Notes: You will be able to answer the following questions using the readings and lecture notes. Provide citations, including page numbers, when pulling any direct quotes from readings or other sources. Full sentences and paragraph structure are expected, unless the instruction asks you to simply “list” items or elements.
1. Many clinicians mistakenly use the word incompetent when talking about a patient with cognitive or other impairments that affects the person’s capacity to give informed consent:
a. Explain as you would to another dentist the meaning of the terms competence and decision-making capacity as they apply to evaluating a patient’s ability to make decisions related to their dental or other health care.
b. Why is this distinction worth making in a clinical context?
2. Use the readings, lecture notes, and case-discussions to respond to the following questions:
a. What are three required components of the informed consent process?
b. What are some limitations of relying solely on a written informed consent document
as evidence that all components of a fully-informed consent process have been met?
c. What are some limitations of delegating someone (other than yourself) to obtain consent from a patient?
3. In the context of Pediatric practice; briefly, but also completely:
a. Describe the role that informed consent, child or minor assent, parental permission, and informed refusal play in clinical shared decision-making
b. How is informed refusal treated differently in adult vs. pediatric practice?
4. Max is a healthy 11 year-old boy. His father brings him to your pediatric dental practice because he is complaining of pain in one tooth. Max just moved to the city where you practice. The father reports that Max’s mother has traditionally taken care of dental appointments, so he’s not sure when Max was last seen by a dentist, but speculates that it is likely a little more than a year ago because they moved almost a year ago.
You examine Max and he is fairly cooperative for your exam. You find a severely carious permanent molar on the lower right mandibular arch with periapical radiolucency. You judge that this tooth cannot be restored. You talk over your findings with Max’s father and Max is present. You explain that you will first provide an anesthetic so Max won’t feel any pain, and explain that removing the tooth will resolve Max’s pain. You review the follow-up options for filling the gap. The father agrees to the immediate extraction of the tooth.
Max flatly refuses the anesthetic injection, despite your explanation and reassurances. You offer nitrous oxide as a means of “taking the edge off,” but Max refuses that also. Max’s father begins to threaten him with punishments, and Max says that his toothache isn’t that bad and he wants to go home.
a. What are the clinical factors?
b. What do we know about the patient’s preferences?
c. What quality of life considerations are there in this case?
d. What are the contextual factors associated with this case?
e. Identify one primary ethical problem or issue that needs to be addressed at this point in the case. Frame the ethical problem or issue in the form of a question.
f. List three of the five ethical principles that apply in this case; give a brief definition of each of the three principles you chose; and describe in 1-2 sentences how each principle relates to the ethical issue you identified in part (e.) above.
g. List two possible options for resolving the issue you identified in this case.
h. Select the best plan of action from your two options in part (g.) above, and provide careful ethical justification for your choice. Write at least 1 paragraph to justify or support your plan of action by referring to the ADA Code of Ethics, the ethical principles, course readings, and/or lectures. Please use complete sentences and check for grammar and spelling in your answer.
i. Give one example of something you could have done earlier in the case that might have prevented you from needing to address the ethical problem you identified in part (e.).
5. Choose any topic or theme that we covered during this course and describe how or why something that you learned might influence or alter your practice as a dental health professional in the future.