Consent Issues in the Management of Acute Ischemic Stroke

Abstract

This position statement briefly reviews the principle of informed consent, the elements of decisional capacity, and how acute stroke may affect this capacity. It further reviews the role of surrogate decision-making, including advance directives, next of kin, physician orders for life-sustaining treatment, and guardianship. In some cases of acute stroke in which the patient lacks decisional capacity and no advance directives or surrogates are available, consent to treatment may be presumed. The document describes the rationale for this position and various considerations regarding its application to IV thrombolysis, neuroendovascular intervention, decompressive craniectomy, and pediatric stroke. The document also reviews consent issues in acute stroke research.

Advance Consent in Acute Stroke Trials: Survey of Canadian Stroke Physicians

“…3 Each of these approaches has drawbacks, most important being the risk that patients may be enrolled into trials against their wishes. 4 Advance consent, 5 a practice accepted and used in dementia research, 6 could address some of the challenges experienced in acute stroke research by identifying at-risk patients in stroke prevention clinics, informing them about ongoing trials, and then inviting them to consent while they are capable of doing so. Their consent could then be documented in the health record, facilitating quicker trial participation for those who are willing and preventing enrollment for those who are not.…”