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

Justin A Sattin; Winston Chiong; Richard J Bonnie; Matthew P Kirschen; James A Russell; Ethics, Law, and Humanities Committee, a joint committee of the American Academy of Neurology, American Neurological Association, and Child Neurology Society

doi:10.1212/WNL.0000000000013040

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

Neurology. 2022 Jan 11;98(2):73-79. doi: 10.1212/WNL.0000000000013040.

Authors

Justin A Sattin¹, Winston Chiong², Richard J Bonnie², Matthew P Kirschen², James A Russell²; Ethics, Law, and Humanities Committee, a joint committee of the American Academy of Neurology, American Neurological Association, and Child Neurology Society

Affiliations

¹ From the Department of Neurology (J.A.S.), University of Wisconsin, Madison; Department of Neurology (W.C.), University of California San Francisco; Institute of Law, Psychiatry and Public Policy (R.J.B.), University of Virginia School of Law, Charlottesville; Department of Anesthesiology and Critical Care Medicine (M.P.K.), University of Pennsylvania, Philadelphia; and Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA. sattin@neurology.wisc.edu.
² From the Department of Neurology (J.A.S.), University of Wisconsin, Madison; Department of Neurology (W.C.), University of California San Francisco; Institute of Law, Psychiatry and Public Policy (R.J.B.), University of Virginia School of Law, Charlottesville; Department of Anesthesiology and Critical Care Medicine (M.P.K.), University of Pennsylvania, Philadelphia; and Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA.

PMID: 35312627
DOI: 10.1212/WNL.0000000000013040

Abstract

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.

MeSH terms

Advance Directives
Child
Decision Making
Humans
Informed Consent
Ischemic Stroke*
Stroke* / therapy