From Informed Consent to Shared Decision-Making – what does it mean for dentistry?

Abstract

Clinical decision-making has evolved from paternalism, where doctors decided what was best for the patient, to informed consent which is still widely used today. The concept of informed consent is governed by certain prerequisites which ensure that the patient makes an autonomous decision regarding their treatment after being presented with the risks and benefits of the available
options. In medical negligence claims, the doctor’s actions are assessed based on clinical judgement and whether a reasonable doctor in the same circumstances would have acted in the same way resulting in the same outcome. The Montogomery v Lanarkshire case of March 2015 in the United Kingdom for medical negligence1, saw the court shift the focus away from the clinical judgement of
the doctor’s alleged negligence, declaring instead that the patient should have been given all options available to her, even if the doctor considered them to be unsuitable for her condition. Medical insurance companies quickly realised how the informed consent model made them vulnerable to medical negligence claims and amended their clauses accordingly. Clinical decisions now require a more personalised approach known as Shared Decision-Making (SDM). This article explores the main ethical principles that underpin SDM, what this means for the practice of dentistry and its effect on the dentist-patient relationship. Future research in this fi eld could assess the success rate of implementation of SDM in different population contexts and geographical settings.