Informed consent in dentistry: a standard of good clinical practice

Authors

  • Maria Noel Marzano Rodrigues Petruzzi Pontifical Catholic University of Rio Grande do Sul
  • Lívia Haygert Pithan Pontifical Catholic University of Rio Grande do Sul
  • Maria Antonia Zancanaro de Figueiredo Pontifical Catholic University of Rio Grande do Sul
  • João Batista Blessmann Weber Pontifical Catholic University of Rio Grande do Sul

Keywords:

Dentistry, bioethical Issues, ethics, dental, informed consent, personal autonomy, practice management,

Abstract

Respect for patient’s autonomy is a principle in healthcare highlighted in the Brazilian Professional Ethical Code of Dentistry and a desirable conduct in every day clinical practice. Informed consent comprises the professional duty of inform all the possible risks, benefits and alternatives for proposed clinical procedures, even for diagnosis or treatment, to the patient. This process is considered a clue for personal autonomy and discloses that they are value options made in the dental clinic context. In health care decision making the best course of action is that one which allies a correct clinical judgment and patient’s personal interest based on cultural and socio-economics issues. However, despite informed consent process being a proper conduct, dental assistance in Brazil continues to be guided by a paternalistic approach. Moreover, the misuse of contracts of adhesion as surrogates of informed consent is not unusual in dental assistance. The present literature review discusses the informed consent process as a prerequisite for mediating the professional/patient relationship in the contemporary clinical practice that ensures patient’s to make an informed decision.

Author Biographies

Maria Noel Marzano Rodrigues Petruzzi, Pontifical Catholic University of Rio Grande do Sul

Postgraduate Program in Dentistry Oral Medicine Unit MSc, PhD Student

Lívia Haygert Pithan, Pontifical Catholic University of Rio Grande do Sul

Law Faculty Assistant Professor PhD

Maria Antonia Zancanaro de Figueiredo, Pontifical Catholic University of Rio Grande do Sul

Postgraduate Program in Dentistry Oral Medicine Unit Associate Professor PhD

João Batista Blessmann Weber, Pontifical Catholic University of Rio Grande do Sul

Postgraduate Program in Dentistry Associate Professor PhD

References

Brasil. Conselho Federal de Odontologia. Resolução. CFO-42/2003. Revoga o Código de Ética Odontológica aprovado pela Resolução CFO- 179/91 e aprova outro em substituição. [Internet]. 2003 may 20. [cited 2012 may 16]. Available from: http://cfo.org.br/servicos-e-consultas/atonormativo/? id=852.

Clotet J. O consentimento informado nos comitês de ética em pesquisa e na prática médica: conceituação, origens e atualidade. Bioética 1995;3:51-9.

Bal BS, Choma TJ. What to disclose? Revisiting informed consent. Clin Orthop Relat Res. 2012;470:1346-56.

Ahmad I. Risk management in clinical practice. Ethical considerations for dental enhancement procedures. Br Dent J. 2010;209:207-14.

Fernandes CF, Pithan LH. Informed consent in health care and contract of adhesion: judicial and bioethical approach. Rev HCPA. 2007;27:78-82.

de Cenival M. Ethics of research: the freedom to withdraw. Bull Soc Pathol Exot. 2008;101:98-101.

Clotet J, Goldim JR, Francisconi CF. Consentimento Informado e a sua prática na assistência e pesquisa no Brasil. Porto Alegre: EDIPUCRS; 2000. p.119.

Dubé-Baril C. The personalized consent form: an optional, but useful tool! J Can Dent Assoc. 2004;70:89-92.

Zinman EJ. Ethics versus legal informed consent: a distinction with little difference. J Hist Dent. 2007;55:134-8.

Jones JW, McCullough LB, Richman BW. Informed consent: it’s not just signing a form. Thorac Surg Clin. 2005;15:451-60.

Moulton B, King JS. Aligning ethics with medical decision-making: the question for informed patient choice. J Law Med Ethics 2010;38:85-97.

Lara MC, de la Fuente JR. On informed consent. Bull Pan Am Health Organ 1990;24:419-24.

Beauchamp TL. Informed consent: its history, meaning, and present challenges. Camb Q Healthc Ethics. 2011;20:515-23.

Paris JJ, Moreland MP. Silence is not always golden in medical decisionmaking. Am J Bioeth. 2007; 7:39-40.

Bulla CM, Benincasa CC, Goldim JC, Franciscone CFM. The use of informed consent forms for medical purposes in the Hospital de Clínicas de Porto Alegre. Rev AMRIGS. 2003;47:101-3.

Gracia D. The many faces of autonomy. Theor Med Bioeth 2012;33:57-64.

Schenker Y, Fernandez A, Sudore R, Schillinger D. Interventions to improve patient comprehension in informed consent for medical and surgical

procedures: a systematic review. Med Decis Making 2011;31:151-73.

Grimes AL, McCullough LB, Kunik ME, Molinari V, Workman RH Jr. Informed consent and neuroanatomic correlates of intentionality and voluntariness among psychiatric patients. Psychiatr Serv. 2000;51:1561-7.

