Inability to fulfill elements of decisional capacity coupled with need for rapid treatment decisions complicates consent
WEDNESDAY, Jan. 19, 2022 (HealthDay News) — Issues relating to consent for people who have experienced acute ischemic stroke are addressed in an American Academy of Neurology position statement published online Jan. 10 in Neurology.
Justin A. Sattin, M.D., from the University of Wisconsin in Madison, and colleagues reviewed the principle of informed consent and how acute stroke may impact the elements of decisional capacity.
The authors note that elements of informed consent include disclosure of relevant information, recommendation of a plan, and patient authorization of the recommended course of action. This framework presumes that the patient has decisional capacity, which requires understanding, appreciation, reasoning, and choice. Obtaining informed consent can be complicated by a sudden, unexpected onset of the inability to fulfill one or more of these elements, coupled with the necessity to make rapid treatment decisions about interventions such as thrombolysis and thrombectomy. For adult patients, a measure of autonomy can be preserved if care can be directed by preferences previously expressed by the patient — either advance directives, which specify interventions that patients anticipate they would accept or reject, or appointment of a surrogate decision maker, which can allow for greater flexibility in decision-making. For pediatric stroke, the lack of data on efficacy and safety of therapeutic options can complicate the counseling of families regarding the risks and benefits of therapy.
“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,” Sattin said in a statement.
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