Testing the Presumption of Consent to Emergency Treatment for Acute Ischemic Stroke

In life-threatening emergencies involving incapacitated patients without surrogates, clinicians may intervene without obtaining informed consent, applying the presumption that reasonable people would consent to treatment in such circumstances. Whether this rationale applies to treatment of acute ischemic stroke with intravenous thrombolysis is controversial, as this intervention improves functional outcomes but is not life-preserving.1 Nonetheless, the presumption of consent to thrombolysis for ischemic stroke has recently been endorsed by professional societies.2,3 Previous empirical studies of preferences for emergency treatment have been limited to surveys of convenience samples that were not demographically representative. We evaluated the presumption of consent by comparing preferences for treatment of acute ischemic stroke with thrombolysis and treatment of sudden cardiac arrest with cardiopulmonary resuscitation (CPR, in which the presumption of consent is generally accepted) in a nationally representative sample of older U.S. adults.