Perhaps most limiting to the capacity assessment of patients with acute stroke is the time pressure caused by the narrow therapeutic window of intravenous thrombolysis. Intravenous rtPA for acute ischemic stroke should be used only within 3 hours of stroke onset,60 and the evidence is clear that better outcomes are obtained with earlier treatment.61 An involved capacity assessment and consent process in the setting of acute stroke could delay treatment and, therefore, reduce the benefit of intravenous thrombolysis. This is especially true when delays already found along the patient pathway are also considered. A systematic review of the literature62 identified 9 studies reporting mean delay times from stroke onset to arrival at US or European hospitals and 27 studies worldwide that reported mean delay times from arrival at the hospital to first assessment by a physician; the shortest mean delays reported were 1.9 hours and 0.3 hours, respectively. This suggests that, at best, there is an average delay of 2.2 hours before computed tomography, necessary to make the diagnosis of ischemic stroke, is even undertaken. Although times may be significantly better than average in centers specifically organized to treat stroke, it is, nevertheless, clear that, given the time pressure, many of the strategies used to assess capacity in the cognitively impaired, including multiple repetitions of the disclosure,34,56,63 multiple meetings for the purpose of disclosure, and time-intensive educational strategies,57,64 cannot be used.