With almost 800,000 strokes occurring each year in the United States, stroke is the fifth biggest cause of death. More than half of adults 65 and older who survive a stroke have limited mobility.
The most frequent kind of stroke is ischemic stroke, which is caused by an obstruction in blood flow to the brain.
“Stroke treatments that are capable of preserving brain function can only help if they are given quickly, sometimes within hours. However, consent for such treatments is often required when the person who has had a stroke lacks the ability to make decisions and those who could make decisions for them are unavailable.
“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,” says position statement author Justin A. Sattin, MD, of the University of Wisconsin in Madison.
When a person with a stroke is unable to give consent for treatment, advance health care directives may provide direction on their wishes, according to the AAN policy statement.
However, it claims that such directives, such as living wills, are sometimes unduly specific or ambiguous, addressing terminal but not debilitating diseases like stroke.
A power of attorney, or a person who acts as a surrogate decision maker, is another type of advance directive that can be employed. Surrogate decision-making authority may also be granted to relatives.
In the position statement, it says that a surrogate decision maker may not be ready to represent a stroke patient’s wishes. Neurologists may need to lead them, prioritizing a patient’s choices if they are documented, and determining what the person would desire based on their beliefs if they are not. When beliefs are unknown, it is suggested that decisions be made in the person’s best interests.
When a stroke patient requires immediate treatment and does not have an advance directive or a surrogate decision maker, the position statement states that therapies can be offered based on ethical presumptions of consent—what a person would consent to if asked.
“A stroke is a medical emergency, so by providing this ethical guidance, the American Academy of Neurology aims to help neurologists navigate issues concerning treatment consent so they can provide the highest quality patient care as quickly as possible, saving lives and improving patient outcomes,” added Orly Avitzur, MD, MBA, FAAN, President of the American Academy of Neurology.
When a generally accepted treatment, such as clot-busting medicines, is available, the position statement states that neurologists may proceed with treatment under the assumption of consent, if necessary.
When treatments necessitate a greater consideration of risks versus benefits, such as endovascular treatment, a procedure to remove a clot, the position statement states that the decision to proceed should be guided by how closely a person’s case matches what is currently recommended in treatment guidelines.
When there are treatments for which there is insufficient evidence, neurologists should collaborate with their medical institutions to develop treatment regimens, according to the statement.
Finally, the position statement states that while rules involving surrogate consent differ by state, the federal Common Norm, a research ethics rule, allows lawful surrogates to grant consent for stroke research.
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