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How many of our patients can really give consent? – a perspective on the relevance of the mental capacity act to dentistry Alexander C L Holden Neil L Holden Dental Update 2024 41:1, 707-709.
Authors
Alexander C LHolden
BDS, HPD, ACIArb, MJDF RCS(Eng)
General Dental Practitioner, Rotherham and Barnsley
The different ways that clinicians perceive adult patients with dental phobia is varied and diverse. From treating the dental phobia as a separate illness to dismissing it as a neurosis, sometimes little consequence is attached to its existence. True dental phobia is classed as a psychological illness and therefore comes under the remit and guidance of the Mental Capacity Act 2005. Failure to assess the impact of dental phobia upon an individual's capacity to consent could lead to allegations of negligence or even assault.
Clinical Relevance: This paper highlights the importance of considering the capacity to consent of some of the most vulnerable dental patients and how we can better protect both their rights in the law and their dignity.
Article
The law on consent in the UK states that three factors must be met for consent to be valid. Consent must be informed, voluntary and the individual to whom the consent relates must be competent to consent for themselves (ie retain capacity). Informed consent is a tautology as, in reality, all valid consent is informed, or at least the opportunity must be given to the patient to make informed choices. By voluntary, it is meant that the consent is given without manipulation or coercion and the patient's dignity through autonomy is respected. As well as giving consent, patients have the right to refuse treatment if they have the capacity to do so.
In dentistry, there has been a shift from paternalism, whereby consent was assumed and the dentist carried out what treatment he or she felt was appropriate, and in the patient's best interests. In 1974, Beauchamp and Childress1 outlined their four principles in bioethics: autonomy, beneficence, non-maleficence and justice. The addition of autonomy at this juncture was a new concept that had gradually developed as a result of the Nuremburg trials in the wake of World War II, and subsequent ethical abuses, such as the Tuskegee syphilis experiment.2 Now autonomy is very much regarded as the most important of the four bioethical principles by many ethicists, and to have a paternalistic attitude to patients is p>unacceptable, with the potential to land a health professional with accusations of serious professional misconduct.
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