10 • Consent
LOOK AT CONSENT
A recent legal ruling has clarified the information that clinicians should share to ensure informed patient consent. MDDUS dental adviser Claire Renton looks at what this means for dentists
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S dentists, we are all aware of our professional duty to provide patients with enough information to allow them to make informed decisions about their dental treatment. It is a topic that generates many advice calls to MDDUS and plays a key role in many of the cases we deal with. There is also extensive advice and guidance available in this area
from the likes of the General Dental Council and other organisations. But a recent, high-profile legal judgement issued by the Supreme
Court has clarified the way in which informed consent should be viewed, including the nature of the information that must be given to patients. It also confirms that the position in Scotland should be regarded as the same as the rest of the UK. The case of Montgomery v Lanarkshire Health Board has crystallised
the law in relation to consent and attracted more than a few headlines, not least because of the £5.25 million award. And while this particular case relates to medical care, its implications do extend to dentistry. In essence, Mrs Montgomery experienced complications during the
birth of her son. The baby’s head failed to descend properly due to a shoulder dystocia – a rare complication where the baby’s shoulder lodges behind the mother’s pubic bone and essentially becomes stuck. In this unfortunate case, there was a 12-minute delay between the baby’s head appearing and delivery, during which time the cord was completely or partially occluded. Sadly the baby suffered significant cerebral palsy. Mrs Montgomery alleged negligence saying that before the birth she
should have been warned about the possibility of shoulder dystocia, as she was only just over five feet tall and diabetic. She also claimed that abnormalities on the tracing of the baby’s heart during delivery should have prompted a Caesarean section. Initially Mrs Montgomery lost her case at trial and later on appeal, but she went to the Supreme Court and won.
Explaining dental risk So what has all this got to do with dentistry? I agree it’s unlikely that we will ever have to advise a patient on such a condition and I admit I had to
consult with my favourite clinician, Dr Google, to find out exactly what a shoulder dystocia was. But there are significant lessons to be learned here and from now on, this case changes the type of information we are required to give to a dental patient during the consenting process. In the past, we simply assessed how likely a complication was before deciding whether or not to inform the patient of this risk. For example, the risk of fracturing the mandible during the extraction of a mobile, periodontally-involved tooth in a young, healthy, six foot rugby player is so small that it’s unlikely that we would inform him of this possibility before the extraction. In contrast, in cases where this complication is more likely to occur then we were obliged to inform the patient of the risk. For example, the chance of a fractured mandible is increased to the level where it would be necessary to issue a warning if the tooth is lone standing, firm and the patient is a tiny 80 year old with osteoporosis. So our decisions on whether to inform the patient or not were based mainly on risk. If the complication was likely to occur, then we warned the patient. If the risk was low, we kept quiet. Yes, I know if the risk was small but the consequences were severe such as anaesthesia or paraesthesia following wisdom tooth removal then we are also obliged
A FRESH
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