Tuesday, February 12, 2008

Informed Consent: Easier for Abortions or Tooth Extractions? [Serge]

As an oral and maxillofacial surgeon, extraction of third molars (wisdom teeth) is the most common procedure that I perform. The process is pretty straight forward. The patient comes to me via a referral, and presents for a consultation appointment where an exam and consent discussion is done. During the process, my patients view a flash program entitled Emmi that shows them diagrams of the planned procedure as well as a discussion of the risks. I then perform an exam on the patient, showing them the teeth in question, the need for the surgery, and describe what I plan to do. The patient then makes another appointment for the surgery, and has it done. Nothing to it.

It should be noted that the program contains descriptions of procedures that the patient may not have. For example, if someone only has lower wisdom teeth, they will also hear a description of upper wisdom teeth extractions. Furthermore, I often discuss issues that are not completely settled in the OMFS community. For example, many patients believe that removing horizontally impacted wisdom teeth will prevent crowding - and I mention that that has not been confirmed but many practitioners believe it is true.

However, my friends at the Guttmacher Institute believe that my policy is a "misuse [of] the informed consent process" and "counter to fundamental ethical principles that have long guided the practice of medicine in the United States". They argue in this article that such information given to patients adversely effects their ability to make an informed consent decision. Of course, they are not speaking of wisdom teeth extractions, but of elective abortions. They argue that giving women additional information regarding abortions as well as opinions that are in conflict unfairly attempts to dissuade women from having this procedure.

If that is the case, why has not one patient of mine complained that I wrongly attempted to convince them not have their wisdom teeth out? Why should the informed consent process for an abortion, a decision that is unquestionable more important than wisdom tooth extractions, be easier and quicker than that for tooth extractions? Lastly, why can't we trust women to make the correct decision using all of the information available to them?

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