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Volume 16
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10.3390/brainsci16060621
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Review

Informed Consent in Patients with Aphasia: Scoping Review of Clinical Decision-Making Tools and Medico-Legal Issues

by
Lara Brunasso
1,†,
Rosario Maugeri
2,†,
Giuseppe Pio Cipollina
2,
Simona Pellerito
3,
Stefania Zerbo
3,
Ginevra Malta
3,
Giovanni Grasso
2,
Domenico Gerardo Iacopino
2,
Antonina Argo
3 and
Giuseppe Davide Albano
3,*
1
Neurosurgery Unit, University Hospital of Parma, 43126 Parma, Italy
2
Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, 90133 Palermo, Italy
3
Institute of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Brain Sci. 2026, 16(6), 621; https://doi.org/10.3390/brainsci16060621
Submission received: 30 April 2026 / Revised: 3 June 2026 / Accepted: 6 June 2026 / Published: 10 June 2026
(This article belongs to the Section Neurosurgery and Neuroanatomy)
Versions Notes

Abstract

Informed consent is a core ethical and legal requirement in clinical practice. For individuals with aphasia, language impairments can hinder communication during consent processes. However, aphasia is primarily a language disorder and does not inherently imply cognitive impairment, a distinction frequently overlooked in clinical and legal settings. This scoping review examines how decision-making capacity (DMC) is assessed and supported in adults with aphasia, and outlines the clinical, ethical, and medico-legal implications for consent procedures. The review followed PRISMA-ScR guidelines. A systematic search of biomedical and legal databases was conducted without time restrictions. Studies addressing informed consent or DMC in adults with aphasia were included and analyzed using a qualitative thematic approach. Out of 519 records, 9 studies (2010–2024) from Australia, Canada, the United Kingdom, and Ireland met inclusion criteria. These studies often referenced national legislation and rights-based frameworks to define clinical responsibilities. Three main themes emerged: (1) DMC assessments rely heavily on language, with limited involvement of speech–language pathologists (SLPs), despite their role in reducing bias; (2) supported communication strategies—such as simplified language, visual aids, alternative response formats, and structured tools—can uncover “hidden competence”; and (3) structural barriers, including time constraints, insufficient training, and limited access to aphasia services, restrict implementation. Current evidence remains limited, largely qualitative, and insufficient to support definitive clinical recommendations. Incorporating supported communication, multidisciplinary assessment, and thorough documentation may enhance fairness and legal robustness. Future research should focus on validating aphasia-sensitive tools and evaluating their impact on outcomes and medico-legal risk.
Keywords: aphasia; informed consent; decision-making capacity; supported communication; speech–language pathology; medico-legal framework aphasia; informed consent; decision-making capacity; supported communication; speech–language pathology; medico-legal framework

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MDPI and ACS Style

Brunasso, L.; Maugeri, R.; Cipollina, G.P.; Pellerito, S.; Zerbo, S.; Malta, G.; Grasso, G.; Iacopino, D.G.; Argo, A.; Albano, G.D. Informed Consent in Patients with Aphasia: Scoping Review of Clinical Decision-Making Tools and Medico-Legal Issues. Brain Sci. 2026, 16, 621. https://doi.org/10.3390/brainsci16060621

AMA Style

Brunasso L, Maugeri R, Cipollina GP, Pellerito S, Zerbo S, Malta G, Grasso G, Iacopino DG, Argo A, Albano GD. Informed Consent in Patients with Aphasia: Scoping Review of Clinical Decision-Making Tools and Medico-Legal Issues. Brain Sciences. 2026; 16(6):621. https://doi.org/10.3390/brainsci16060621

Chicago/Turabian Style

Brunasso, Lara, Rosario Maugeri, Giuseppe Pio Cipollina, Simona Pellerito, Stefania Zerbo, Ginevra Malta, Giovanni Grasso, Domenico Gerardo Iacopino, Antonina Argo, and Giuseppe Davide Albano. 2026. "Informed Consent in Patients with Aphasia: Scoping Review of Clinical Decision-Making Tools and Medico-Legal Issues" Brain Sciences 16, no. 6: 621. https://doi.org/10.3390/brainsci16060621

APA Style

Brunasso, L., Maugeri, R., Cipollina, G. P., Pellerito, S., Zerbo, S., Malta, G., Grasso, G., Iacopino, D. G., Argo, A., & Albano, G. D. (2026). Informed Consent in Patients with Aphasia: Scoping Review of Clinical Decision-Making Tools and Medico-Legal Issues. Brain Sciences, 16(6), 621. https://doi.org/10.3390/brainsci16060621

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