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Informed consent for emergency research.

To the Editor. —The Consensus Statement on informed consent in emergency research 1 is a needed plea for direction and sensibility to enable researchers to pursue socially desirable research in emergency care. Nonetheless, the statement under-emphasizes the legitimate role prior expressions of treatment desires by competent patients should play in such research. First, no distinction is drawn between patients who are in the care of physicians in a hospital and those not in the care of physicians at the time an emergency arises. The authors consider securing prospective consent from patients when they are admitted to the hospital, but dismiss it. They assert that patients may not consider their options carefully if there is only a remote chance of study entry, and thus they may not be protected adequately from research risks. The reasoning behind this conclusion is flawed and the result unacceptably paternalistic. It is wrong to presume that