Treatment recommendations: "doctor knows best".

Patients often develop an abiding trust in their health care providers and may agree with any recommendations that a dentist offers. This level of trust is a compliment to the dentist and the profession. However, patients who request that a doctor perform the treatment that he or she feels is best and who prefer to avoid an informed consent process must be educated as to the role of informed consent and their part in the process. Even when a patient is adamant in refusing information about his or her condition or states a clear reason as to why he or she does not desire to know a diagnosis or treatment plan (for example, dental phobia or fear of cancer), the dentist has an ethical and legal obligation to work with an appropriate surrogate of the patient's choice and make reasonable attempts at including the patient in the discussion. These patients should be offered the option of discussing the diagnosis and treatment alternatives with a family member or friend present and may include such a surrogate in the informed consent process. When patients clearly lack capacity to consent, the process of informed consent will revert automatically to appropriate surrogates. Finally, patients from different cultures may bring a new set of considerations to the process of informed consent and may require that a modification of the Western tradition be considered, allowing a significant role for the family of the patient in making treatment decisions.