Balancing Medical Ethics to Consider Involuntary Administration of Electroconvulsive Therapy

Surya, Sandarsh; Bishnoi, Ram J.; Shashank, Reddy Beesam

doi:10.1097/yct.0000000000000624

Cited by 5 publications

(3 citation statements)

References 4 publications

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“…It should also be highlighted that previous studies describe high satisfaction with the outcome of involuntary ECT among patients and their relatives. 45,46 For these reasons, it is highly unfortunate that involuntary ECT is often dismissed because of legal and bureaucratic obstacles, despite the potentially fatal consequences of not administering it in due time. [47][48][49] In Denmark, the treating consultant psychiatrist refers to involuntary ECT when indicated (lawful)-and the treatment is not delayed by legal and bureaucratic obstacles.…”

Section: Discussionmentioning

confidence: 99%

“…The results of this study are compatible with this evidence base and clearly support the use of involuntary ECT for patients in life-threatening conditions. It should also be highlighted that previous studies describe high satisfaction with the outcome of involuntary ECT among patients and their relatives 45,46 . For these reasons, it is highly unfortunate that involuntary ECT is often dismissed because of legal and bureaucratic obstacles, despite the potentially fatal consequences of not administering it in due time 47–49 .…”

Section: Discussionmentioning

confidence: 99%

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Survival Rate Following Involuntary Electroconvulsive Therapy: A Population-Based Study

Salagre

Rohde

Ishtiak‐Ahmed

et al. 2020

J ECT

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Objective: Involuntary electroconvulsive therapy (ECT) can be a lifesaving intervention for patients suffering from potentially lethal conditions who are unable to give informed consent. However, its use is not widespread, probably partly because of the scarce data on hard outcomes following involuntary ECT. In Denmark, involuntary ECT is only used when patients are at imminent/potential risk of dying if not receiving ECT. Here, we aimed to estimate the 1-year survival rate after the administration of involuntary ECT as a proxy for the effectiveness of this treatment. Methods:We conducted a register-based cohort study involving (i) all patients receiving involuntary ECT in Denmark between 2008 and 2019, (ii) age-and sex-matched patients receiving voluntary ECT, and (iii) ageand sex-matched individuals from the general population. One-year survival rates were compared via mortality rate ratios. Results:We identified 618 patients receiving involuntary ECT, 547 patients receiving voluntary ECT, and 3080 population-based controls. The survival rate in the year after involuntary ECTwas 90%. For patients receiving involuntary ECT, the 1-year mortality rate ratios were 3.1 (95% confidence interval, 1.9-5.2) and 5.8 (95% confidence interval, 4.0-8.2) compared with those receiving voluntarily ECT and to the population-based controls, respectively. Risk factors for early death among patients receiving involuntary ECT were male sex, being 70 years or older and having organic mental disorder as the treatment indication. Conclusions:Treatment with involuntary ECT is associated with a high survival rate, suggesting that the intervention is effective. However, patients receiving involuntary ECT constitute a high-risk population that should be monitored closely after this treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Survival Rate Following Involuntary Electroconvulsive Therapy: A Population-Based Study

Salagre

Rohde

Ishtiak‐Ahmed

et al. 2020

J ECT

View full text Add to dashboard Cite

show abstract

“…Although medical treatments should comply with all the ethical principles, it is necessary to set priorities among them if it is deemed impossible to follow all of them in certain situations. The principle of beneficence can be considered more important than respect for autonomy 32,33 in some clinical situations where failure to treat patients effectively could lead to deterioration, prolonged illness, or even death. For example, a patient with an acute stroke who cannot provide consent in an emergency situation should be treated with the consent of his/her relatives or legal guardians.…”

Section: Ethical Issues Surrounding Ect In Patients Lacking Capacity ...mentioning

confidence: 99%

Electroconvulsive Therapy for Patients With Depression Who Lack Capacity for Consent

Takamiya

Bouckaert

Sienaert

et al. 2021

J ECT

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Objective: Electroconvulsive therapy (ECT) is provided in real-world clinical settings for patients lacking capacity for consent. The aim of this study was to investigate the clinical characteristics and clinical effectiveness of ECT in this population.Methods: A retrospective chart review was conducted to collect data from patients who received ECT to treat their depressive episodes between April 2012 and March 2019. Differences in clinical characteristics and short-/long-term clinical outcomes between patients who received ECT with their relatives' consent and patients who received ECT by their own consent were examined. The short-/long-term clinical outcomes were determined by clinical global impression scores and readmission rate, respectively. Results:Of 168 patients with depressive episodes, 34 (20.2%) received ECT with their relatives' consent. Those patients were older, had lower body mass index, and had shorter episode duration. They also exhibited more frequent psychotic, melancholic, and catatonic features. The main indication for ECT in this population was the need for rapid recovery. Patients lacking capacity for consent showed similar remission (61.8%) and response (82.4%) rates to those with capacity for consent. Readmission rate was not significantly different between groups.Conclusions: There were no significant differences in short-/long-term ECT effectiveness between patients with/without capacity for consent. Electroconvulsive therapy is the only established and effective treatment in clinical settings for the most severe cases, wherein patients are incapable of giving consent but need rapid recovery. A general rejection of this practice due to concerns surrounding consent may be unethical under the ethical principles of medical care.

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The ethical imperative of trauma-sensitive care for electroconvulsive therapy (ECT)

Coman

Bondevik

2023

Journal of Mental Health

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Balancing Medical Ethics to Consider Involuntary Administration of Electroconvulsive Therapy

Cited by 5 publications

References 4 publications

Survival Rate Following Involuntary Electroconvulsive Therapy: A Population-Based Study

Survival Rate Following Involuntary Electroconvulsive Therapy: A Population-Based Study

Electroconvulsive Therapy for Patients With Depression Who Lack Capacity for Consent

The ethical imperative of trauma-sensitive care for electroconvulsive therapy (ECT)

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