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Exceptions to disclosureThe dentist has no duty to disclose where:• the patient asks not to be advised.• the procedure is simple and any danger is remote and commonly understood to be remote. Forexample, the risk of death by anaphylactic reaction following an injection is a remote risk oftreatment.• the risk is minor and seldom results in serious side effects. For example, gingival discomfortwhile biting down on bitewing x-ray films is a minor risk of treatment.• disclosure would so seriously upset the patient that he or she would be unable to rationallyweigh the risks of refusing the procedure (known as the therapeutic exception).In addition to these exceptions, informed consent is not required in very rare instances where the needto respond immediately to an unanticipated condition or a life-threatening emergency makes itimpossible to obtain the patient’s informed consent. However, since dental emergencies, unlikemedical emergencies, are rarely life-threatening, the dentist should make every reasonable effort toobtain the patient’s informed consent or refusal.The informed consent discussionThe dentist should obtain the patient’s informed consent through a face-to-face discussion thatallows the patient sufficient time to make an informed decision. The discussion should beappropriate to the patient’s level of understanding.Ideally, the informed consent discussion should take place at least several days before treatment, suchas when the dentist presents the treatment plan (this is particularly important for extensive, complexor risky treatment). Since the dentist is legally obligated to disclose information in a manner thepatient can understand, the discussion should involve lay terminology, not scientific jargon. For thesame reason, consider providing translated informed consent materials and, if necessary, aninterpreter for non-English-speaking patients who may require it. The dentist must decide what to tellthe patient about a procedure based on whether the patient has undergone the same or similarprocedure previously. The use of educational materials is recommended.Because the dentist bears the ultimate legal and ethical responsibility for informing the patient, theinformed consent discussion cannot be delegated to staff. Although staff can assist by presenting thepatient with printed or audiovisual materials, the dentist should personally solicit and address thepatient’s questions and concerns.Informed consent for minor patientsFor minor patients, obtain the informed consent of the parent, custodial parent or legal guardian.Where parents live separately, the patient’s personal information form should indicate which parent isthe custodial parent. Where separated parents share custody, the patient’s record should containletters from each providing consent and authorization to treat. Asking for a parent’s or custodialparent’s blanket consent for emergency treatment in advance of an emergency is one useful way toavoid confusion and delays should the patient require emergency care when a parent or legal guardianis not present.Page 2 of 3
Documenting informed consentThe patient’s treatment record should document the informed consent discussion and the patient’sdecision, including informed refusal.Nothing in New Jersey law specifies a means for documenting the informed consent discussion. Atminimum, the patient record should document the fact that the patient received information aboutrisks, benefits and alternatives and consented to or refused the proposed treatment or procedure.Where the proposed treatment or procedure is extensive, invasive or risky, a written informed consentform is recommended for facilitating and documenting the discussion.Content of informed consent formsForms for many procedures are available through professional liability insurers, commercial vendorsand dental specialty organizations. Many dentists customize purchased forms or develop their ownforms. In either case, adequate forms should address the nature of the proposed treatment, benefitsand alternatives, risks and the potential consequences of not performing treatment, as well as enablethe dentist to include information specific to the case at hand. The form should be signed by thepatient, the dentist and a witness. The patient should receive a copy of the form and the originalshould be kept in the patient’s chart.Summary• Obtaining informed consent involves providing the patient with information about the nature ofthe proposed treatment, the benefits and alternatives of the proposed treatment, the risks oftreatment, as well as any other information specific to the patient’s unique condition. Patientswho refuse treatment must be informed of the potential consequences of their decision.• Informed consent is a process, not a form. It involves a face-to-face discussion between thedentist and patient, conducted with sufficient time to address all of the patient’s questions andconcerns. The task of obtaining a patient’s informed consent cannot be delegated to staff.• The informed consent discussion should be documented in the patient record, although the lawdoes not specify the means. Informed consent forms can be useful for helping the patient retaininformation, as well as for guiding and documenting the informed consent discussion.• The informed consent discussion, even if properly conducted and documented, does notabsolutely insulate the dentist from an allegation of negligence or lack of informed consent.However, being able to supply documentation of the discussion often dissuades patients frompursuing a complaint. In all cases, thorough documentation greatly increases the dentist’schance of successfully defending against such allegations.For more informationFor more information about informed consent call 800.733.0634 or fax your request to 916.498.6175.Page 3 of 3Guidelines NJ
Page 1: GUIDELINES FOR INFORMED CONSENTHist

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