Consent For Electroconvulsive Therapy Research Articles

Audit Reviewing Consent for Electro Convulsive Therapy

AimsThe National Institute for Health and Clinical Excellence (NICE) recommends that valid consent be sought for Electro Convulsive Therapy (ECT) in all instances where the individual has the capacity to provide or deny consent. Individuals should get comprehensive information on the general risks and potential advantages of ECT. When informed consent and decision-making are not possible, advance directives are fully considered, and the individual's advocate and caregiver are consulted. Additionally, patients should be informed that they can discontinue treatment at any moment. The purpose of this audit is to determine whether we are adhering to the NICE-recommended standards and recommendations.MethodsThis is a retrospective audit looking at case notes from the last 30 individuals who received ECT at University Hospital Wishaw. Individuals' electronic and paper light notes were analysed for data.In informal patients, the aspects reviewed were: 1.Documentation about adequate information given.2.Documentation of risks and benefits explained.3.Documentation of information given about withdrawing consent.In Formal patients the aspects reviewed were: 1.Number of cases who received urgent ECT under Mental Health Act (Scotland) with Record of notification on T4 form.2.Number of cases who received ECT under Mental Health Act (Scotland) with Certificate of the designated medical practitioner completing T3A form.3.Number of cases who regained capacity to consent for ECT during the course of treatment and had appropriate informed consent with Certificate of consent to treatment completed on T2 form.4.Did any of the cases have Advance Statement either for or against having ECT as a treatment option for them?ResultsObservations of the data collected revealed that over 30% of cases lacked the documentation proposed by NICE standards. Only 25% of cases with complete documentation were informal patients, whereas the remaining 75% received ECT under the Mental Health Act Scotland.ConclusionBased on the observations, this audit establishes that our results do not meet generally accepted standards. The full results will be disseminated with appropriate recommendations to the prescribing Consultant Psychiatrists. This Audit process has also prompted us to redesign the ECT booklet to include the required documents in accordance with standards.

Informed Consent for Electroconvulsive Therapy--Finding Balance.

Informed consent underpins all medical decisions, including the decision to undergo electroconvulsive therapy (ECT). Written informed consent remains the standard before the initiation of ECT and requires the inclusion of several components to be considered valid. Prospective patients must be aware of risks and benefits of ECT as well as risks and benefits of alternate, and potentially less effective, interventions. Patients must also possess adequate decision-making capacity to make an informed choice about treatment. Consent for ECT may present unique issues, such as the interplay between potential cognitive adverse effects and informed consent. Options to address this concern include thorough explanation of this topic before the initiation of ECT, continued reassessment of consent during ECT, or some combination of approaches.

Court-Approved Electroconvulsive Therapy in Patients Unable to Provide Their Own Consent: A Case Series.

For patients who lack capacity to consent to electroconvulsive therapy (ECT) for various reasons (intellectual disability, severe mental illness, dementia, etc), court approval must be obtained to proceed with the treatments. We reviewed our experiences on a busy tertiary center ECT service in which we have treated 24 patients in recent years under the auspices of court approval for consent. We found that these patients generally tolerated the treatments well and had noticeable improvement in their symptoms as well as overall better quality of life. In particular, although the patients were unable to provide their own consent for ECT, they were amenable to receive the treatments and did not seem resistant or hostile to the treatment process. We conclude that, in patients unable to provide their own consent, court-approved ECT is well tolerated.

Consent to ECT: patients' experiences in an Irish ECT clinic

Aims and MethodThe aim of this study was to examine the subjective experience of the procedure for obtaining consent for electroconvulsive therapy (ECT) in an Irish setting. A total of 89 consecutively treated patients were sent a postal survey at an average of 17 weeks after ECT treatment.ResultsThis survey revealed low rates of perceived coercion in relation to consenting to ECT. Overall, there were high rates of satisfaction with the consenting procedure in terms of information and staff support.Clinical ImplicationsIn an accredited clinic, the consenting procedure can be conducted in an environment free of coercion, resulting in higher levels of patient satisfaction than previously reported.

Voices of people who have received ECT

Electroconvulsive therapy (ECT) is controversial but widely practised in India. We elicited perspectives, using qualitative interviews, from patients who received ECT and their relatives. Ethical issues related to personal autonomy, right to information, competence, informed consent and consent by proxy are discussed. We suggest strategies to ensure a basic minimum standard for obtaining informed consent for ECT in India.

Consent for electro-convulsive therapy in Singapore.

Consent for electro-convulsive therapy in Singapore.

Civil commitment and consent for electroconvulsive therapy in Ontario.

Among the most contentious legal and ethical issues concerning the use of electroconvulsive therapy (ECT) are the criteria for obtaining a valid consent to treatment and its administration to involuntarily hospitalized patients, with or without consent. This paper reviews the consent process, in particular the assessment of competence, as it is affected by the symptoms and clinical circumstances, including civil status, of those patients for whom ECT is prescribed. The ECT caseload at one psychiatric facility was reviewed to determine the diagnosis and civil status of each patient and the source of consent for each course of ECT prescribed over a 10-year period. Significant differences were found in the diagnostic distribution and the source of consent by diagnostic group between the 1,042 courses administered to informal patients and the 249 courses to involuntary patients. The results are discussed in the context of relevant Ontario legislation and hospital policies. Recommendations are made for the improvement of procedural safeguards to protect the autonomy of all patients.

Psychotic patients' understanding of informed consent.

Courts have found psychiatric patients to have the qualified right to refuse treatment. Particularly problematic is whether newly admitted psychiatric patients can comprehend information and give informed consent. The authors examined the ability of voluntary and involuntary psychotic patients to understand information about antipsychotic medication, related this assessment to psychopathology, and evaluated factors involved in hypothetical acceptance or refusal of treatment. Although most patients stated they had understood informed consent material, objective ratings did not support this. Impaired understanding was significantly associated with thought disturbance but did not affect hypothetical acceptance or refusal of antipsychotics. Legal status was not a significant factor.