Make the discussion meaningful
Consent should help a patient understand and decide about proposed care. In a busy dental practice, it is useful to ask whether the patient could explain, in their own words, what is being proposed and why.
In Samira Kohli v. Dr. Prabha Manchanda, (2008) 2 SCC 1, the Supreme Court described valid consent in terms of capacity, voluntariness and adequate information. The information should address the treatment’s nature and purpose, benefits, alternatives, substantial risks and consequences of refusal. The Court also explained that consent to one procedure does not ordinarily authorise a different procedure; a limited exception concerns urgent necessity where delay to obtain consent would be unreasonable. [1]
These principles provide a foundation. The following checklist is a practical recommendation for dental teams rather than a quotation of a universal statutory form.
A useful consultation checklist
Identify the proposed procedure, tooth or anatomical site. Explain the diagnosis or working diagnosis and any important uncertainty. Discuss realistic benefits, relevant risks, reasonable alternatives and what may happen if treatment is deferred or refused.
Give the patient time to ask questions. Use language they understand. Where an interpreter is needed, record who assisted and how communication took place. Where appropriate, asking the patient to summarise the plan can reveal misunderstandings before treatment begins.
For invasive procedures, a procedure-specific written record is a prudent part of this process. Its content should reflect the actual discussion. Avoid relying on a generic clause purporting to authorise every possible intervention.
When the plan changes
Pause to consider whether the proposed change falls within the consent already obtained. Where practicable, discuss a material change before proceeding and record the patient’s decision. Urgency, capacity and the clinical circumstances require individual assessment.
Record decisions clearly
The clinical notes should identify the discussion, questions, decisions and any refusal. If recommended care is declined, record the recommendation, the information explained and the follow-up advice.
A patient’s signature does not establish that every relevant conversation occurred. Equally, consent does not excuse negligent treatment. In Kusum Sharma v. Batra Hospital, the Supreme Court discussed the continuing expectation of reasonable professional skill and care. [2]
The practical aim is a patient who understands the decision and a record that accurately reflects how it was made.
Sources
[1] Supreme Court of India. Samira Kohli v. Dr. Prabha Manchanda & Anr., (2008) 2 SCC 1, judgment dated 16 January 2008, particularly paragraph 32. Judgment text: https://indiankanoon.org/doc/438423/
[2] Supreme Court of India. Kusum Sharma & Ors. v. Batra Hospital & Medical Research Centre & Ors., (2010) 3 SCC 480, judgment dated 10 February 2010. Judgment text: https://indiankanoon.org/doc/29738758/
Educational discussion of Indian legal principles. Particular disputes require assessment of the complete facts and applicable law.