Electroconvulsive therapy (ECT) is one of the most controversial therapies used in medicine today. While some psychiatrists believe that ECT is an effective, life-saving psychiatric treatment, others have grave concerns about its use and the associated side effects.
The term “informed consent” refers to the consent given by a patient to proceed with a therapeutic approach after they have been fully informed of the benefits and risks associated with the therapy. The patient’s written consent is obtained prior to initiation of an ECT treatment plan. A 2005 publication from the World Health Organization entitled “Human Rights and Legislation WHO Resource Book on Mental Health” states that ECT can be administered only after informed consent has been obtained from the patient.
In the United States, any doctor treating a patient is under a legal obligation to ensure that the patient understands the following points before they undergo ECT:
- The reason for the treatment
- The risks associated with the ECT treatment plan.
- The risks and benefits of alternative treatments at the stage of disease concerned
- The risks and benefits of not receiving any ECT therapy versus receiving therapy
Once these facts are explained, the patient is given the opportunity to reject or accept the treatment. At any time during the course of the treatment plan, the patient retains the right to refuse the treatment and revoke his or her informed consent.
Until 2009, the use of ECT to treat detained patients was allowed in England and Wales under the 1983 Mental Health Act, regardless of whether their consent had been obtained. However, the treatment could only be administered if it was authorized by a psychiatrist from the Mental Health Act Commission’s panel.
After 2009, the law was altered and now ECT cannot be given to any patient who is able to refuse consent. Emergency administration may still be allowed regardless of capacity to consent, if a psychiatrist says the treatment is urgently needed (under Section 62 of the Act).
Reviewed by Sally Robertson, BSc