Download PDF
Semin Neurol 2018; 38(05): 515-521
DOI: 10.1055/s-0038-1667383
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ethical Issues in Vascular Neurology

Natalie C. Wheeler
1   Department of Neurology, University of Wisconsin, Madison, Wisconsin
,
Sadhana Murali
1   Department of Neurology, University of Wisconsin, Madison, Wisconsin
,
Justin A. Sattin
1   Department of Neurology, University of Wisconsin, Madison, Wisconsin
› Author Affiliations
Further Information

Publication History

Publication Date:
15 October 2018 (online)

    Permissions and Reprints

Abstract

There are ethical aspects to each of the three phases of cerebrovascular disease: hyperacute management, acute prognostication and management of early complications, and long-term recovery and reintegration with the community. This article addresses ethical concerns pertinent to each phase. First, we discuss ethical issues regarding consent for thrombolysis and endovascular treatment for acute ischemic stroke, including a review of considerations regarding the provision of acute stroke treatment advice over the telephone. Next, we discuss capacity for consent and prognostication after ischemic stroke and intracranial hemorrhage, with a focus on the problems of the self-fulfilling prophecy. Finally, we discuss residual disability and patients' return to driving. Consideration of these ethical dimensions of cerebrovascular disease will assist neurologists in caring for patients and families suffering from this complex condition.

