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Inability to consent does not diminish the desirability of stroke thrombolysis
Author(s) -
Chiong Winston,
Kim Anthony S.,
Huang Ivy A.,
Farahany Nita A.,
Josephson S. Andrew
Publication year - 2014
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.24209
Subject(s) - thrombolysis , medicine , informed consent , cardiopulmonary resuscitation , stroke (engine) , intervention (counseling) , presumption , medical emergency , emergency medicine , intensive care medicine , resuscitation , psychiatry , myocardial infarction , alternative medicine , mechanical engineering , pathology , engineering , political science , law
Objective Some have argued that physicians should not presume to make thrombolysis decisions for incapacitated patients with acute ischemic stroke because the risks and benefits of thrombolysis involve deeply personal values. We evaluated the influence of the inability to consent and of personal health‐related values on older adults' emergency treatment preferences for both ischemic stroke and cardiac arrest. Methods A total of 2,154 US adults age ≥50 years read vignettes in which they had either suffered an acute ischemic stroke and could be treated with thrombolysis, or had suffered a sudden cardiac arrest and could be treated with cardiopulmonary resuscitation. Participants were then asked (1) whether they would want the intervention, or (2) whether they would want to be given the intervention even if their informed consent could not be obtained. We elicited health‐related values as predictors of these judgments. Results Older adults were as likely to want stroke thrombolysis when unable to consent (78.1%) as when asked directly (76.2%), whereas older adults were more likely to want cardiopulmonary resuscitation when unable to consent (83.6% compared to 75.9%). Greater confidence in the medical system and reliance on statistical information in decision making were both associated with desiring thrombolysis. Interpretation Older adults regard thrombolysis no less favorably when considering a situation in which they are unable to consent. These findings provide empirical support for recent professional society recommendations to treat ischemic stroke with thrombolysis in appropriate emergency circumstances under a presumption of consent. Ann Neurol 2014;76:296–304