Ethical issues in research with patients who have experienced stroke

There are a myriad of ethical issues surrounding inclusion of persons who have had strokes into clinical research. Assessment of decision-making capacity is especially challenging as stroke can impair communication such that the patient appears to lack decision-making capacity or can impair executive function and preserve expressive language so that it appears the patient has capacity when he or she may not. Other issues such as vulnerability, therapeutic misconception, surrogate decision making, and other concerns unique to persons who have had strokes are discussed. Recommendations of national commissions are described.