Context and principles must drive alternatives to consent in emergency research

摘要

Patients with traumatic brain injury and stroke are typically unconscious or too impaired to make decisions about participation in clinical trials. Improvements in the care of such patients depends on trials of interventions that often must be delivered very early after injury. In The Lancet Neurology, Erwin J O Kompanje and colleagues1 review the landscape of alternatives to informed consent in the context of clinical trials for acute brain trauma or ischaemic stroke. They conclude that researchers have too often been unaware of, or intimidated by, alternatives to prospective informed consent in these emergency settings. The authors' Personal View addresses important opportunities, but ethically addressing these issues requires greater nuance than their Personal View suggests.