{"id":25402,"date":"2023-11-19T09:05:45","date_gmt":"2023-11-19T15:05:45","guid":{"rendered":"https:\/\/www.aae.org\/specialty\/?p=25402"},"modified":"2023-11-03T13:57:53","modified_gmt":"2023-11-03T18:57:53","slug":"informed-consent-and-the-right-to-refuse","status":"publish","type":"post","link":"https:\/\/www.aae.org\/specialty\/informed-consent-and-the-right-to-refuse\/","title":{"rendered":"Informed Consent and the Right to Refuse"},"content":{"rendered":"<p><em><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-full wp-image-23366\" src=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2023\/02\/Tsatalis200.jpg\" alt=\"\" width=\"200\" height=\"200\" srcset=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2023\/02\/Tsatalis200.jpg 200w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2023\/02\/Tsatalis200-150x150.jpg 150w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2023\/02\/Tsatalis200-83x83.jpg 83w, https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2023\/02\/Tsatalis200-104x104.jpg 104w\" sizes=\"auto, (max-width: 200px) 100vw, 200px\" \/>By Andrea Tsatalis, DDS, MS<\/em><\/p>\n<p><u>Imagine this clinical scenario:<\/u> <em>your patient presents asymptomatic for evaluation of tooth #3.\u00a0 Radiographic imaging displays the presence of an untreated MB2 canal and a large periapical radiolucency.\u00a0 You explain to your patient that endodontic retreatment is indicated due to the aforementioned findings, but they adamantly refuse treatment due to their lack of symptoms.\u00a0 How do you respond?<\/em><\/p>\n<p>As endodontists, one of our many roles as clinicians involves obtaining informed consent from our patients.\u00a0 Informed consent is an ongoing discussion during treatment, not simply a document signed at intake.\u00a0 The informed consent conversation involves explaining risks and benefits of treatment, the alternatives to the procedure, and the risks and benefits of those alternatives.\u00a0 During informed consent discussions, it is crucial to provide realistic expectations of what will likely be achieved by our procedures\u2014a step which can mitigate potential patient misunderstanding and frustration if endodontic treatment does not prove entirely successful.<\/p>\n<p>When approaching situations of both treatment acceptance and treatment refusal, there are three essential elements of patient assessment that we must consider as providers: capacity, informed decision, and voluntary decision.\u00a0 Let\u2019s briefly delve into each:<\/p>\n<p><strong>Capacity<\/strong> describes an individual\u2019s ability to make a decision.\u00a0 Patient capacity is thereby a crucial facet of patient autonomy and should be assumed until proven otherwise.\u00a0 Situations do arise when a patient\u2019s cognitive intactness must be questioned\u2014for example, when a patient presents under the influence of drugs\/alcohol, or when a patient presents with impairing mental or emotional conditions (dementia).\u00a0 Throughout all of these clinical scenarios, the bottom line ultimately remains the same:\u00a0 a patient <u>must <\/u>exhibit mental capacity to provide consent.<\/p>\n<p><strong>Informed Decision Making<\/strong> involves the candid and clear discussion of treatment options, risks, benefits, and prognosis.\u00a0 These aspects of treatment should be discussed in easily understandable terms and opportunities should be presented for patients to ask questions.\u00a0 The consequences of failing to undergo treatment should also be emphasized.<\/p>\n<p>Recalling the clinical scenario with which we began this article, if a patient indicates that they would like to refuse treatment, it is worthwhile to explore their reasons for refusal.\u00a0 Treatment refusal can be attributed to misinformation, fear, or personal values.\u00a0 Taking time to discuss the basis of their decision can potentially aid patients in surmounting treatment barriers by revealing a more agreeable solution\/approach.\u00a0 Regardless of which path they choose, detailed documentation of a patient\u2019s consent or refusal should always be notated in their medical record.<\/p>\n<p>Lastly, when obtaining informed consent, ensure that it is a <strong>Voluntary Decision<\/strong>.\u00a0 A decision to accept or decline treatment must be made voluntarily without coercion from their clinician, family, or friends.<\/p>\n<p>Keeping these principles in mind ultimately cultivates a patient-centered care environment, in which both the doctor and patient can more easily (and legally!) navigate the endodontic treatment planning process.<\/p>\n<p><em>Dr. Andrea Tsatalis practices endodontics in Tampa, Florida. She is passionate about providing high-quality care to her patients &amp; contributing to the greater endodontic community through her work as a lecturer, researcher, and clinician.\u00a0<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Andrea Tsatalis, DDS, MS Imagine this clinical scenario: your patient presents asymptomatic for evaluation of tooth #3.\u00a0 Radiographic imaging displays the presence of an untreated MB2 canal and a&hellip;<\/p>\n","protected":false},"author":12,"featured_media":21688,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"content-type":"","_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[366],"tags":[],"feature":[236],"class_list":["post-25402","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-treatment-planning","feature-paperpoint"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.1.1 - 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