INTERNATIONAL INSTITUTIONS PRACTITIONER-PATIENT RELATIONSHIP INFORMED CONSENT
Plan
Part One:
International institutions
- The International Dental Federation (FDI)
- The World Health Organization (WHO)
Part two:
Practitioner-patient relationship
Part Three:
Informed consent
Part One: International Institutions
Introduction
An international organization is an association of sovereign states established by an international treaty or a multilateral convention between its members and it has several organs which may be common depending on the international organizations.
- The International Dental Federation (FDI)
The birth of the International Dental Federation took place on August 15, 1900, under the leadership of the French doctor Charles Godon, founder of the Paris Dental School during the 3rd International Dental Congress.
The FDI represents more than one million dentists from 230 associations in more than 100 countries.
a)- The aims of the FDI
- Represent the dental profession on an independent and international level,
- Improving the global dental organization,
- To establish and teach international programs likely to promote the progress of science and dental art
- Improving the state of the dental profession
- To improve oral health in all its forms and to recognize the essential place of oral health in general health.
b)- The work of the FDI: all the work of the FDI is carried out within 7 permanent and study commissions:
* Armed Forces Dental Services Commission:
Role: to collect, study and evaluate in all their aspects the data relating to dental services in the armed forces and to develop a training plan for dental surgeons intended to prepare them for the tasks of civil protection.
- Commission for classification and statistics of oral diseases:
Role: to define an international classification of oral diseases, to formulate international standards for carrying out epidemiological surveys relating to oral diseases.
- Health Education Commission:
Role: recruitment and selection of dental students, training and legal qualifications of dentists, university and post-university studies and training of teachers, recognition of certain specialties within dental practice, international exchanges of teachers and students, theoretical and practical training of dental auxiliaries.
* Commission for dental products, instruments, equipment and therapeutic agents:
Role: Formulate and review standards and specifications for dental products, instruments, equipment and therapeutic agents.
* Dental Practice Commission:
Role : to collect and study all data relating to the administration and operation of dental associations, to analyse statistical data relating to the practice of dentistry and dental staff from a socio-professional and economic perspective, to study all questions relating to the health of dental surgeons.
* Dental Research Commission :
Role: to encourage ongoing dental projects, training and education of researchers, to plan exchange programs between researchers in basic sciences and clinical sciences.
- Commission for Dental-Stomatological Social Services :
Role : to recommend standards and principles of collaboration between the dental profession and independent and official health organizations and with social security in order to organize dental-stomatological social services, to plan the curriculum of dental hygiene studies
The FDI organizes congresses every 5 years and annual sessions which help to consolidate contacts between dental practitioners and odonto-stomatological organizations around the world.
The FDI sponsors international awards:
-Miller Prize: awarded to 1 or maximum 3 people who have made the most eminent successes in dental art
-Georges Villain Prize: for ODF or dental prosthesis work.
-Albert Joachim Prize: for original work in laboratory or clinical scientific research.
-Jessen Scholarship: in pediatric dentistry for the study of child dental hygiene.
The FDI publishes the International Dental Journal which is written by specialist practitioners in the various branches of dentistry in the English language with abstracts in French, German, Italian and Spanish.
INTERNATIONAL INSTITUTIONS PRACTITIONER-PATIENT RELATIONSHIP INFORMED CONSENT
2 ) The World Health Organization WHO
The World Health Organization is a specialized agency of the United Nations for public health. It was established at the International Health Conference in New York in 1946 and began operations on 7 April 1948.
It reports directly to the United Nations Economic and Social Council and is headquartered in Pregny-Chambésy, in the canton of Geneva, Switzerland.
Founders : United States, Brazil, Mexico, France, United Kingdom, and others
Director General : Tedros Adhanom Ghebreyesus
Parent organization : United Nations
Members: 194
What are the domains of WHO?
Noncommunicable diseases, communicable diseases, crisis preparedness, surveillance and response, promoting health across the life course, health systems
WHO has 3 important organs
- the world health assembly:
Composed of delegates chosen by the states from among the most qualified people in the field of health, this assembly meets every year.
- the executive council :
Consisting of 24 WHO member states elected by the World Assembly according to their geographical distribution; these 24 member states are elected for 3 years and are eligible for re-election; each of them must designate a person particularly qualified in health matters; the executive board meets at least twice a year.
- the secretariat :
It is headed by a Director General appointed by the World Assembly on the proposal of the Executive Council; it is up to this Director to appoint the officials who will work in the secretariat, taking into account geographical distribution.
