2022 Volume 43 Issue 2 Pages 137-142
We provided dental treatment under general anesthesia to a patient with severe intellectual disability who was living independently. For the provision of dental treatment under general anesthesia, the consent of the patient is required ; in this case, the patient made the decision to consent. However, questions remained as to how decision-making by patients with severe intellectual disability should be evaluated when a decision cannot be made by the patient.
An adult guardian had been designated for the patient by the Family Court and was managing their assets, including the medical contract between the medical institution and the patient. However, as this guardian did not have the authority to make decisions on the nature of medical treatment, which is a matter of physical guardianship, they were unable to consent to or refuse the provision of treatment under general anesthesia. A support meeting was required to make a decision in this case. Patient decision-making support meetings require the attendance of not only medical staff but also the adult guardian as well as family members and welfare service representatives. In practice, such meetings consist mainly of the one-sided provision of medical information, making a lively exchange of views difficult.
By working in partnership with welfare services, we were able to obtain their cooperation in managing this severely disabled patient who lived alone before and after treatment under dental anesthesia. This case illustrated the need for an understanding of welfare services on the part of dental staff about decision-making support for adult disabled patients, as well as the necessity of training dental staff capable of coordinating collaboration with welfare services to enable the dental treatment of patients.
