Yes, this the brave future imagined by pro-tPA colleagues: there are neurologists in a van down by the river, and they’ll drive right to your house and give you tPA – without your consent!
This is a research letter from JAMA, in which researchers from UCSF performed a survey of patient preferences through an online cohort representative of the adult U.S. population over 50 years of age. These authors, as they would lead you to believe, asked participants to compare their desire to receive CPR after cardiac arrest with their desire to receive tPA after a stroke. 75.9% of surveyed participants wanted CPR and 76.2% wanted tPA. Therefore, these authors conclude:
“… there are equally strong empirical grounds for presuming individual consent to thrombolysis for stroke as for presuming individual consent to CPR.”
I am not an ethicist, so I’m unable to precisely articulate how odd this comparison is at face value. Would any therapy patients would choose 75% of time mean we ought to presume consent? Is CPR the “gold standard” for emergency consent? There are interesting questions regarding how this data ought to be interpreted in the context of emergency consent I’m not qualified to answer.
However, I am qualified to comment on their methodology, i.e., the best way to get the answer you want: ask a question in such a way they’ll answer how you intend. How did they ask patients if they wanted CPR? They showed them a “depiction of probabilistic outcomes after paramedic-initiated CPR”. This depiction is not provided in the text, only a reference to an article they used to make it. For tPA? They used a graphical depiction of the benefits of tPA from this article. They do not specify which graphical depiction they used, but the final product of the previous pro-tPA physicians was this, Figure 3:
With a graphic like this, is it any wonder the patients surveyed were amenable to tPA? Interestingly, the authors who created the graphical depiction state this graphic “complements the numeric text of a national patient education tool developed jointly by US neurology, emergency medicine, and stroke patient organizations.” The link in their citations is broken, but I have found a reproduction here, which contains the following fantastic isolated quote:
“If given promptly, 1 in 3 patients who receive tPA resolve their symptoms or have major improvement in their stroke symptoms.”
It boggles the mind ACEP was complicit in approving this horrible flyer. As you can now see, this seemingly trivial document has since catastrophically mutated into the terrifying basis of giving tPA without informed consent.
“Testing the Presumption of Consent to Emergency Treatment for Acute Ischemic Stroke”
http://jama.jamanetwork.com/article.aspx?articleid=1861784