An ethical Dilemma!

Over the recent years the UK has become a significantly litigious country. Litigations faced by dentists are far more common now than what they used to be.

Recent figures published by Dental Protection revealed that the willingness in the UK to sue dentists outstripped even the litigation-loving USA. The latest figures state that there are 73 claims for every 1,000 dentists in the UK, compared with 58 in the US.

Simran Kaur is a final year student at Liverpool.  In this article she discusses an ethical scenario and the issues raised within it. This is particularly aimed at young dentists due to the relative inexperience in dealing with such situations, but will also be helpful to final year dentists studying for the DF1 interviews.

The scenario

You are a newly qualified dentist in practice. A 14 year old boy attends with his father. The father does not want the son to have any teeth taken out; however the son is in pain and is trying to tell you that he would like to have the tooth removed. The son and the father cannot speak much English.

So how would you address this situation?

Let us consider all the possible issues raised in this scenario:

1. Act in the best interest of your patient - your decisions should have this at its core. You need to get this young man out of pain, that's for sure.
2. Obtain valid consent - this scenario is particularly tricky as there are many potential pitfalls in obtaining informed consent. For example, you should politely ask the father if he is a married father or a 'partner father', as in the latter case the father would not have the right to consent for his son. Another consideration is whether the son is Gillick/Fraser competent and may be able to consent for himself. However, the overriding issue with consent in this scenario is the language barrier. How can you obtain informed consent if the patient and his father cannot understand what you are saying? A practical solution for this is to arrange for a translator to aid effective communication. You may even have a practice policy on how you handle such cases. And remember, as a DF1 you always have the support of your trainer in these tricky scenarios.
3. As always, good, contemporaneous record keeping is of paramount importance. You need to mention in the notes about how you obtained consent, what your discussions entailed, a diagnosis (often forgotten in these cases!) and the treatment options.
4. Finally do NOT forget Safeguarding - why is the father adamant for his son not to have an extraction? Speak to the safeguarding lead within the practice for advice if unsure.

In summary, if you acted in the patient's best interest by getting him out of pain; arranged for a translator to aid effective communication; obtained valid consent before carrying out any procedure; maintained patient confidentiality; sought advice from your trainer or even an indemnity organisation; and documented all your actions in the patient's notes then well done you!

Lastly, keep yourself updated with what's going around the dental world by reading various dental magazines and journals. Obtaining CPD in legal and ethical issues is recommended by the GDC. Regularly discuss ethical scenarios in practice meetings to prepare yourself for the real life challenges faced regularly in the dental surgery.  One of the most important things you could possibly read is the GDC standards and then act in accordance to these standards.

Simran Kaur