recognise a patient’s legal and ethical right to autonomy and informed choice and sweeps away any notion that doctor (or dentist) knows best. Patients must be fully informed about the risks to them that any procedure carries and be permitted to decide whether to proceed at all or whether they wish to pursue alternative options or no treatment at all.
It is for the profession now to determine, clinical area by clinical area, what the risks that ought to be disclosed are and then it is for the individual clinician to decide what emphasis they need to place on those risks to the particular patient they have in their dental chair.
The moral of the story for dentists is that it is prudent to get to know your patients so that you can discuss with them risks that any patient would want to know, plus any risks that you would consider would be relevant to the particular patient concerned. In order to be able to satisfy the latter requirement, patients need to be asked if there is anything of particular relevance to them that they would want to know. The clinician’s advice must be both ‘fact sensitive and sensitive also to the characteristics of the patient.'”

My take:

  • Know yourself.
  • Know your patient.
  • Communicate effectively.

Some things don’t change

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