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Witt K. J Med Ethics 2017;43: 384–390

Reconstruction of the anterior tooth sextant, the inane clip-on veneer, non-surgical facial aesthetics, orthognathic surgery and facial allograft transplantation, each can transform appearances if not shape identity. The author of this scholarly paper uses the example of an individual who has been suffering from Parkinson's disease for many years. But when treated with deep brain stimulation he was changed from a modest, loving husband with a clear work ethic, to a person who is loud, easily offended, rows with his wife and has left his job. Is this an acceptable trade-off for an improvement in motor symptoms? This powerful example focuses on identity change.

At the heart of this open access extended essay, is the proposal that the following three pillars should each be met in order that consent is given for identity change:

Requirement 1: 'an assessment of preintervention quality of life and the identity change from...(the) preintervention perspective,'

Requirement 2: 'an assessment of postintervention quality of life from...(the) postintervention perspective,' and the key requirement that links Requirement 1 and Requirement 2 is

Requirement 3: 'preintervention and postintervention quality of life are weighted equally...'.

The essayist refers to this process of achieving informed consent as the 'perspective-sensitive account'. This contrasts with the 'standard conception' of informed consent that is based on information and yet more information. In addition, too much emphasis is given to the preintervention perspective. It is argued that the 'standard conception' is flawed in that it ignores opposing judgements. These are categorised according to the 'blatant mistake', the 'subtle mistake', and when 'patients overlook “ordinary” bits of information about the consequences of an intervention'. An avenue to consider these from a dental viewpoint is the somewhat banal example of altering someone's appearance and possibly identity by placing ceramic veneers in combination with non-surgical facial aesthetics. If the patient overlooks the rare but catastrophic effect of incorrect placement of fillers, or a chipped veneer, they have overlooked '“ordinary” bits of information about the consequences of an intervention'. The 'blatant mistake' is when the patient is uncomfortable with the outcome of the intervention. For example, oro-facial aesthetics may have the consequence that the patient is now the centre of unwanted attention. The 'subtle mistake' is when the individual denies themselves treatment because they are too concerned with the possible outcome of that treatment.