• Kompanje Erwin J O EJO Department of Intensive Care Adult, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands; Department of Ethics and Philoso, van Dijck Jeroen T J M JTJM University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center & Haga Teaching Hospital, Leiden and The , Vicky Chalos, Sophie A van den Berg, Paula M Janssen, Paul J Nederkoorn, Mathieu van der Jagt, Giuseppe Citerio, Nino Stocchetti, Dippel Diederik W J DWJ Department of Neurology, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands., and Wilco C Peul.
• Department of Intensive Care Adult, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands; Department of Ethics and Philosophy of Medicine, Erasmus University, Rotterdam, The Netherlands. Electronic address: e.j.o.kompanje@erasmusmc.nl.
• Lancet Neurol. 2020 Dec 1; 19 (12): 1033-1042.

AbstractHealth-care professionals and researchers have a legal and ethical responsibility to inform patients before carrying out diagnostic tests or treatment interventions as part of a clinical study. Interventional research in emergency situations can involve patients with some degree of acute cognitive impairment, as is regularly the case in traumatic brain injury and ischaemic stroke. These patients or their proxies are often unable to provide informed consent within narrow therapeutic time windows. International regulations and national laws are criticised for being inconclusive or restrictive in providing solutions. Currently accepted consent alternatives are deferred consent, exception from consent, or waiver of consent. However, these alternatives appear under-utilised despite being ethically permissible, socially acceptable, and regulatorily compliant. We anticipate that, when the requirements for medical urgency are properly balanced with legal and ethical conduct, the increased use of these alternatives has the potential to improve the efficiency and quality of future emergency interventional studies in patients with an inability to provide informed consent.Copyright © 2020 Elsevier Ltd. All rights reserved.

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