Decision making capacity (DMC)

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Sibil Shibu

The University of Alabama Birmingham Hospital, United States

: Dent Health Curr Res

Abstract

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Decision making capacity(DMC) is a determination tool utilized across clinical settings to determine if a patient is able to partake in conversations regarding their course of treatment. Scholars around the globe have utilized various approaches to determine if a patient has DMC. Physician and scholar Paul S. Applebaum presents four criteria to determine if a patient has DMC. This includes oneâ??s ability to: communicate a choice, understand the relevant information, appreciate the situation and its consequences, and reason about treatment options. Although conversations around DMC are prevalent in a medical context, there is a lack of conversation around DMC for patients in dental settings. In this project, I present various considerations to determine DMC in a dental setting. This is accomplished by presenting various clinical cases of diverse patients who interact with the realm of dentistry. An analysis of these case studies present practical tools to uphold the autonomy of patients in dental encounters, even patients who may lack DMC. EXAMPLE OF A CASE STUDY IN MY PRESENTATION: Patient Jane Doe is a 24-year-old female patient with an intellectual disability residing in a group home. Ms. Doe presents to a dental clinical after recurrent tooth pain. After further analysis, her dentist recommended that tooth extractions would be necessary to treat her gingivitis. As the patient lacks decision making capacity, her surrogate decision maker is her aunt, who she doesnâ??t reside with. As the date for the scheduled tooth extraction arrives, Ms. Doe presented to the dental clinic with her caregiver from her group home. As the oral surgeon approaches Ms. Doe prior to the tooth extraction, she becomes frustrated and is not compliant with undergoing the tooth extraction. Although her aunt had consented to the procedure, there was an element of dissent present. This brings about an ethical dilemma on whether it would be appropriate to proceed with the tooth extraction over the patientâ??s objection or to postpone the tooth extraction. After further conversation with the patient it was revealed that she did not want to undergo the extraction as she felt uncomfortable without the presence of her aunt at the clinic. Although the patient lacks decision making capacity, it is beneficial to take into consent the notion of assent and dissent to uphold the patientâ??s autonomy. After further conversation, the medical team determined that it may be appropriate to postpone the procedure as postponing the tooth extraction would not be medically detrimental if oral antibiotics were utilized as treatment. Although Ms. Doe would eventually need to have tooth extractions, postponing this treatment till the patientâ??s aunt would be available to accompany her in clinic was vital to build trust in the dentist-patient relationship.

Biography

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Sibil Shibu is a Clinical Ethics Consultant at an academic medical center in the United States named the University of Alabama Birmingham Hospital. She graduated with a Bachelor of Arts in Bioethics and Health Studies, and a minor in Theology from Saint Louis University during the Summer of 2022. After her undergraduate education, she completed a Master of Bioethics and a Certificate in Leadership for Public Health and Healthcare through the Berman Institute of Bioethics at the Johns Hopkins Bloomberg School of Public Health. She will be starting her Doctoral Degree in Bioethics in January 2024. Her initial exposure to the field of Bioethics was through an ethics course during her junior year of high school at the Illinois Mathematics and Science Academy.