Neurology Groups Update Position on Stroke and Informed Consent

By Jonathan Springston, Editor, Relias Media

When stroke occurs, time to treatment is of the essence. However, stroke can impair decisional capacity, and there may be no guiding documents or surrogates available. This can leave clinicians in a bind. Neurological experts recently released updated ethical guidance that aims to help.

The guideline authors suggested clinicians follow wishes stated in advance care directives, if available, to treat stroke patients. However, these legal instruments often do not exist or are not readily available. Further, the authors noted the language contained therein can be confusing or vague. Other documents designate a family member as surrogate decision-maker, but that person may not be immediately available when treatment timing is critical.

Even if a surrogate decision-maker is available, he or she may struggle to decide next steps. The authors of the position statement offered suggestions to help neurologists guide this process. When no legal documents or surrogates are available, the position statement indicated clinicians may have to make some ethical presumptions of consent.

Other parts of the position statement include the latest best practices on stroke treatment as well as consent issues in acute stroke research. This position statement was written by members of a joint committee from the American Academy of Neurology (AAN), the American Neurological Association, and the Child Neurology Society. It replaces a 1999 AAN position paper and 2011 policy statement on this topic.

For more on this and related subjects, be sure to read the latest issues of Medical Ethics Advisor and Neurology Alert.