Ethics & Law · patient case question
What should be kept in mind above all while treating this patient?
Patient case: Elderly man with Alzheimer disease and a symptomatic upper left molar
Patient: Male, 78 years old
Chief complaint: “His tooth has been hurting him and his face is swollen.” Reported by the wife, who accompanies him.
Background: Alzheimer disease, moderate stage. Medication: donepezil. His wife attends every appointment and manages his daily care.
Current findings: Periapical radiograph shows tooth #15 lying on its side (slanted/impacted) with an associated radiolucency. Swelling and pain localised to #15. Patient is pleasantly confused and defers all questions to his wife.
Show answer and explanation
Correct answer: B. Treatment must proceed on the basis of valid consent, with capacity and proxy authority established
- A. Hygiene instruction directed at a moderately demented patient has limited value — it is the CAREGIVER who must be instructed.
- B. CORRECT. Cognitive impairment puts CAPACITY and CONSENT at the centre of the encounter. Before any treatment you must establish whether the patient can consent for himself and, if not, who holds legal authority to consent for him. Everything else is secondary to that.
- C. Alcohol-free rinse is a sensible product choice (alcohol stings and risks aspiration), but again a minor point.
- D. Caregiver-assisted brushing is genuinely useful in dementia, but it is a home-care detail, not the governing principle for delivering treatment.
Note: Consent and capacity is the recurring INBDE theme for any dementia, intellectual disability or paediatric case. Ask first: can this person consent, and if not, who can?