Keywords

stroke - ethics - capacity - consent - prognostication
 

  • References

  • 1 Benjamin EJ, Virani SS, Callaway CW. , et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2018 Update: a report from the American Heart Association. Circulation 2018; 137 (12) e67-e492
    CrossrefPubMedGoogle Scholar
  • 2 Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 7th ed. New York: Oxford University Press; 2013
    Google Scholar
  • 3 National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333 (24) 1581-1587
    CrossrefPubMedGoogle Scholar
  • 4 Hacke W, Donnan G, Fieschi C. , et al; ATLANTIS Trials Investigators; ECASS Trials Investigators; NINDS rt-PA Study Group Investigators. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 2004; 363 (9411): 768-774
    CrossrefPubMedGoogle Scholar
  • 5 Murtagh MJ, Burges Watson DL, Jenkings KN. , et al. Situationally-sensitive knowledge translation and relational decision making in hyperacute stroke: a qualitative study. PLoS One 2012; 7 (06) e37066
    CrossrefPubMedGoogle Scholar
  • 6 Buchan AM, Barber PA, Newcommon N. , et al. Effectiveness of t-PA in acute ischemic stroke: outcome relates to appropriateness. Neurology 2000; 54 (03) 679-684
    CrossrefPubMedGoogle Scholar
  • 7 Lopez-Yunez AM, Bruno A, Williams LS, Yilmaz E, Zurrú C, Biller J. Protocol violations in community-based rTPA stroke treatment are associated with symptomatic intracerebral hemorrhage. Stroke 2001; 32 (01) 12-16
    CrossrefPubMedGoogle Scholar
  • 8 Lyerly MJ, Albright KC, Boehme AK. , et al. Safety of protocol violations in acute stroke tPA administration. J Stroke Cerebrovasc Dis 2014; 23 (05) 855-860
    CrossrefPubMedGoogle Scholar
  • 9 American Academy of Neurology. Policy on Consent Issues for the Administration of IV tPA. Available at: http://buyabrain.net/globals/axon/assets/8847.pdf . Accessed March 11, 2018
    PubMedGoogle Scholar
  • 10 Powers WJ, Derdeyn CP, Biller J. , et al; American Heart Association Stroke Council. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015; 46 (10) 3020-3035
    CrossrefPubMedGoogle Scholar
  • 11 Albers GW, Marks MP, Kemp S. , et al; DEFUSE 3 Investigators. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018; 378 (08) 708-718
    CrossrefPubMedGoogle Scholar
  • 12 Nogueira RG, Jadhav AP, Haussen DC. , et al; DAWN Trial Investigators. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018; 378 (01) 11-21
    Google Scholar
  • 13 Sattin JA. Telephone consultations for tissue plasminogen activator administration in acute stroke. Continuum (Minneap Minn) 2014; 20 (2 Cerebrovascular Disease): 429-435
    PubMedGoogle Scholar
  • 14 Meyer BC, Raman R, Hemmen T. , et al. Efficacy of site-independent telemedicine in the STRokE DOC trial: a randomised, blinded, prospective study. Lancet Neurol 2008; 7 (09) 787-795
    CrossrefPubMedGoogle Scholar
  • 15 Chen Y, Bogosavljevic V, Leys D, Jovanovic D, Beslac-Bumbasirevic L, Lucas C. Intravenous thrombolytic therapy in patients with stroke mimics: baseline characteristics and safety profile. Eur J Neurol 2011; 18 (10) 1246-1250
    CrossrefPubMedGoogle Scholar
  • 16 Zinkstok SM, Engelter ST, Gensicke H. , et al. Safety of thrombolysis in stroke mimics: results from a multicenter cohort study. Stroke 2013; 44 (04) 1080-1084
    CrossrefPubMedGoogle Scholar
  • 17 Olick RS, Bergus GR. Malpractice liability for informal consultations. Fam Med 2003; 35 (07) 476-481
    PubMedGoogle Scholar
  • 18 Appelbaum PS. Clinical practice. Assessment of patients' competence to consent to treatment. N Engl J Med 2007; 357 (18) 1834-1840
    CrossrefPubMedGoogle Scholar
  • 19 Grisso T, Appelbaum PS, Hill-Fotouhi C. The MacCAT-T: a clinical tool to assess patients' capacities to make treatment decisions. Psychiatr Serv 1997; 48 (11) 1415-1419
    CrossrefPubMedGoogle Scholar
  • 20 Marson DC, Ingram KK, Cody HA, Harrell LE. Assessing the competency of patients with Alzheimer's disease under different legal standards. A prototype instrument. Arch Neurol 1995; 52 (10) 949-954
    CrossrefPubMedGoogle Scholar
  • 21 Wilks I. The debate over risk-related standards of competence. Bioethics 1997; 11 (05) 413-426
    CrossrefPubMedGoogle Scholar
  • 22 The Patient Self Determination Act, Pub. L. No. 101–508, §§4206 & 4751, 104 Stat. 1388 (codified in 42 USC §§ 1395cc(f), 1396a(w) (1994))
    PubMed
  • 23 Fried TR, Zenoni M, Iannone L, O'Leary J, Fenton BT. Engagement in advance care planning and surrogates' knowledge of patients' treatment goals. J Am Geriatr Soc 2017; 65 (08) 1712-1718
    CrossrefPubMedGoogle Scholar
  • 24 Downey L, Au DH, Curtis JR, Engelberg RA. Life-sustaining treatment preferences: matches and mismatches between patients' preferences and clinicians' perceptions. J Pain Symptom Manage 2013; 46 (01) 9-19
