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Consent in Orthodontics: Advice Sheet 4 British Orthodontic Society
Consent in Orthodontics: Advice Sheet 4 British Orthodontic Society
Consent in Orthodontics: Advice Sheet 4 British Orthodontic Society
CONSENT IN ORTHODONTICS
In 1998 the BMA Representative Board recognised that "…the current practice of obtaining
informed consent fails to serve patients or doctors" and set up a working party to produce
guidelines to assist clinicians (BMA 2001). Their aim and that of other recent reports is to
achieve the highest standards of ethical practice, rather than just the legal minimum.
Consent to treatment is essentially a process, not a signature. This process is the
communication of key information to the patient about the proposed treatment and the
patient's response in terms of an informed decision whether or not to proceed. Any
subsequent signature is merely a written record that such a process has occurred.
The main issues in consent are summarised in the Department of Health document "12
Key Points on Consent: the Law in England". The Toolkit of Consent Cards produced by
the Consent Working Party of the BMA are also a concise source of guidance. More
detailed information is to be found in the other publications referred to below.
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Recommendations may change in the light of new evidence.
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<Clinic or practice address>
Clinician ………………………………………….
M/F
1
To be completed in advance by a clinician or clinicians with appropriate
knowledge of the proposed procedure [this page in duplicate]
Orthodontic treatment
Describe below what is proposed in everyday language, including as appropriate: -
(a) the aim of the treatment
(b) any extractions or surgery which may be required
(c) the type of appliance to be used
(d) the likely duration of the treatment
(e) any limitations to the expected outcome of the treatment
(f) serious or frequently occurring risks
(g) any common side effects or problems.
(h) possible alternative options for treatment
This may well be done over more than one visit. It is helpful to supply pre-printed
information, such as the patient information leaflets provided by the BOS. Make a note of
any such leaflets provided in order to reinforce and clarify the consent process.
Treatment:
Extractions………………………………..
Upper removable appliance……………….
Lower removable appliance……………….
Upper fixed appliance……………………...
Lower fixed appliance……………………..
Extra-oral appliance (headgear)………….
Functional appliance……………………….
Retainers at completion of treatment…….
2
To be filled in by the clinician(s) providing information to the patient:
I confirm that I have explained the treatment to the patient, along with the significant risks
and the possible alternatives. I also confirm that I have the necessary competence to
provide this information.
Name (PRINT) Date
Signature Position
If interpreter present: I have interpreted the information on page 2 to the patient to the
best of my ability and in terms which I believe he/she can understand.
To be filled in by the patient or (in the case of children unable to consent for
themselves) by a person with parental responsibility:
Please read this form carefully. If your treatment has been planned in advance, you should
already have been given your own copy of page 2, which describes the proposed
treatment. If you have any further questions do ask the person who is asking you to sign
this form. You have the right to change your mind at any time, including after you have
signed this form.
I understand that the procedure may not be done by the person who has been
treating me or my child so far;
I have been advisedof additional procedures which may become necessary. I have listed
below those which I do not wish to be carried out without further
consultation and consent.
To be completed by the patient (children who are unable to give a valid consent may
still be invited to sign here to show they agree with their parent’s decision):
3
Information for patients about consent
[separate sheet to be given at an early stage ]
4
Guidance to clinicians
What a consent form is for
This form documents the patient’s agreement to go ahead with the orthodontic treatment
you have proposed. It is not a legal waiver — if patients, for example, do not receive
enough information on which to base their decision, then the consent may not be valid
even though the form has been signed. Patients also have every right to change their mind
after signing the form. The form should act as an aide-memoire to clinicians and patients,
by providing a check-list of the kind of information patients should be offered, and by
enabling the patient to have a written record of the main points discussed. However, the
written information provided should not be regarded as a substitute for face-to-face
discussions with the patient.
This orthodontic consent form derives from the DOH draft consent form and should only be
used in connection with orthodontic treatment. Where the proposed treatment also
includes surgery and general anaesthesia the standard DOH form should be used instead.
(www.doh.gov.uk/consent) For orthodontic treatment performed in either the hospital
dental service or the community dental service the standard NHS DOH consent form
should be used (www.doh.gov.uk/consent/consentform1.doc or
www.doh.gov.uk/consent/consentform3.doc) or a Trust agreed version.
If a child under the age of 16 has “sufficient understanding and intelligence to enable him
or her to understand fully what is proposed”, then he or she will be competent to give
consent for himself or herself. If the child is not competent to give consent to the particular
intervention, consent should be sought from someone with “parental responsibility”. This
will usually be the birth parents, but may also be a legally appointed guardian, the local
authority where the child is on a care order, or a person named in a residence order in
respect of the child. Fathers who have never been married to the child’s mother will only
have parental responsibility if they have acquired it through a court order or a parental
responsibility agreement (although this may change in future). See the Reference guide to
consent for examination or treatment for further detail. Even where someone with parental
responsibility is giving consent, you should involve the child himself or herself as much as
possible in the decision-making process.
While legally you may treat a child under the age of 18 on the basis of their parent’s
consent, it is good practice always to seek the child’s own consent where they are
competent to give it. Some children/young people may be competent to give consent for
themselves, but still wish a parent to sign their form as well.
If a patient is mentally competent to give consent but is physically unable to sign a form,
you should complete this form as usual, and note on it that the patient has given their
consent orally or in another way.
5
Procedure for the practitioner who provided the first opinion
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for the practitioner providing the second opinion
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Produced by the Ethics Committee of the British Orthodontic Society 2006.
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Recommendations may change in the light of new evidence.
Administrative Office: 291 Gray’s Inn Road, London, WC1X 8QJ. Email: ann.wright@bos.org.uk Telephone: 020 7837 2193
Administrative Office: 12 Bridewell Place London EC4V 6AP Telephone: 020 7353 8680 Fax: 020 7353 8682 Email: ann.wright@bos.org.uk www.bos.org.uk
Fax: 020 7837 7886. BOS is a Company Limited by Guarantee. Registered in England & Wales. Company Number 03695486
BOS is a Company Limited by Guarantee. Registered in England & Wales, Company No. 03695486. Registered Charity No. 1073464