Patient rights and informed consent are a critical part of modern medicine. As a patient, you have the right to understand your condition, the treatments available to you and the potential risks connected to those treatment options. But what happens when you can’t speak for yourself?
When you arrive at the hospital with a life-threatening condition, time is of the essence. According to a recent article in Reuters Health, roughly one quarter of all adults would not want to receive a blood-clotting stroke drug called tissue plasminoegen activator (tPA) in the event that they could not make the decision themselves. This represents a serious ethical dilemma for many health professionals.
When a patient shows up at the hospital with a stroke, every second counts. This is true not just in terms of the administration of life-saving treatments but also those treatments aimed at preserving brain function and improving neurological recovery.
tPA can significantly improve the latter two possibilities but only when administered in the first three to four-and-a-half hours. One of the reasons that many patients are apprehensive of the drug is the risk it carries of bleeding in the brain. After a delay of more than a few hours, doctors say this risk begins to outweigh the potential benefits.
As the Reuters article points out, tPA is neither a life-saving nor a life-threatening drug. But for many older Americans, it represents a chance at something just as important as stroke survival. It represents the chance to recover your mobility, mental faculties and quality of life. To date though, the article notes, only 5% of stroke victims receive the treatment.
In the case of stroke or other incapacitating and life-threatening episode, informed consent constitutes one of the most challenging bioethical questions that physicians must face. Where tPA is concerned, most doctors would argue that the benefits of fast administration supersede the imperative of informed consent.
According to research recently published in the Journal of the American Medical Association (JAMA), clinicians may legally intervene with treatment of life-threatening emergencies involving incapacitated patients without informed consent. The risks involved in the use of tPA, however, make this assumptive intervention a great deal more complex, most especially because the treatment is not life preserving in nature.
It does bear noting that for many who were surveyed on the subject, the concept of informed consent overshadowed all other concerns. Just as with tPA, a quarter of study respondents said they would also wish not to receive CPR for cardiac arrest without first giving consent.
Physicians are very sensitive to the importance of informed consent. But for most, there is nothing that is more important than helping their patients make a full recovery. This is why, in recent years, the American Academy of Neurology and the American Heart Association/American Stroke Association have released statements endorsing the use of TPA without consent in patients who are incapacitated and lack advocacy.
Striking a Balance
As a patient, the best thing you can do to ensure that your wishes are met when the unthinkable happens is to assign a family member, caretaker or relation to serve as your surrogate. Find somebody who you can trust to represent your true wishes so that you are the one in control of your treatment even when you can’t speak for yourself.