Ethical issues in managing the noncompliant child

Children who refuse treatment present a particularly difficult ethical problem in the practice of dentistry. Five areas should be considered when a patient refuses treatment. First, the urgency of the dental needs should be assessed to determine if treatment can be delayed or avoided with no lasting ill effects. Second, the capacity of the child to participate in decision making should be considered, and the child involved to the extent of that capacity. Next, the potential harm of management techniques should be weighed against the benefits of treatment. Then, the informed permission of parents should be obtained. Finally, pediatric dentists have a responsibility to attempt to shape policy to make care more available on the basis of need as part of an overall system of justly distributed health care.