May 2020 Volume LV Number 3


Litch’s Law Log: What to Do About Refusal to Consent?

September 2012 Volume XLVIII Number 5

There are many downsides to the medias general inability to accurately report on science and levels of health risks, and tendency to sensationalize such coverage. One fallout is to needlessly increase consumer fears about potential harm. A recent example is the coverage of the American Cancer Societys article on exposure risk from dental X-rays.1 While some criticisms were leveled at the study for relying on self-reported recollections concerning exposures many years ago from older X-ray technology, the larger issue is failure to compare various levels of radiation exposure in the health care environment. There must obviously be a balance between utilization of useful diagnostic tools versus too-frequent exposure to radiation. Subsequently to this article, the Wall Street Journal reported findings that one CT scan is equivalent to 1,000 dental X-ray exposures.2 Putting both items in context, it is obvious that parents and guardians should not be overly concerned about X-rays in the dental office when needed to assist in diagnosis and treatment planning.

But what if the parent or guardian refuses to consent to a treatment? Quoting the ADA Practical Guide to Frequently Asked Legal Questions:

"The key here is to document the refusal. Should a patient 3not agree to a recommended procedure, or refuse the treatment, you should inform the patient of the risks that may arise from such a refusal and document that the patient understands those risks. This can be done in the chart or better yet—on an informed refusal form, signed by the patient and kept in the patients record. Obtaining informal refusal does not release the dentist from responsibility of providing the standard of care. For example, if a patient refuses to have radiographs take and the dentist believes that radiographs are a necessary prerequisite to proper care in that case, the dentist should refer the patient to another dentist."


Even more specifically, should the dentist proceed with treatment even if the parent or guardian will not consent to recommended diagnostic procedures? According to the same ADA guide:

"Its not a good idea to proceed with treatment if the patient will not consent to the diagnostic procedures your recommend. However, sometimes patients refuse recommended diagnostic procedures (especially Xrays) and demand treatment anyway. As a general rule, this demand can be refused. Indeed, if you have recommended diagnostics in order to be able to develop a treatment plan, you open to the door to a malpractice claim if you proceed with treatment against your own recommendations. Your notes in the patient’ chart might be the first exhibit used against you

at trial."The AAPDs guideline on informed consent is also a useful reference: http:// InformedConsent.pdf.

Despite these challenges, pediatric dentists must continue to their best to explain to parents and guardians the various benefits and risks of treatment, including diagnostic tools and restorative materials. The AAPD will help by producing evidence-based clinical guidelines and disseminating to members, the public, and the media the most accurate scientific information available.


For further information, please contact Chief Operating Officer and General Counsel C. Scott Litch at (312) 337-2169, ext. 29, or




3 In the case of a child, the parent or guardian.