Ect Legal Issues
Summary of the latest published findings on ECT and discussion of the ethical and legal implications of its use, informed by the empirical description of a clinical vignette. Although there is agreement in the literature on the syndromes or target diseases for which ECT is indicated, there appear to be disagreements about contemporary standards of care before starting treatment. In particular, the issues of consent of a person with acute mental illness and consultation or assessment by a second psychiatrist (called a psychiatrist with ECT privileges) remain controversial.2,8,9 Essentially, it is agreed that the person giving or refusing consent must be competent, informed, free from coercion and of legal age10 to consent to ECT. In general, it is recognized that competence can be affected by the underlying symptoms of mental illness. In cases where consent or rejection is based on a thought that indicates or is severely impaired by mental illness, psychiatrists are advised to consider the patient incapable of consenting.10,11 However, there is no generally accepted, validated, replicated and standardized proficiency test related to ECT.10 As with involuntary administration of neuroleptics, the unintentional use of ECT as a treatment modality adds another level of complexity to the process. The applicable laws and regulations of the 50 states, the District of Columbia and Puerto Rico were reviewed. The LexisNexis legal search engine was used to access laws and administrative codes. In addition, the psychological and psychiatric literature was reviewed with PsychInfo and PubMed respectively. From 1972 to April 2006, the PsychInfo search engine generated 2281 articles with the search terms “electroconvulsive therapy” and “shock therapy”. When the word “standard$” was added and the search was limited to Articles in English that deal with persons and were published after 2000, 32 articles were selected.
Abstracts of these articles were reviewed to ensure they were appropriate. The keyword “electroconvulsive and standard therapy” was entered into the PubMed search engine on April 22, 2006 and resulted in 258 articles. When the research was limited to “published in the last 10 years”, in English, treated with people, in a “basic clinical journal” and with adults over 18 years of age, an article was recovered. The content of articles, administrative codes, and legal laws has been compared to The American Psychiatric Association (APA)7 guidelines and JCAHO requirements.9 Although electroconvulsive therapy (ECT) is highly effective in treating many psychiatric disorders, it is heavily regulated by government bylaws and laws.1-3 Some have suggested that the regulatory influence of patient advocates and special stakeholders were motivated. and therefore differ in each state.1 Others have suggested that “. gradual penetration of state power in areas traditionally in the field of medical judgment. and “. the comprehensive safety precautions adopted by the psychiatric community [for the use of ECT]… ” existed before the legal regulation (Az. 2, p. 1349). Finally, some believe that the legal regulation of ECT is a phenomenon related to its overuse when it was first available as a therapeutic treatment modality in the late 1930s.3 Whatever the reasons, it is clear that ECT is one of the most regulated psychiatric treatments currently available. Today, the use of electroconvulsive therapy (ECT) is blocked in legal regulations.
Obtaining valid informed consent before administering the ECT is the duty of the treating psychiatrist; Failure to obtain such consent is the most common area of professional compensation. The trend towards increasing judicial review of ECT has created clinical and ethical dilemmas, particularly in the context of the emerging concept of the right to effective treatment. Doctors don`t know exactly how it works, but they believe it “resets” the trembling parts of the brain. It is legal in the United States, although it is illegal to give it to patients under the age of 16 in Texas and Colorado. In some cases, with the permission of the courts, doctors can force very sick patients to undergo ECT. Table 1 summarizes the legislative and administrative codes related to ECT in the 50 states, the District of Columbia, Puerto Rico and the Virgin Islands.19–83 The practice of consulting a psychiatrist familiar with ECT in Alaska is supported by Wyatt v. Hardin.2,84 The decision determined that two psychiatrists who have experience with ECT must make the decision, and the hospital director must agree. The court said he “did not commit to determining what forms of treatment were appropriate for certain situations,” and the court said he did not intend to practice medicine. However, the court specifically looked at procedural safeguards and “.
The court banned certain uses of TCE and found 14 rules that severely limited its use” (Ref 2, p. 1350). The rules required ranged from due process and consent to the qualifications of physicians who could recommend ECT and the conditions under which ECT can be provided. The Hardin decision represented the addition of the third component to the ECT approaches: professional recommendations or medical approach as embodied by the APA; legislative or administrative approaches; and finally, the legal approach. Literature review on ethical and legal issues related to the use of ECT in forcibly treated patients, taking into account efficacy, risks, mental health legislation in Portugal and several international guidelines. The decision whether or not to administer the ECT reflects in many respects a balance between the right to treatment and the right not to receive treatment. It is the doctor`s job to give the patient the opportunity to receive a clinically indicated treatment that is relatively safe and effective. At the same time, this role also includes the need to ensure that the informed consent process makes sense and that there is the possibility of refusing treatment.
The American Psychiatric Association recently published comprehensive practice guidelines that cover these topics and help set a standard for ECT practice in this country.2 The use of ECT for serious mental illness is still hampered by legal and ethical restrictions. A future revision of the law could protect patients from exclusion from treatment that could alter the course of the disease. In the United States, any physician treating a patient is required by law to ensure that the patient understands the following before undergoing an ECT: Some of the information on this page is legal information that applies to adults in England and Wales. Katherine Dukakis, like other notable people, swears by electroconvulsive therapy (ECT) to treat major depression. Published online by Cambridge University Press: August 13, 2021 The term “informed consent” refers to a patient`s consent to proceed with a therapeutic approach after being fully informed of the benefits and risks of treatment. The patient`s written consent is obtained prior to the commencement of an ECT treatment plan. A 2005 World Health Organization publication entitled “Human Rights and Legislation WHO Resource Book on Mental Health” states that ECT can only be administered after obtaining the patient`s informed consent.
