Criticisms of ECT Laid Bare: Dr. Gergel's Commentary in BJP
In the British Journal of Psychiatry is this commentary:
And an excerpt from from the text:
The first question must surely be motivation. Around 1.4
million people worldwide receive ECT annually.1 In psychiatric
terms, ECT is relatively costly and complex, involving general
anaesthesia in most countries, with estimates of annual treatment
costs that ‘can exceed $10 000’.
14 If, after 80 years of ECT, there
really was no evidence for effectiveness, why would healthcare providers continue funding ECT and what would psychiatrists stand to
gain, especially in the face of such acrimonious criticism?
Moreover, claiming that psychiatry knowingly inflicts an invasive
medical treatment with potentially serious side-effects and no evidence of substantive therapeutic benefits implies a global breach of
core medical ethical principles. Not only would this violate both beneficence and nonmaleficence, but also justice, through allocating
limited resources to expensive and ineffective treatments. Moreover,
deliberately misleading patients about therapeutic benefits would
surely negate ‘informed’ consent and autonomous decision-making
concerning treatment. Although psychiatry may sometimes involve
errors of clinical judgement, the idea that so many medical practitioners are complicit in breaching fundamental professional ethics
seems implausible and devoid of apparent motivation.
This is a wonderful commentary that carefully debunks the major criticisms of anti-ECT activists. Tania Gergel, PhD, is a Wellcome Trust Senior Research Fellow at King's College, London. Her main area of interest is mental health ethics and law. She has published widely about patient capacity, advanced directives and involuntary treatment.
An accompanying brief editorial in BJP will be the subject of another blog post.
My only (minor) critique of this commentary is the reliance on UK statistics for the discussion of involuntary treatment; absolute numbers of ECT treatments in the UK are so small compared to many other countries that using the UK as an example may not be generalizable. But it is the British Journal of Psychiatry....
I strongly recommend a full and careful read of this piece to all healthcare professionals involved in ECT, ~15 minutes.
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