There have been arguments as to whether these approaches meet the needs of these patients, since care approaches based on the current guidelines have shown deterioration of the quality of life of these patients significantly, mainly due to the loss of autonomy of these patients. This concept of loss of autonomy stands prominent since many patients with stroke lose their capabilities of communication, and in this scenario, maintenance of ethical standards in nursing care become extremely problematic.
Since stroke may be associated with impairments, seeking consents from these patients in the area of care is not only an ethical requirement. Consent implies patient's participation and grants autonomy to the patient. Cohen (1991) commented that care delivered with inappropriate or inadequate consent bears the risk of inadequacy of care provision and support, and this becomes more intense in patients with stroke who are dependent and who may have perceived deterioration of mental capacity and impairment of communication due to stroke. Explanation of treatment, care, and seeking their permission to proceed with the care delivery process also ensures understanding of the individual with stroke which cannot be offered by just medical, cognitive, and functional assessments. Consent also reflects a person's thoughts, feelings, beliefs, and desires about his care. Conformity with the consent procedure allows the care processes to be responsive, flexible, person-centered, and need oriented (Keady et al. 1995). As far as nursing in neurosciences is concerned, the concept of gaining consent is applicable both for acute hospital setting and the rehabilitation setting. It is well known from the available researches that the stroke patients consider their experiences with the available rehabilitation services as less than adequate since they rarely include patients' autonomous choices. Although there are ample literature on the topic of patient autonomy, literatures examining the consent procedure in stroke patients fail to examine the issue of validity of gaining consent by neuroscience nurses adequately and beyond doubt. This clout is further aggravated by the fact that three basic ethical concepts of autonomy implied in the process of gaining consent, namely, self-governance, self-realisation, and actual autonomy are devoid of empiric evidence, although philosophical and theoretical discussions are available. Whatever empiric evidence is available mainly centre around permanent residents of nursing homes, where in reality neuroscience nurses deliver care.
It is important to note that consent is related to self-determination, which is affected during or after stroke when the patient needs rehabilitation. Thus making choices about own treatment and making decisions about own health and treatment is put to test in a consent procedure, which may even include the choice of the therapist. In a patient with stroke, independence is grossly affected, and this may affect the consent in the true sense of the term. As indicated by Doyal (1997) had commented that informed consent may not be necessary in unconscious or semi-conscious patients, which often is the case in case of patients with stroke. Mangset et al. (2008) defined