Ethics, Incapacity, Laws on ECT: New Commentary in Journal of the American Academy of Psychiatry and Law

 Out on PubMed, from US investigators, is this paper:

Ethics Considerations in Laws Restricting Incapacitated Patients' Access to ECT.

Iltis AS, Fortier R, Ontjes N, McCall WV.J Am Acad Psychiatry Law. 2023 Jan 16:JAAPL.220029-21. doi: 10.29158/JAAPL.220029-21. Online ahead of print.PMID: 36646453
The abstract is copied below:
Electroconvulsive therapy (ECT) is a safe and effective treatment used for numerous psychiatric conditions. While many patients for whom ECT is indicated are able to give voluntary informed consent, some lack decision-making capacity (DMC), at least temporarily. Case reports from numerous countries involving ECT for patients who lack DMC indicate overall positive outcomes and high patient satisfaction with results comparable with those of consenting patients; some patients regain DMC with ECT. Laws and regulations pertaining to ECT vary widely around the world and across the United States. Many United States jurisdictions over-regulate ECT relative to other interventions with comparable risks and potential benefits. While laws restricting whether and under what circumstances patients who lack DMC may receive ECT likely are aimed at protecting incapacitated persons, such laws sometimes undermine important ethics obligations and should be re-evaluated.


Keywords: decision-making capacity; electroconvulsive therapy; informed consent; involuntary treatment; nonvoluntary treatment.

The article is here.

And from the text:




This is an excellent, extremely well presented and written commentary on the ethics of laws regarding ECT in patients who lack decision-making capacity. The distinction between non- and involuntary ECT is interesting, as is the information about "medical" versus "psychiatric" emergency situations. It would be so helpful to actually know the cost, in terms of suffering and death, of all the restrictive ECT laws; the truth is likely so radically different from the lay public's monolithic idea that such laws "protect" patients from harm.  These authors call for activism to implement policy change; kudos to them for that call, as well as a superb article.

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