A recent survey of people aged 50 or over has revealed that not everyone would consent to the use of certain types of medications immediately after having a stroke.

The drug in question is known as tissue plasminogen activator (tPA) and it serves to break up clots in the brain directly following the event of a stroke. Its purpose is not to save a person’s life, but it has been shown to preserve brain function, allowing a person more range in recovery and more independence after a major stroke.

But not everyone finds the benefits of tPA useful enough to consent to treatment. The study cited that nearly a quarter of those surveyed would not want to receive the treatment and would prefer to have it forgone in the event that they were unable to communicate during emergency treatment.

Most of the importance of these findings centers on the complicated ethical ground that medical professionals must maneuver when treating non-responsive patients. Often, there are conflicting senses of urgency between the immediate need for medical intervention and the need to respect the wishes of the patient.

Dr. Winston Chiong headed up the study, which also surveyed adults about their preferences in receiving CPR following cardiac arrest. The two sets of data were compared and revealed similar rates of individuals who would rather abstain from treatment in these circumstances. CPR is already widely practiced on patients who are unable to communicate and have no records of their wishes for treatment after a cardiac arrest. Currently, tPA and similar medications are only being given to roughly five percent of stroke patients.

Part of the reason for this low administration rate has to do with the time sensitive nature of the medication’s effectiveness. If given to a patient less than four and a half hours after a stroke, the medication poses few threats to the patient. However, if given after this time, it can cause life-threatening bleeding in the brain. “That’s been the main cause for reluctance on the part of many physicians to use this medicine, particularly when the patient can’t engage in a conversation about the risks and benefits,” said Chiong.

Among the reasons patients might chose to refrain from receiving medical interventions after a stroke is the perception that reduced function and dependence on family is worse than death. Experts encourage people to discuss their preferences with their families beforehand to avoid confusion or delay during an emergency.