Issues with consent in stroke patients

Abstract

Background: Consent in stroke management may be required for either treatment, intervention or for research reasons. Consent capacity is an integral element of informed consent to treatment which requires that a patient's consent be voluntary, informed and competent. Without proper informed consent, medical treatment provided to a patient is a legal and ethical minefield, even if the treatment is benign and intended to benefit the patient. Results: Recent advances have enabled dramatic recovery in some stroke victims, transforming the previously generally negative outcomes of stroke care, whereas others face varying levels of disability. Explaining and sharing such details with patients and their families is essential. If this is not possible then there are other options such as emergency consent which may be justified in specific scenarios. Stroke may affect various areas of the brain and this may also include the prefrontal cortex which is involved in decision-making. There have been observations that individuals with damage to the ventromedial prefrontal cortex may be prone to impulsive decision-making in real life and these patients are impaired on laboratory decision-making tasks that require balancing rewards, punishments and risk. This may therefore have an impact on consent decisions made by the patient. Conclusion: Ethical clinical research requires balancing several ethical requirements, including the requirement for scientific validity and the requirement to respect individuals by treating them as autonomous agents through the process of informed consent. Opportunities to improve on public awareness about stroke are essential to change the perception of this potentially devastating disorder.