Electroconvulsive therapy, capacity and the law in Ireland

Abstract

The Mental Health Act (MHA) 2001 has major implications for treating patients with electroconvulsive therapy (ECT), especially as those referred for treatment are among the most severely ill and often lose capacity. Under the MHA 2001, a person may only be treated without consent if they are an involuntary patient. However, there is no provision in the Act for treating voluntary inpatients whose mental state has deteriorated but who do not seek to leave hospital. Such people may lack capacity to make treatment decisions but be passively compliant.The Wards of Court system is currently the only legal recourse but has been criticised by the Law Reform Commission and is unwieldy. Further legislation governing treatment of people lacking capacity to consent to ECT or withhold consent is required to protect and advance treatment of all concerned.

Refractory mania and inability to consent: an important role for involuntary ECT

“…This case also underlines the need to retain the legislative capacity for treating patients with ECT when they lack capacity to consent to such treatment, a pertinent issue in the context of the recent Private Member's Bill in the Seanad [Seanad Eireann, Mental Health (Involuntary Procedures) (Amendment) Bill, 2008], which proposes to prohibit the prescription of ECT for involuntary patients who do not consent (Dunne et al 2009). Section 59 (1) , 2010].…”

Five years after implementation: A review of the Irish Mental Health Act 2001

“…(MHC, 2012) There is significant regional variation in the use of ECT. (Dunne & McLoughlin, 2011) However, there are no statistics available on variation according to the legal status of the patient.…”

“…Currently, the law around the use of ECT for involuntary patients demands clear standards for such treatment. However, there is no provision for the use of ECT for voluntary patients whose mental state has deteriorated but who do not seek to leave hospital (Dunne & McLoughlin, 2011). The Wards of Court system is the only current legal recourse but this approach has been criticised by the Law Reform Commission (Dunne & McLoughlin, 2011).…”

“…However, there is no provision for the use of ECT for voluntary patients whose mental state has deteriorated but who do not seek to leave hospital (Dunne & McLoughlin, 2011). The Wards of Court system is the only current legal recourse but this approach has been criticised by the Law Reform Commission (Dunne & McLoughlin, 2011). It is anomalous that MHC standards exist for involuntary patients but the same standards are not applied to voluntary patients, who may or may not maintain capacity.…”