Application of the Mental Capacity Act (2005) and Consenting for Treatment under Concious Sedation.

The Mental Capacity Act 2005 (MCA) is one piece of legislation with which all clinicians should be familiar. As treating clinicians, a capacity assessment is carried out each time a patient is seen, in order to obtain informed consent. When clinicians question the capacity of their patients, they should ensure steps are taken to provide relevant adjuncts to aid understanding, from visual aids to alternative time and environment. If a patient is deemed to lack capacity, it should be determined if this is temporary, fluctuating or permanent, as well as the severity. For those who lack capacity a best interest assessment should be undertaken with all relevant parties involved, with the overall decision being made in the patient's best interest and in the least restrictive manner. Considerations of sedation technique, clinical holding, or any other procedures should be included in the consent form, with periodic review of the best interest decision as a patient's circumstances may change over time.

What's new in ... The Process of Consent.

An understanding of mental capacity is fundamental to the process of obtaining valid consent. This article looks at the processes of both consent and capacity assessment, and highlights the importance of fully informed consent following recent changes in the law.

How many of our patients can really give consent? A perspective on the relevance of the Mental Capacity Act to dentistry.

UNLABELLED: The different ways that clinicians perceive adult patients with dental phobia is varied and diverse. From treating the dental phobia as a separate illness to dismissing it as a neurosis, sometimes little consequence is attached to its existence. True dental phobia is classed as a psychological illness and therefore comes under the remit and guidance of the Mental Capacity Act 2005. Failure to assess the impact of dental phobia upon an individual's capacity to consent could lead to allegations of negligence or even assault. CLINICAL RELEVANCE: This paper highlights the importance of considering the capacity to consent of some of the most vulnerable dental

[Dental and health law 4. The treatment of minors and of adults who are unable to give informed consent]. / Tandheelkunde en gezondheidsrecht 4. De behandeling van minderjarigen en meerderjarige wilsonbekwamen.

When minors are treated, a complex triangular relationship can emerge among dentist, patient and the individual legally responsible for the patient. Generally speaking, both parents are those legally responsible for a child. This might not be the case if the parents are not married to each other or have divorced, or when there is a question of a child protection ruling. The governing rule is that dentists are required to honour the obligations to the legal representatives thatfollow from the patients' rights concerning the treatment of children under the age of 12. In the case of patients between the ages of 12 and 16, dentists are required to act in accordance with their obligations to both those legally responsible and to the patients. Finally, in the case ofpatients who are 16 and older, dentists are required to act only in accordance with their obligations to the patients. There are, however, various exceptions to this governing rule. One of the most common examples is the patient who is a minor of 16 or older who is unable to determine what is in his own best interest. That criterium is also used in determining the capability to give informed consent in adults.

[Patients with unusual requests for extractions 2. Mental incompetency and psycho-pathologic causes]. / Patiënten met ongewone extractiewensen 2. Wilsonbekwaamheid en psychopathologische oorzaken.

If there is no indication for tooth removal purely based on dental criteria, but the patient requests for removal due to fear of dental treatment, or because of a mental disorder such as posttraumatic stress disorder, a somatoform pain disorder or a disorder of body image perception, then the question is whether the patient is mentally competent to make this decision. In case of a tooth removal request on psychopathologic basis, a dentist has to refuse to carry out such treatment, but he should make an effort to help or guide the patient in some other way.

Consent, restraint, and people with special needs: a review.

Dentists providing treatment to individuals with developmental disabilities are often faced with unique medical/legal issues. Obtaining informed consent when a patient does not have capacity can be an involved process. Issues regarding therapeutic aides used for immobilization (i.e., restraint) during treatment may further complicate the situation. This area is controversial and has even resulted in legal difficulties for some dentists. Several topics related to the use of restraint are addressed in this article. A review of the literature and applicable laws pertaining to consent issues for people with special needs is presented and appropriate use of medical immobilization is discussed. Existing guidelines are reviewed. Informed consent and the use of restraint should be incorporated into overall guidelines for the use of anesthesia, sedation, and alternative behavior management techniques in providing dental care to patients with special needs.

[Dental aspects of palliative care. Possibilities and limits of dental care and the special demands on the dentist]. / Zahnmedizinische Aspekte in der Palliativmedizin. Möglichkeiten und Grenzen zahnmedizinischer Betreuung und die speziellen Anforderungen an den Zahnarzt.

