Ethics Committees and Involuntary Care: ECT Included in J Med Ethics Article

Out on PubMed, from a German author, is this article:

Using coercion in mental disorders or risking the patient's death? An analysis of the protocols of a clinical ethics committee and a derived decision algorithm.

Steinert T.J Med Ethics. 2023 Nov 23:jme-2023-109578. doi: 10.1136/jme-2023-109578. Online ahead of print.PMID: 38050143

The abstract is copied below:

While principle-based ethics is well known and widely accepted in psychiatry, much less is known about how decisions are made in clinical practice, which case scenarios exist, and which challenges exist for decision-making. Protocols of the central ethics committee responsible for four psychiatric hospitals over 7 years (N=17) were analysed. While four cases concerned suicide risk in the case of intended hospital discharge, the vast majority (N=13) concerned questions of whether the responsible physician should or should not initiate the use of coercion in patients lacking mental capacity. The committee's recommendations were non-uniform. Forced feeding and electroconvulsive therapy were endorsed in each one case. In two cases of intermittent loss of capacity due to heavy drinking or intermittent severe suicidal ideation, a self-binding contract was recommended and the use of coercion was considered as justified for a very limited period. In all other cases, most of which involved involuntary treatment, the use of coercion was not endorsed. Without exception, the recommendations were accepted with relief by the physicians and their treatment teams, who feared liability in the event of harm to the patient. Eventually, a model of a decision algorithm was derived from the ethical arguments in the protocols.

Keywords: Coercion; Death; Disabled Persons; Ethics- Medical; Human Rights.

The article is here.

And from the text:

There are interesting general ethics issues discussed in this article. The three cases involving possible involuntary ECT are shown in the above table, but as far as I can tell, not discussed in detail in the text. In only one of the three cases was involuntary ECT deemed appropriate; it would have been helpful to hear the circumstances of the other two cases.