    CrossrefPubMedGoogle Scholar
  • 25 Winter L, Parks SM, Diamond JJ. Ask a different question, get a different answer: why living wills are poor guides to care preferences at the end of life. J Palliat Med 2010; 13 (05) 567-572
    CrossrefPubMedGoogle Scholar
  • 26 Lackland DT, Roccella EJ, Deutsch AF. , et al; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; Council on Functional Genomics and Translational Biology. Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association. Stroke 2014; 45 (01) 315-353
    CrossrefPubMedGoogle Scholar
  • 27 Zahuranec DB, Morgenstern LB, Sánchez BN, Resnicow K, White DB, Hemphill III JC. Do-not-resuscitate orders and predictive models after intracerebral hemorrhage. Neurology 2010; 75 (07) 626-633
    CrossrefPubMedGoogle Scholar
  • 28 Kelly AG, Hoskins KD, Holloway RG. Early stroke mortality, patient preferences, and the withdrawal of care bias. Neurology 2012; 79 (09) 941-944
    CrossrefPubMedGoogle Scholar
  • 29 Morgenstern LB, Zahuranec DB, Sánchez BN. , et al. Full medical support for intracerebral hemorrhage. Neurology 2015; 84 (17) 1739-1744
    CrossrefPubMedGoogle Scholar
  • 30 Zahuranec DB, Brown DL, Lisabeth LD. , et al. Early care limitations independently predict mortality after intracerebral hemorrhage. Neurology 2007; 68 (20) 1651-1657
    CrossrefPubMedGoogle Scholar
  • 31 Hemphill III JC, Newman J, Zhao S, Johnston SC. Hospital usage of early do-not-resuscitate orders and outcome after intracerebral hemorrhage. Stroke 2004; 35 (05) 1130-1134
    CrossrefPubMedGoogle Scholar
  • 32 Hemphill III JC, Greenberg SM, Anderson CS. , et al; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015; 46 (07) 2032-2060
    CrossrefPubMedGoogle Scholar
  • 33 Fried TR, Bradley EH, Towle VR, Allore H. Understanding the treatment preferences of seriously ill patients. N Engl J Med 2002; 346 (14) 1061-1066
    CrossrefPubMedGoogle Scholar
  • 34 Hanger HC, Fogarty B, Wilkinson TJ, Sainsbury R. Stroke patients' views on stroke outcomes: death versus disability. Clin Rehabil 2000; 14 (04) 417-424
    CrossrefPubMedGoogle Scholar
  • 35 Albrecht GL, Devlieger PJ. The disability paradox: high quality of life against all odds. Soc Sci Med 1999; 48 (08) 977-988
    CrossrefPubMedGoogle Scholar
  • 36 Kiphuth IC, Köhrmann M, Kuramatsu JB. , et al. Retrospective agreement and consent to neurocritical care is influenced by functional outcome. Crit Care 2010; 14 (04) R144
    CrossrefPubMedGoogle Scholar
  • 37 Holloway RG, Benesch CG, Burgin WS, Zentner JB. Prognosis and decision making in severe stroke. JAMA 2005; 294 (06) 725-733
    CrossrefPubMedGoogle Scholar
  • 38 Holloway RG, Arnold RM, Creutzfeldt CJ. , et al; American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, and Council on Clinical Cardiology. Palliative and end-of-life care in stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45 (06) 1887-1916
    CrossrefPubMedGoogle Scholar
  • 39 Anstey KJ, Wood J, Lord S, Walker JG. Cognitive, sensory and physical factors enabling driving safety in older adults. Clin Psychol Rev 2005; 25 (01) 45-65
    CrossrefPubMedGoogle Scholar
  • 40 Devos H, Akinwuntan AE, Nieuwboer A, Truijen S, Tant M, De Weerdt W. Screening for fitness to drive after stroke: a systematic review and meta-analysis. Neurology 2011; 76 (08) 747-756
    CrossrefPubMedGoogle Scholar
  • 41 Marshall SC, Molnar F, Man-Son-Hing M. , et al. Predictors of driving ability following stroke: a systematic review. Top Stroke Rehabil 2007; 14 (01) 98-114
    CrossrefPubMedGoogle Scholar
  • 42 Winstein CJ, Stein J, Arena R. , et al; American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2016; 47 (06) e98-e169
    PubMedGoogle Scholar
  • 43 American Medical Association. Declaration of Professional Responsibility. 2000: 144–45 in Code of Medical Ethics 2000–2001 Edition xiv. Chicago, IL: American Medical Association;
    Google Scholar
  • 44 Department of Health & Human Services Aging and Disability Services Division. Quick Facts Regarding Cognitive Impairment and Age Related License Restrictions. Available at: http://adsd.nv.gov/uploadedFiles/adsdnvgov/content/Boards/TaskForceAlzheimers/StateRegulationsDementiaandDriving.pdf . Accessed March 13, 2018
    PubMedGoogle Scholar
  • 45 Berger JT, Rosner F, Kark P, Bennett AJ. ; The Committee on Bioethical Issues of the Medical Society of the State of New York. Reporting by physicians of impaired drivers and potentially impaired drivers. J Gen Intern Med 2000; 15 (09) 667-672
    CrossrefPubMedGoogle Scholar
  • 46 Bacon D, Fisher RS, Morris JC, Rizzo M, Spanaki MV. American Academy of Neurology position statement on physician reporting of medical conditions that may affect driving competence. Neurology 2007; 68 (15) 1174-1177
    CrossrefPubMedGoogle Scholar