Involuntary ECT in Europe: New Survey of Legislation

Out on PubMed, from authors in Denmark and the USA, is this article:

Clinical and Legal Differences in the Use of Involuntary Electroconvulsive Therapy for Life-Threatening Illness Across European Countries.

Krarup M, Kellner CH, Østergaard SD.J ECT. 2024 Jan 4. doi: 10.1097/YCT.0000000000000984. Online ahead of print.PMID: 38194602

The abstract is copied below:

Objectives: Electroconvulsive therapy (ECT) can be life-saving in situations where patients are at risk of dying from severe manifestations of psychiatric illness. In some of these cases, patients are unwilling/unable to consent to ECT, and involuntary ECT is required. Such use of involuntary ECT varies substantially across European countries for unclear reasons. The aim of this study was to examine clinical and legal differences in this use of involuntary ECT across European countries.

Methods: A questionnaire based on a case vignette (a 55-year-old female inpatient with psychotic depression at imminent risk of dying from metabolic derangement because of refusal to eat and drink) was sent to an ECT practitioner in each of 31 European countries.

Results: We received responses from ECT practitioners in 18 countries. In 7 of these countries, involuntary ECT could be carried out without approval from others and/or involvement of the court system in the case described in the vignette. Practitioners in the remaining 11 countries responded that they either could not carry out involuntary ECT or would have to meet certain requirements before initiating involuntary ECT (e.g., approval from medical/ethics committee and second opinion from an independent psychiatrist). Notably, the rules regarding involuntary ECT differed for adults and minors (more restrictive for the latter) in 6 of the 18 countries.

Conclusions: In many European countries, legislation precludes or delays the use of involuntary ECT. Harmonization of the legislation on involuntary ECT across European countries to allow for better access to this potentially life-saving treatment seems warranted.

The article is here.

And from the text:

These are important data documenting the legal and clinical landscape of involuntary ECT in Europe. Kudos and thanks to Mette and Søren for asking me to collaborate.

The United Nations and WHO misunderstandings about ECT (see discussion above) are particularly egregious. 

I hope this compendium of facts will be interesting to all ECT practitioners, not just our European colleagues. Our call is for consistent, fair regulations about the use of involuntary ECT, not burdensome restrictions based on stigma, that may interfere with timely patient care.