Article

Is informed consent a "yes or no" response? Enhancing the shared decision-making process for persons with aphasia.

Stroke/Neurology Rehabilitation Program, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Topics in Stroke Rehabilitation (impact factor: 0.95). 02/2006; 13(4):42-6. DOI:10.1310/tsr1304-42 pp.42-6
Source: PubMed

ABSTRACT Respect for patient autonomy and the need to have a comprehensive discussion of the risks and benefits of a medical intervention are two important issues involved in the process of obtaining informed consent. In dealing with individuals with aphasia, there may be particular challenges in balancing these two ethical imperatives. Although decision-making capacity may be preserved with aphasia, the patients' ability to fully participate in a dialogue regarding a proposed medical intervention is frequently impaired. We propose a process of enhancing informed consent for persons with aphasia while continuing to respect and enhance patient autonomy and the exercise of decision making for these patients. The use of a patient-selected "helper" during the informed consent process can improve the quality of the informed consent, while reserving final decision-making authority for the patient.

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  • Article: Transcranial direct current stimulation and aphasia: the case of mr. C.
    Leora R Cherney, Edna M Babbitt, Rosalind Hurwitz, Lynn M Rogers, James Stinear, Xue Wang, Richard L Harvey, Todd Parrish
    [show abstract] [hide abstract]
    ABSTRACT: Purpose: To illustrate the ethical challenges that arose from investigating a novel treatment procedure, transcranial direct current stimulation (tDCS), in a research participant with aphasia. Method: We review the current evidence supporting the use of tDCS in aphasia research, highlighting methodological gaps in our knowledge of tDCS. Then, we examine the case of Mr. C, a person with chronic aphasia who participated in a research protocol investigating the impact of tDCS on aphasia treatment. We describe the procedures that he underwent and the resulting behavioral and neurophysiological outcomes. Finally, we share the steps that were taken to balance beneficence and nonmaleficence and to ensure Mr. C's autonomy. Results: The objective data show that while Mr. C may not have benefitted from participating in the research, neither did he experience any harm. Conclusion: Researchers must consider not only the scientific integrity of their studies, but also potential ethical issues and consequences to the research participants.
    Topics in Stroke Rehabilitation 20(1):5-21. · 0.95 Impact Factor
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Keywords

aphasia
 
decision-making capacity
 
helper
 
informed consent
 
informed consent process
 
medical intervention
 
patient autonomy
 
patient-selected
 
patients
 
patients' ability
 
persons
 
proposed medical intervention
 
reserving final decision-making authority
 
two ethical imperatives
 

Joel Stein