WHO conducts numerous surveys on dental matters, on infant dental hygiene, on the fluoridation of global waters.
Part Two : PRACTITIONER-PATIENT RELATIONSHIP
(duties towards the sick).
The quality of the practitioner-patient relationship is essential to obtain an
optimal therapeutic result.
Based on listening, empathy, respect, physical examination, clarity and sincerity of language, it aims to establish trust, the first condition for patient adherence and the therapeutic alliance. Its favorable action is exerted mainly by improving treatment compliance, but also by specific effects, related to placebo effects, especially used in the treatment of non-lesional disorders.
Today’s practitioner must face several difficulties in his relationship with the patient:
more informed and more critical patient; lack of time due to the weight of administrative tasks; team work which disperses and impoverishes the relationship; and above all the primacy of technologies.
The solutions to these difficulties are to be found in the training of practitioners, the organization of teams, and in the responsible use of technologies, which in no way dispense with the necessary face-to-face contact, and, for those which involve artificial intelligence, always require the human guarantee of the practitioner.
Article 9: The doctor or dental surgeon must provide assistance to a patient in immediate danger or ensure that he or she receives the necessary care.
Article 42: The patient is free to choose or leave his doctor, his dental surgeon. The doctor, the dental surgeon must respect and ensure that this right of the patient is respected. This free choice constitutes a fundamental principle of the doctor-patient, dental surgeon-patient relationship. Subject to the provisions of Article 9 above, the doctor, the dental surgeon may refuse to provide care for personal reasons.
Article 43: the doctor, the dental surgeon must endeavour to enlighten his patient with intelligible and fair information on the reasons for any medical act.
Article 44: Any medical act, when it presents a serious risk to the patient, is subject to the free and informed consent of the patient or that of persons authorized by him or by law. If the patient is in danger or unable to express his consent, the doctor or dental surgeon must provide the necessary care.
Article 45: once he has agreed to respond to a request, the doctor or dental surgeon undertakes to provide his patients with conscientious, dedicated care, in accordance with recent scientific data and to call upon, if necessary, the help of competent and qualified colleagues.
Article 46: The doctor, the dental surgeon must never depart from a correct and attentive attitude.
He must respect the dignity of the patient.
Article 47: The doctor, the dental surgeon must formulate his prescriptions with all the necessary clarity. He must ensure that the prescriptions are properly understood by the patient or by his entourage. He must strive to obtain the correct execution of the treatment.
Article 48: The doctor, the dental surgeon, called upon to provide care in a family or in a community, must strive to obtain compliance with the rules of hygiene and prophylaxis. He points out to the patient and his entourage their responsibility in this regard towards themselves and their entourage.
Article 49: In the event of refusal of medical care, the patient is required to make a written declaration to this effect.
Article 50 : the doctor or dental surgeon may be released from his mission provided that continuity of care for patients is ensured.
Article 51: for legitimate reasons that the doctor or dental surgeon assesses in all conscience, a patient may be left in ignorance of a serious prognosis; but the family must be informed of this unless the patient has previously forbidden this disclosure or designated the third parties to whom it must be made. This serious diagnosis or fatal prognosis must only be revealed with the greatest circumspection.
Article 52: The doctor or dental surgeon called upon to provide care to a minor or an incapacitated adult must endeavour to notify the parents or legal representative and obtain their consent.
In case of emergency or if he cannot be reached, the doctor, the dental surgeon must provide the necessary care. If the incapacitated adult can give an opinion, the doctor, the dental surgeon must take it into account.
Article 53 : the doctor or dental surgeon must be the defender of the sick child when he considers that the child’s health interests are misunderstood or misperceived by those around him.
Article 54: When a doctor or dental surgeon, called to assist a minor or a disabled person, finds that they are victims of abuse, inhuman treatment or deprivation, he must inform the competent authorities.
Article 55: The doctor, the dental surgeon must not interfere in the family affairs of his patients.
Article 56: Any prescription, certificate, attestation or document drawn up by a doctor or dental surgeon must be written legibly and allow the signatory to be identified and include the date and signature of the doctor or dental surgeon.
Article 57: Without giving in to any abusive requests from his patients, the doctor, the dental surgeon must endeavour to facilitate their obtaining social benefits to which their state of health entitles them. Any fraud, abuse of quotation, inaccurate indication of fees or acts performed are prohibited.
Article 58 : the issuance of a biased report or a certificate of convenience is prohibited.
