A pilot study on the global practice of informed consent in paediatric dentistry

N. Potgieter, Gemma Bridge, Marlies Elfrink, M. Foláyan, Sherry S. Gao, S. Groisman, Ashwin Jawdekar, Arthur Musakulu Kemoli, David Lim, Phuong Ly, Shani A. Mani, Ray M. Masumo, Joana Monteiro, Marjorie K. Muasya, Ambrina Qureshi, Norman Tinanoff
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Abstract

Conducting oral treatment early in the disease course, is encouraged for better health outcomes. Obtaining informed consent is an essential part of medical practice, protecting the legal rights of patients and guiding the ethical practice of medicine. In practice, consent means different things in different contexts. Silver Diamine Fluoride (SDF) and Silver Fluoride (SF) is becoming popular and cost effective methods to manage carious lesions, however, cause black discolouration of lesions treated. Obtaining informed consent and assent is crucial for any dental treatment—and has specific relevance with SDF/ SF treatments.The aim of this paper is to describe informed consent regulations for dental care in a selection of countries, focusing on children and patients with special health care needs. An online survey was shared with a convenience sample of dental professionals from 13 countries. The information was explored and the processes of consent were compared.Findings suggest that there are variations in terms of informed consent for medical practice. In Tanzania, South Africa, India, Kenya, Malaysia and Brazil age is the determining factor for competence and the ability to give self-consent. In other countries, other factors are considered alongside age. For example, in Singapore, the United Kingdom, and the United States the principle of Gillick Competence is applied. Many countries' laws and regulations do not specify when a dentist may overrule general consent to act in the “best interest” of the patient.It is recommended that it is clarified globally when a dentist may act in the “best interest” of the patient, and that guidance is produced to indicate what constitutes a dental emergency. The insights gathered provide insights on international practice of obtaining informed consent and to identify areas for change, to more efficient and ethical treatment for children and patients with special needs. A larger follow up study is recommended to include more or all countries.
儿童牙科知情同意全球实践试点研究
鼓励在病程早期进行口腔治疗,以获得更好的健康效果。获得知情同意是医疗实践的重要组成部分,它保护患者的合法权益,并指导医疗实践的道德规范。实际上,同意在不同的情况下有不同的含义。二胺氟化银(SDF)和氟化银(SF)正成为治疗龋齿的流行且经济有效的方法,但会导致治疗后的病变变黑。获得知情同意和同意对于任何牙科治疗都是至关重要的,这与 SDF/ SF 治疗具有特殊的相关性。本文旨在介绍一些国家的牙科治疗知情同意规定,重点关注儿童和有特殊医疗保健需求的患者。本文对 13 个国家的牙科专业人员进行了在线调查。调查结果表明,在医疗实践的知情同意方面存在差异。在坦桑尼亚、南非、印度、肯尼亚、马来西亚和巴西,年龄是能力和自我同意能力的决定因素。在其他国家,除年龄外还考虑其他因素。例如,新加坡、英国和美国采用吉利克能力原则。许多国家的法律法规没有明确规定牙医何时可以推翻一般同意,以患者的 "最大利益 "为出发点行事。建议在全球范围内明确牙医何时可以以患者的 "最大利益 "为出发点行事,并制定指导意见,说明什么情况构成牙科急诊。收集到的信息为获得知情同意的国际惯例提供了启示,并确定了需要改变的领域,从而为儿童和有特殊需求的患者提供更高效、更合乎道德的治疗。建议开展更大规模的后续研究,以纳入更多或所有国家。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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