Deferral of Consent in Randomized Clinical Trials of Acute Stroke: Ethical, Methodologic, and Practical Challenges

Shared decision making and mutual trust form the basis of the physician-patient relationship, and information and consent are essential elements of that relationship. This is also true in a situation that calls for immediate action, aimed at improving outcome of a patient with acute stroke. In this issue of Neurology®, Faris et al.1 clearly described 5 important and concise checkpoints for implantation of deferral of consent (DOC). DOC means that a treatment of yet unproven benefit is allocated to patients in the context of a randomized trial, without their knowledge. Only after the treatment has been allocated and executed, the patients or their representatives are informed and asked for consent.