Delany C. Making a difference: incorporating theories of autonomy into models of informed consent. J Med Ethics 2008;34:e3.

Reid KI. Respect for patients’ autonomy. J Am Dent Assoc. 2009;140:470-4.

Goldim JR, Fernandes MS, Pechansky F. Ethical, legal and social issues related to alcohol and drug research. Curr Opin Psychiatry 2011;24:181-5.

Zimring SD. Health care decision-making capacity: a legal perspective for long-term care providers. J Am Med Dir Assoc. 2006;7:322-6.

Cegala DJ, Chisolm DJ, Nwomeh BC. Further examination of the impact of patient participation on physicians’ communication style. Patient Educ Couns 2012;89:25-30.

Goldim JR. Consent and information: the importance of using quality texts. Rev HCPA 2006;26:117-22.

Lopez-Nicolas M, Falcón M, Perez-Carceles MD, Osuna E, Luna A. Informed consent in dental malpractice claims. A retrospective study. Int Dent J. 2007;57:168-72.

Brasil. Conselho Nacional de Saúde. Resolução nº 196 de 10 de Outubro de 1996. [Internet]. 1996. [cited 2012 may 11]. Available from: http://conselho.saude.gov.br/resolucoes/reso_96.htm.

Brasil. Lei nº 9.263, de 12 de janeiro de 1996. Regula o § 7º do art. 226 da Constituição Federal, que trata do planejamento familiar, estabelece penalidades e dá outras providências. [Internet]. 1996. [cited 2012 may

. Available from: http://www.planalto.gov.br/ccivil_03/Leis/L9263.htm.

Brasil. Conselho Federal de Medicina. Resolução CFM nº 1.358/1992. [Internet]. 1992. [cited 2012 may 16]. Available from: http://www.portalmedico.org.br/resolucoes/CFM/1992/1358_1992.htm.

Graskemper JP. A new perspective on dental malpractice: practice enhancement through risk management. J Am Dent Assoc. 2002;133: 752-7.

Godinho AM, Lanziotti LH, de Morais BS. Informed consent: the understanding of lawyers and courts. Rev Bras Anestesiol 2010;60: 207-14, 119-23.

Brasil. Lei no 10.406, de 10 de janeiro de 2002. Institui o Código Civil. [Internet]. 2002. [cited 2012 may 11]. Available from: http://www.planalto.gov.br/ccivil_03/leis/2002/L10406.htm.

Brasil. Lei nº 8.078, de 11 de setembro de 1990. Dispõe sobre a proteção do consumidor e dá outras providências. [Internet]. 1990. [cited 2012 may 15]. Available from: http://www.planalto.gov.br/ccivil_03/leis/L8078.htm.

Conselho Federal de Medicina (BR). Resolução CFM nº 1.081/82. [Internet]. 1982. [cited 2012 may 16]. Available from: http://www.portalmedico.org.br/resolucoes/CFM/1982/1081_1982.htm.

Brasil. Conselho Federal de Medicina. Resolução CFM nº 1890/2009. [Internet]. 2009. [cited 2012 may 16]. Available from: http://www.portalmedico.org.br/resolucoes/CFM/2009/1890_2009.htm.

Brasil. Conselho Federal de Odontologia. Código de ética odontológica. [Internet]. Rio de Janeiro: CFO; 2006. [cited 2012 may 15]. Available from:

http://cfo.org.br/wp-content/uploads/2009/09/codigo_etica.pdf.

Whitney SN, McCullough LB. Physicians’ silent decisions: because patient autonomy does not always come first. Am J Bioeth 2007;7:33-8.

Kirby R, Challacombe B, Dasgupta P, Fitzpatrick JM. The importance of obtaining truly consensual informed consent. BJU Int. 2012;109:1743-4.

World Medical Association. Declaration of Helsinki. Ethical prinicples for medical research involving human subjects. 59th WMA General Assembly. Seoul; Oct. 2008.

Council for International Organization of Medical Sciences. International ethical guidelines for epidemiological studies. Geneva; Feb. 2008.

Convention on Human Rights and Biomedicine. Convention for the protection of human rights and dignity of the human being with regard to the application of biology and medicine. Oviedo; Apr. 1997.

Downloads

Published

2013-02-11

Issue

Vol. 28 No. 1 (2013)

Section

Literature Review

License

COPYRIGHT
The submission of originals to Odonto Ciência implies the transfer by the authors of the right for publication. Authors retain copyright and grant the journal right of first publication. If the authors wish to include the same data into another publication, they must cite Odonto Ciência as the site of original publication.

CREATIVE COMMONS LICENSE
As this journal is open access, the articles are allowed free use in scientific and educational applications, with citation of the source.
According to the type of Creative Commons License (CC-BY 4.0) adopted by Odonto Ciência, the user must respect the requirements below.

You are free to:
Share — copy and redistribute the material in any medium or format.
Adapt — remix, transform, and build upon the material for any purpose, even commercially.

However, only under the following terms:
Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests Odonto Ciência endorses you or your use.
No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.

Notices:
You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation.
No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.

For more details on the Creative Commons license, please follow the link in the footer of this website.