Emergency management of acute ischemic stroke in incapacitated patients who have no surrogate decision makers

摘要

When hospitalized patients with acute ischemic stroke are unable to make their own medical decisions, clinicians usually turn to advance directives and the patient's close family members and friends to define the patient's wishes and expectations regarding treatment and prognosis. Inmany jurisdictions, if there is no surrogate for an incapacitated patient, an emergency ethics or risk management consultation is advisable and is usually done with a representative of the hospital's law office. The ethics team can represent the patient's interests by hearing the recommendations of the treating physicians and then deciding whether their recommended treatment plan is ethically permissible and in the patient's interests. Depending on the jurisdiction, it is sometimes necessary for the courts to appoint a guardian for incapacitated patients who have no surrogate decision makers available.