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The myth about consent forms

When dental professionals are trained, consent is usually taught as part of a law and ethics curriculum. The background of the personnel providing this training will largely determine just where the emphasis is placed in this potentially complex subject. Sometimes the legal aspects of consent will dominate discussions, whilst on other occasions the teaching may be left to someone with no formal legal training, and here the emphasis might have a more practical clinical focus and, by comparison, it might appear to be more simplistic in nature.

At both extremes, but for different reasons, the process of obtaining consent can soon appear to be predominantly concerned with getting the patient's signature on a form to protecting an individual or an institution. But It is a complete myth that the patient's signature at the end of the form provides such protection. The origin of this misunderstanding has been lost in the mists of time, but that doesn't alter the fact that asking the patient to sign a form does little other than confirm that they signed the form on the date next to their signature.

The reason for this is simply that a signature on a 'consent form' is not, in itself, a reliable indication that the patient has actually understood any of the issues involved in the treatment they will be having - even if the form states that they have - or that the patient has given valid consent for a procedure.

The consent process is not about creating legal protection for the clinical team that will be providing treatment. It is a communication process that reflects the autonomy of the patient who will be receiving that treatment. Any consent form that you have asked the patient to sign, should be regarded as just one small part of the overall record of the communication that has taken place between patient and clinician in advance of treatment being provided. The larger part of the record needs to capture the essence of the information provided to the patient, the issues raised by any of the treatment options and the clinician's response along with the patient's final decision about their preferred choice from the options discussed.

Only in this way can it be demonstrated that the consent process was valid, should the question be raised at a later date. In spite of the long-standing myth, a signed form on its own does not demonstrate that valid consent had been obtained.

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Correspondence to Russell Heathcote-Curtis.

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Heathcote-Curtis, R. The myth about consent forms. BDJ In Pract 33, 23 (2020). https://doi.org/10.1038/s41404-020-0355-2

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