Abstract
Electroconvulsive therapy (ECT) is an essential treatment for severe mental illnesses such as depression with suicidality and catatonia. However, its availability is being threatened by resource limitations and infection concerns due to the COVID-19 pandemic. This may necessitate the triage of patients for ECT but there is no established ethical framework to prioritise patients. We offer an application of an ethical framework for use of scare medical resources in the ECT setting.
Highlights
Health and Care Excellence (NICE) treatment guidelines for ECT2 and the Royal College of Psychiatrists’ position statement on ECT3 state that Electroconvulsive therapy (ECT) should be a first-line treatment where rapid response is required because of high suicide risk, poor oral intake or other conditions where the patient’s physical health is at risk
Electroconvulsive therapy (ECT) is the most effective acute treatment for severe depression.[1]. It is effective in reducing psychotic symptoms in treatment-resistant schizophrenia and in treating mania and catatonia
A substitute decision maker should be available to patients lacking capacity to give consent, as there is increasing evidence that patients lacking capacity have equivalent[4] to superior responses[5] to ECT
Summary
Model for ethical triaging of electroconvulsive therapy patients during the COVID-19 pandemic. The National Institute for Health and Care Excellence (NICE) treatment guidelines for ECT2 and the Royal College of Psychiatrists’ position statement on ECT3 state that ECT should be a first-line treatment where rapid response is required because of high suicide risk, poor oral intake or other conditions where the patient’s physical health is at risk These guidelines state that valid informed consent should be obtained without pressure or coercion, in the context of significant stigma, discrimination and controversy associated with the treatment.[2] A substitute decision maker should be available to patients lacking capacity to give consent, as there is increasing evidence that patients lacking capacity have equivalent[4] to superior responses[5] to ECT compared with capacitous patients. We suggest a useful ethical model that can be used in conjunction with existing ethical frameworks to assist ECT practitioners to take a consistent approach to triaging patients for ECT, rather than relying on individual institutional norms or clinician intuition
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