American Academy of Neurology Issues Ethical Guidance on Consent During Ischemic Stroke

As published in Neurology, the American Academy of Neurology's committee on Ethics, Law, and Humanities has issued a position statement on ethical consent for treatment during acute ischemic stroke (AIS). Noting that stroke treatments are time sensitive, and individuals are often unable to give consent during stroke, it is suggested that neurologists may ethically proceed with accepted treatments, such as thrombolysis, on the presumption of consent. 

Although advance directives may provide guidance on a patient's wishes, these are frequently overly specific or, conversely, too general. Advance directives often address terminal life-ending conditions but not necessarily acute debilitating events like AIS. Next of kin may also be authorized as surrogate decision makers but may not be adequately prepared for this role. 

The position statement suggests it is ethical and necessary, in these circumstances, to guide decision makers while giving priority to documented wishes of the patient, when those exist, and next, determination of what the patient might want given their beliefs. If the patient's wishes and beliefs cannot be determined, decisions should be guided by what would be in the patient's best interest. 

“Stroke treatments that are effective in preserving brain function can only help if administered quickly, sometimes within just a few hours, yet consent for such treatments must often happen when the person who has had a stroke lacks the ability to make decisions and when those who could make decisions for them may be unavailable,” said position statement author Justin A. Sattin, MD, of the University of Wisconsin in Madison. “This position statement provides ethical guidance for neurologists on how to navigate the decision-making process for stroke patients when time is of the essence.”