The legal status of informed consent for behavior management techniques in pediatric dentistry

Resident’s Name: Joanne Lewis Date: September 19, 2008
Article title: The legal status of informed consent for behavior management techniques in pediatric dentistry
Author(s): Patricia P. Hagan, DDS, MS, et al
Journal: Pediatric Dentistry
Volume (number): Vol. 6 No. 4
Month, Year: December 1984
Major topic: the legal obligation of informed consent with regard to the use of certain behavior management techniques
Minor topic(s): the history and background of informed consent within the medical and legal professions
Type of Article: Educational
Main Purpose: to examine the legal status of informed consent as it applies to behavior management techniques in pediatric dentistry
Overview of method of research: Reviewed findings from court cases and research articles.
Findings: There is a national trend of expansion and defense of patient’s rights. The idea of informed consent gained attention with a case in California in 1957, and it is now widely accepted that consent is only valid if it is informed. Informed consent encompasses both express consent (consent for a specific procedure) and implied consent (consent that is inferred by the patient’s actions). Pediatric dentists may run into problems if they feel that parents gave implicit consent for behavior management when they gave express consent for dental treatment. Historically, most states have adhered to the “professional community” standard for a guideline as to what information the health professional was required to provide – that is, the doctor was required to disclose information which a reasonable practitioner would make under the same or similar circumstances. Recently, an alternative standard, the “reasonable patient” standard, has developed in American courts. Under this standard, a practitioner may be held liable if the patient or parent did not receive all the information that was material to their decision to accept or reject proposed treatment. Research shows that parents rank the use of HOME and restraint devices as unacceptable as sedation and general anesthesia. Therefore, dentists who use HOME or patient restraint should obtain express parental consent for their use, since these procedures would be considered significant to the average patient.
Key points/Summary: There is a national trend towards the “reasonable patient” standard, but it varies state by state. Any dentist will minimize legal problems by obtaining express consent for any procedure that the average patient might find objectionable. Failure to obtain express consent for any material medical fact constitutes a legal wrong to the patient, even if no physical injury occurs. The informed consent doctrine is designed to give patients and parents a more meaningful guarantee of personal choice in health care matters. Ultimately, the best defense for potential disputes is to prevent them from arising, so if you plan to use HOME or physical restraint, get an informed consent.
Assessment of article: A rather dull article, but a good reminder of how to stay out of trouble.