It is widely acknowledged internationally that obtaining the written, informed consent of the patient is important before ECT is administered.
The World Health Organization, in its 2005 publication "Human Rights and Legislation WHO Resource Book on Mental Health," specifically states, "ECT should be administered only after obtaining informed consent."
In the US, this doctrine places a legal obligation on a doctor to make a patient aware of: the reason for treatment, the risks and benefits of a proposed treatment, the risks and benefits of alternative treatment, and the risks and benefits of receiving no treatment.
The patient is then given the opportunity to accept or reject the treatment.
The form states how many treatments are recommended and also makes the patient aware that the treatment may be revoked at anytime during a course of ECT.
In the UK, in order for consent to be valid it requires an explanation in "broad terms" of the nature of the procedure and its likely effects.
One review from 2005 found that only about half of patients felt they were given sufficient information about ECT and its adverse effects and another survey found that about fifty percent of psychiatrists and nurses agreed with them.
Until 2009 in England and Wales, the Mental Health Act 1983 allowed the use of ECT on detained patients whether or not they had capacity to consent to it, so long as the treatment was likely to alleviate or prevent deterioration in a condition and was authorized by a psychiatrist from the Mental Health Act Commission's panel.
However, following amendments which took effect in 2009, ECT may not be given to a patient who has capacity to refuse to consent to it, irrespective of his or her detention under the Act, although treatment may still be given to capacious patients in an emergency under Section 62 of the Act.
If the treating psychiatrist thinks the need for treatment is urgent they may start a course of ECT before authorization.
About 2,000 people a year in England and Wales are treated without their consent under the Mental Health Act.
In Scotland the Mental Health (Care and Treatment) (Scotland) Act 2003 also gives patients with capacity the right to refuse ECT.
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