Informed Consent/Refusal

Informed consent is the basis for every treatment you propose to and perform on patients. Dentists must obtain informed consent from each patient or from the patient’s legal guardian or decision-maker. State laws impact whether consent can be verbal or written. For common simple procedures such as an evaluation or prophylaxis for a healthy individual, the act of sitting in the dental chair may be interpreted as implied or waived consent. This too, may vary by state law.

The concept of informed consent is actually based on the “assault and battery” doctrine of old common law which would not allow one individual to lay hands on another person without permission. Keep in mind that informed consent is a process, not just a signature on a form. Many dentists find informed consent and documenting refusal of treatment a complex subject and benefit from continuing education dedicated to the subject. Ask your liability carrier if it offers courses on informed consent.

• Make sure that the informed consent process is carried out for every patient by having an office policy in place that is referenced and followed in every case.
  • You can develop an informed consent form based on existing customized templates or you can create your own. Practices that develop their own informed consent form should consider having the document reviewed by an attorney licensed in your state. Your liability company may also have suggestions on what to include in your informed consent process and form. 
  • Having a patient sign a consent form does not satisfy your legal duty to discuss proposed treatment with the patient. Failure to have that conversation is a breach of your moral responsibility to the patient and, in the event of a malpractice lawsuit, could even raise questions about whether you actually received informed consent.
• At some point in their career, all dentists have a patient who refuses to consent to treatment. It is the patient’s right to refuse consent. When that happens, carefully document the refusal and inform the patient of the potential health issues involved because treatment was refused. Document the discussion, the reasons for the refusal and the patient’s understanding of those issues in the chart or in an informed refusal form. If the patient will not sign an informed refusal form, it would be prudent to document your conversation in the patient record (e.g., patient verbalizes understanding of the treatment needs but has chosen to decline treatment until more dental benefits are available).
  
  
• If a patient refuses treatment, you must decide whether or not to keep them in your practice. There is no right or wrong decision and each decision carries its own risks. 
  • Even though the patient may have a dismissive attitude toward what you believe is an important issue, you have the moral and ethical responsibility to inform the patient of the best treatment possible and to make sure that the patient understands the potential risks of not proceeding with recommended treatment. This can minimize your liability and you’ll sleep better at night knowing you did the right thing.
  • If you choose to continue to treat the patient, you are committing to evaluating and treating the patient for as long as the doctor-patient relationships exists. This means that you should continually inform the patient of the recommended treatment, even though it was previously declined, and to advise the patient of how the refused treatment can impact their oral health.
  • Informed refusal may indicate that you and the patient have different values and expectations. Consider whether it would be best if that patient is dismissed from the practice and referred to another dentist. Example: the patient who refuses a radiograph you believe essential to proper diagnosis and treatment. Information on dismissing a patient from the practice may be found in the “Patient Relations” section of this module.

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