Consent - what is it?

In the medical context and as the law on consent to medical treatment has evolved, it has become a basic accepted principle that “every human being of adult years and of sound mind has the right to determine what shall be done with his or her own body.”^[1] Denturists may do nothing to or for a patient or client without valid consent. For a consent to be deemed valid, the consent must be voluntary, the patient must have had the capacity or authority to consent; and the patient must have been properly informed of what they are consenting to. As such, it is important that denturists be aware of their legal obligations in obtaining consent.

In obtaining consent for a treatment, it is essential to remember that patients have the right to consider and control the decisions made regarding their health and healthcare, except as specified by law. Consent does not merely consist of providing the patient with a document to read and sign. Consent requires that you discuss the proposed treatment plan with the patient so that they may make an informed decision.

The level of consent required for treatment, and that is required to disclose information, must be delineated. Whereas consent to treatment may be implied, consent to disclose information must be written. Informed Consent may be either implied or expressed.

Informed Consent

Informed Consent occurs when a patient has been specifically informed of all aspects of a treatment that a reasonable person in the same circumstance would want or need to know – including the estimated costs – and they have voluntarily agreed to proceed with the treatment (either by implied or expressed consent).

For a patient to be able to provide Informed Consent, the details of the treatment plan must be explained to the patient in language that the patient can understand.

Content that should be explained includes, but is not limited to:

• The diagnosis
• All viable treatment options – including no treatment
• Initial prognosis and indication of the expected outcome/success of all treatment options
• Recommended treatment and the justification for the recommended treatment
• Materials to be used
• Risks or possible complications associated with each treatment option
• Fees related to the recommended treatment, and where applicable, the anticipated estimated portion covered by third party insurance
• Financial terms and agreements
• Recommended referrals to other practitioners

Implied Consent

Implied Consent is granted through the patient’s actions or words.

For example, when a patient voluntarily attends for treatment, understands and is fully aware of what is being done or will be done, allows themselves to be treated, and does not object to or refuse treatment.

Expressed Consent

Expressed Consent is clear and unequivocal consent for treatment, whether verbal or written, provided to you by the patient or patient representative. It is preferred that this type of consent be written.

For example, a patient stating, “You can fit me with new top and bottom dentures” or providing a written and signed consent to a specific treatment plan.

It is prudent to have written expressed consent in cases such as, but not limited to, the following:

• Complex/lengthy treatment plans
• Major services such as those involving surgery
• Treatments with known risks
• Cases that involve referral of the patient to other practitioners
• Cases in which the patient is referred to you by another practitioner
• Cases where the patient refuses recommended treatment(s)
• Cases in which the patient has unrealistic expectations of treatment outcomes

Third party consent

There are situations in which a patient cannot or does not have the legal capacity to provide informed consent for their treatment.

Dependent Adults
An adult patient (18 years of age or older) may not be legally able to make decisions on their own behalf and may be under the care of a legal guardian.

The Adult Guardianship & Trusteeship Act (AGTA) became law in Alberta in 2009. AGTA provides decision-making options for healthcare providers, patients, and their families to use to ensure that consent for healthcare services is obtained from the appropriate decisionmaker(s).

 If a dependent adult attends your clinic with an individual who identifies themself as the legal guardian of that patient, but who lacks documentation to confirm the guardianship, you must take additional steps to determine guardianship status prior to providing any treatment. Written consent to treatment must be obtained from a guardian prior to providing any service to a dependent adult patient.

For additional information, AGTA may be found here.

Minors
Usually minor aged patients (less than 18 years of age) attend a denturist clinic with a parent or guardian.

If the denturist is unsure if the accompanying adult is a legal guardian of the minor, the denturist must take additional steps to determine guardianship prior to providing any treatment. Written consent to treatment must be obtained from a guardian prior to providing any service to a minor.

 The Family Law Act became law in Alberta in 2003. This Act has rules for determining who the legal guardian of a minor aged individual is.

[1] https://www.cmpa-acpm.ca/en/advice-publications/handbooks/consent-a-guide-for-canadian-physicians#intro