GUIDELINES TRADITIONAL CHINESE INFORMED CONSENT

GUIDELINES FOR TRADITIONAL CHINESE
INFORMED CONSENT
TDIC designed these forms to facilitate your “Informed Consent” discussions with your Traditional Chinesespeaking
patients. While the forms are excellent educational tools and assist patients with making an informed
decision, if you do not speak and understand Traditional Chinese a person who can translate the patients’ questions
and the dentist’s answers is required to fulfill the informed consent duty
History of informed consent
The modern doctrine of informed consent is based on the assumption that the patient must bear the expense,
pain and suffering of any injury resulting from medical treatment and, therefore, has the right to know all
material facts about the proposed treatment.
The American doctrine of informed consent grew out of the concept of battery, which is defined as unpermitted
physical contact. Early in this century several court cases established the duty of health care providers to obtain
the patient’s consent prior to treatment. Consent became informed consent in the 1950s and ’60s when several
courts specified the types of information that health care practitioners must disclose to patients in the course of
obtaining informed consent.
In Illinois, as in most states, the dentist has an affirmative duty to disclose the risks, benefits and alternatives of
treatment. A failure to obtain informed consent is professional negligence, whereas failure to obtain consent is a
question of battery.
A definitive statement as to how much a doctor should disclose to his patients is found in Miceikis v Field
(1976), 37 Ill.App.3d 763, 768, 347 N.E.2d 320, 324:
A doctor has a special relationship with his patient. [Citation.] This relationship not only vests the doctor with the
responsibility of disclosure, but also requires the doctor to exercise discretion in prudently disclosing information in
accordance with his patient’s best interests. To disclose more than that which is material would run counter to the
responsibility assumed through the doctor-patient relationship.
455 North Eastern Reporter, 2d Series
The duty to disclose
Although informed consent specifically involves the education of the patient, it also represents the culmination
of the process of developing a diagnosis and treatment plan. Only by having a solid diagnosis and realistic plan
for treatment can the dentist reliably inform the patient about the nature of the proposed treatment, the benefits
and alternatives, risks and potential consequences of not performing treatment. The process of informing the
patient can be seen as a model for the dentist-patient relationship, one in which the dentist shares his or her
knowledge, findings and recommendations as part of a cooperative effort to help the patient achieve a healthy
oral condition.
The dentist should assist the patient in making an informed decision about proceeding with the proposed
treatment or procedure by explaining:
• if the dentist is HIV+, this must be disclosed [IL Sexually Transmissible Disease Act]
• the nature of the proposed treatment or procedure, including the cost and expected time for
recuperation or healing.
• the benefits of the proposed treatment or procedure.
• the most common and severe risks associated with the proposed treatment or procedure, including the
effect of the individual patient’s specific condition or needs as well as the possible need for further
treatment, including the possibility of death if applicable, i.e., reaction to anesthesia.
• any reasonable alternatives to the proposed treatment or procedure, including the benefits and risks of
each, and the risks and consequences of doing nothing.
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Informed refusal
If the patient refuses the proposed treatment or procedure, the dentist must inform the patient about the likely
consequences and obtain the patient’s informed refusal.
Merely obtaining a patient’s informed refusal does not relieve the dentist from practicing within the standard of
care. Even if the dentist fully discloses the potential consequences of refusal and the discussion has been
documented properly, a patient may not consent to substandard care nor may the dentist ethically or legally
agree to provide it. Particularly in the case of refused x-rays, the patient’s decision may effectively prevent the
dentist from providing further treatment. This fact should be addressed during the informed refusal discussion.
Exceptions to disclosure
The 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. For
example, the risk of death by anaphylactic reaction following an injection is a remote risk of treatment.
• the risk is minor and seldom results in serious side effects. For example, gingival discomfort while
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 rationally weigh 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 need to
respond immediately to an unanticipated condition or a life-threatening emergency makes it impossible to
obtain the patient's informed consent. However, since dental emergencies, unlike medical emergencies, are
rarely life-threatening, the dentist should make every reasonable effort to obtain the patient's informed
consent or refusal.
The informed consent discussion
The dentist should obtain the patient’s informed consent through a face-to-face discussion that allows the
patient sufficient time to make an informed decision. If the dentist does not speak the same language as the
patient, in this case Traditional Chinese, a person who can translate the patient’s questions and the dentist’s
answers is needed in addition to the written information translated into the patient’s language.
Ideally, the informed consent discussion should take place at least several days before treatment, such as when
the dentist presents the treatment plan (this is particularly important for extensive, complex or risky treatment).
Since the dentist should disclose information in a manner the patient can understand, the discussion should
involve lay terminology, not scientific jargon. For the same reason, consider providing translated informed
consent materials and, if necessary, an interpreter for non-English-speaking patients who may require it. The
dentist must decide what to tell the patient about a procedure based on whether the patient has undergone the
same or similar procedure previously. The use of educational materials is recommended.
Because the dentist bears the ultimate legal and ethical responsibility for informing the patient, the informed
consent discussion cannot be delegated to staff. Although staff can assist by presenting the patient with printed
or audiovisual materials, the dentist should personally solicit and address the patient’s questions and concerns.
Informed consent for minor patients
For 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 is the custodial parent.
Where separated parents share custody, the patient’s record should contain letters from each providing consent
and authorization to treat. Asking for a parent’s or custodial parent’s blanket consent for emergency treatment in
advance of an emergency is one useful way to avoid confusion and delays should the patient require emergency
care when a parent or legal guardian is not present.
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Documenting informed consent
The patient’s treatment record should reflect: 1) that the patient read the form in Traditional Chinese and
had all questions answered in Traditional Chinese, 2) who translated the questions and answers during the
discussion, and 3) whether the patient consented or refused treatment as proposed.
Nothing in Illinois law specifies a means for documenting the informed consent discussion. At minimum, the
patient record should document the fact that the patient received information about risks, 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 consent form is
recommended for facilitating and documenting the discussion.
Content of informed consent forms
Forms for many procedures are available through professional liability insurers, commercial vendors and dental
specialty organizations. Many dentists customize purchased forms or develop their own forms. In either case,
adequate forms should address the nature of the proposed treatment, benefits and alternatives, risks and the
potential consequences of not performing treatment, as well as enable the dentist to include information specific
to the case at hand. The form should be signed by the patient, the dentist and a witness. The patient should
receive a copy of the form and the original should be kept in the patient’s chart.
Summary
• Obtaining informed consent involves providing the patient with information about the nature of the
proposed treatment, the benefits and alternatives of the proposed treatment, the risks of treatment, as well as
any other information specific to the patient’s unique condition. Patients who 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 the dentist and
patient, thus a translator is needed if the dentist and the patient do not speak the same language. The
discussion should be conducted with sufficient time to address all of the patient’s questions and concerns.
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 law does not
specify the means by which this is done. It should indicate: 1) that the patient read the informed consent
form in Traditional Chinese and had all questions answered in Traditional Chinese, 2) who translated the
questions and answers during the discussion, and 3) whether the patient consented or refused treatment as
proposed.
• The informed consent discussion, even if properly conducted and documented, does not absolutely 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 from pursuing a complaint. In all cases, thorough
documentation greatly increases the dentist’s chance of successfully defending against such allegations.
For more information
For more information about informed consent call 800.733.0634 or fax your request to 916.498-6175.
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Traditional Chinese - IL