INTERNATIONAL INSTITUTIONS PRACTITIONER-PATIENT RELATIONSHIP INFORMED CONSENT
Part Three: Informed Consent
Before performing an invasive procedure or providing medical treatment, physicians must obtain informed and voluntary permission from the capable person. The process is known as informed consent. The person has the right to know the risks, benefits, and alternative treatments in order to make decisions about medical care.
Self-determination means that sane adults have the right to decide what should be done to their bodies. This is the basis of the legal and ethical doctrine of informed consent.
The informed consent process should involve a discussion between the person and the doctor.
Article 44 : Any medical act, when it presents a serious risk to the patient, is subject to the free and informed consent of the patient or that of persons authorized by him or by law. If the patient is in danger or unable to express his consent, the doctor or dental surgeon must provide the necessary care.
Article 52 : The doctor or dental surgeon called upon to provide care to a minor or an incapacitated adult must endeavour to notify the parents or legal representative and obtain their consent.
In case of emergency or if he cannot be reached, the doctor, the dental surgeon must provide the necessary care.
If the incapacitated adult can give an opinion, the doctor or dental surgeon must take it into account.
Special cases of consent expressed by a third party
In some cases, it is difficult, if not impossible, to ask a patient to personally express their consent before an act of care:
- For minor patients, particularly young children: it is then the parents or legal representatives who give consent,
- For adult patients under guardianship: the expression of informed consent falls to the guardian if the judge has so decided when the guardianship was placed or later, depending on the evolution of the patient’s state of health. Apart from such a decision by the judge, the principle of autonomy applies to a protected adult who cannot be represented in the expression of his consent.
- For patients whose state of health does not allow them to express themselves at the time when care is necessary. In this case, the doctor or the care team must obtain informed consent, either from relatives or from the trusted person if the patient has designated one.
In all cases, faced with a serious and urgent health situation and in the inability of the patient and their possible representatives to express themselves, doctors and care teams must provide the necessary care under their sole responsibility.
Patients should be encouraged to ask questions about their condition and treatment options, and physicians should share facts, perspectives, advice, and support.
Physicians must present information in a way that is understandable to the patient and clearly communicate the risks and benefits.
The law requires that physicians take reasonable steps to communicate appropriately with people who have communication barriers.
The purpose of informed consent is largely achieved when the individual understands the following:
- Her current state of health, including its likely evolution if she does not take any treatment
- Potentially useful treatments, including description and explanation of possible risks, benefits and burdens
- Generally, the professional opinion of the healthcare professional as to the best alternative
- The uncertainties associated with each of these elements
Typically, a document summarizing the discussion is signed by the person for all decisions regarding major treatments.
INTERNATIONAL INSTITUTIONS PRACTITIONER-PATIENT RELATIONSHIP INFORMED CONSENT
Refusing care
Along with the right to informed consent, the person also has the right to informed refusal. A person with legal and clinical capacity can refuse to receive medical care. They can refuse it, even if it is care that almost everyone would accept or treatment that could clearly save their life.
For example, a person with diffuse cellulitis may refuse hospitalization, even though it could lead to death. Even if some people think that the person is making a mistake or acting irrationally, the decision to refuse treatment cannot be used in itself as evidence that the person is incapacitated.
In most cases, the person refuses treatment due to fear, misunderstanding, lack of confidence or financial problems. However, refusal can also be a consequence of depression, delirium or other pathologies that can affect the person’s ability to make health care decisions.
A refusal of care should prompt the practitioner to engage in further discussion to determine why the patient is refusing care and whether concerns about care can be addressed.
A patient’s refusal of treatment is not considered a suicide attempt, nor is a doctor’s compliance with that refusal legally considered medical assistance in suicide. On the contrary, the subsequent death is legally described as a natural consequence of the course of the disease itself.
Sometimes refusing treatment can harm others. For example, patients who refuse treatment for certain infectious diseases, such as tuberculosis, put others at risk of becoming infected. In addition, people who refuse treatment for others, such as a child or dependent adult, may endanger the other person’s health. In such cases, doctors often consult with lawyers, judges, and ethics experts.
INTERNATIONAL INSTITUTIONS PRACTITIONER-PATIENT RELATIONSHIP INFORMED CONSENT
Wisdom teeth can be painful if they are misplaced.
Composite fillings are aesthetic and durable.
Bleeding gums can be a sign of gingivitis.
Orthodontic treatments correct misaligned teeth.
Dental implants provide a permanent solution for missing teeth.
Scaling removes tartar and prevents gum disease.
Good dental hygiene starts with brushing twice a day.