Consent Issues in the Management of Acute Ischemic Stroke:AAN Position Statement

摘要

This position statement briefly reviews the principle of informed consent, the elements of decisional capacity, and how acute stroke may affect this capacity. It further reviews the role of surrogate decision-making, including advance directives, next of kin, physician orders for life-sustaining treatment, and guardianship. In some cases of acute stroke in which the patient lacks decisional capacity and no advance directives or surrogates are available, consent to treatment may be presumed. The document describes the rationale for this position and various considerations regarding its application to IV thrombolysis, neuroendovascular intervention, decompressive craniectomy, and pediatric stroke. The document also reviews consent issues in acute stroke research.Introduction:Despite recent advances in treatment and prevention, stroke remains the second leading cause of death worldwide and the fifth leading cause of death in the United States, with nearly 800,000 strokes occurring each year. There is a rapidly evolving repertoire of treatments that are highly effective in preserving neurologic function after stroke, but only if administered quickly, during a time when patients often lack decisional capacity and surrogate decision-makers may be unavailable. Whereas there are ethical issues surrounding many aspects of stroke prevention and treatment,1 this position statement, which replaces the American Academy of Neurology’s 1999 position paper2 as well as a 2011 policy statement, focuses specifically on issues of informed consent that arise in the context of acute ischemic stroke treatment.