Palliative medicine deals with patients in the final phase of their life. These terminally ill patients should receive a treatment which focuses on the prevention and relief of suffering by means of early identification and assessment and treatment of pain and other problems, physical, psychosocial and spiritual. The treatment should focus on the improvement of the Quality of Life (QoL) instead of straining curative treatment approaches. It should also deal with the needs of the families. In palliative medicine an interdisciplinary approach is inevitable and imperative. Although an oral care provider should be a member of the palliative care team this is not always the case in palliative care settings. The prevention of infections, treatment of xerostomia, mucositis and candidiasis as well as the removal of sore spots are some of the important aspects of palliative oral treatment. They can have an immediate positive impact on the patients OHRQoL and their comfort in general. The particular dental work profile requires a practitioner with empathy and professional experience.

The Mental Capacity Act 2005: Considerations for obtaining consent for dental treatment.

The Mental Capacity Act 2005 provides a legal framework within which specific decisions must be made when an individual lacks the mental capacity to make such decisions for themselves. With an increasingly aged, medically complex and in some cases socially isolated population presenting for dental care, dentists need to have a sound understanding of the appropriate management of patients who lack capacity to consent to treatment when they present in the dental setting. Patients with acute symptoms requiring urgent care and un-befriended patients present additional complexities. In these situations a lack of familiarity with how best to proceed and confusion in the interpretation of relevant guidance, combined with the working time pressures experienced in dental practice may further delay the timely dental management of vulnerable patients. We will present and discuss the treatment of three patients who were found to lack the mental capacity necessary to make decisions about their dental care and illustrate how their differing situations determined the appropriate management for each.

The role of competence and capacity in relation to consent for treatment in adult patients.

Obtaining informed consent for dental and medical treatment is a fundamental ethical and legal responsibility for all clinicians. It is an opportunity for patients to have healthcare that is based on their informed choice. The assessment of a patient's competence is an essential part of the consent process and clinicians need to be aware that patients can be misunderstood and wrongly deemed incompetent. This paper aims to aid the clinician to better understand the concept of patient competency and capacity in relation to obtaining valid consent.

Mental capacity and professional advice in a patient with dysphagia.

This article considers the implications of a dispute between a speech therapist and other health professionals over whether a patient suffering from dysphagia should be allowed to take liquids by mouth. The right of the patient to act contrary to professional advice is discussed. The patient cannot insist that a health professional acts contrary to his or her professional judgment. The article also considers the law if the patient were to lack mental capacity.

Providing dental care to patients with developmental disabilities: medical/legal issues.

Dentists providing treatment to individuals with developmental disabilities are often faced with unique medical/legal issues. Obtaining informed consent when a patient does not have capacity can be an involved process. Issues regarding therapeutic aids used for immobilization during treatment may further complicate the situation.

Capacity, Consent and Dentistry - Who Decides and How Do They Do It?

Dental interventions can only occur within a legal framework. This means either the patient gives their informed consent to the procedure or, if this is not possible, an assessment is made whether they lack the ability to consent, in which case a decision on treatment is made under the Mental Capacity Act (MCA). This article takes a brief look at how the MCA sets out the test of capacity, who makes decisions when the patient is unable to do so and how 'best interest' decisions are made in a way that protects the rights of the patient and protects the dental professional from legal liability.

The treatment of adult patients with a mental disability. Part 2: Assessment of competence.

Over recent years practitioners are increasingly being asked to attend to, or to provide treatment for, adult patients with some degree of mental illness, either in their homes or in the dental surgery. Because the issue of competence and the assessment of the patient is crucial to this aspect of dental practice this second paper is devoted to an overview of that assessment process; outlining the legal tests and standards to be employed.

The treatment of adult patients with a mental disability. Part 3: The use of restraint.

Over recent years practitioners are increasingly being asked to attend to, or to provide treatment for, adult patients with some degree of mental illness, either in their homes or in the dental surgery. This final paper in the series deals with the lawful delivery of care or treatment in the face of resistance, through the use of restraint.

Understanding the issue of 'informed consent' in dental treatment.

The concept of consent to treatment is increasingly becoming contested in United Kingdom courts of law. Any practitioners who cannot demonstrate that a patient has properly consented to treatment are laying themselves open to litigation. This paper demonstrates that valid consent is not as straightforward as may be assumed and that a patient can easily challenge a standardised approach to obtaining consent. Current Department of Health guidelines on obtaining consent are discussed, and changes in the USA. Europe and Australia are brought into focus with regard to the situation in the UK.