Electroconvulsive Therapy for Patients With Depression Who Lack Capacity for Consent

Abstract

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.

Effectiveness of electroconvulsive therapy in patients lacking decision making capacity: A systematic review and meta-analysis

“…This is an important and ethically relevant empirical finding for all those involved in decision-making processes about ECT in patients lacking DMC-T. Although the legal regulations of who the surrogate decision-maker is (e.g., a patient's relative, a legal guardian), according to which normative standard he or she decides (e.g., the substituted judgment standard or the best interests standard), and which procedural safeguards are followed in this process (e.g., involvement of an external reviewer or a court), may vary greatly between different jurisdictions, decisions about ECT for patients lacking DMC-T should consider the broadly shared ethical principles of respect for patients' autonomy, beneficence (doing good), nonmaleficience (inflicting not harm), and justice [11,12,14,76].…”

What Can We Tell About the Effect of Electroconvulsive Therapy on the Human Hippocampus?

“…Indeed, this practice is conducted all over the world. 8,36,37 Although psychiatrists may be reluctant to provide ECT to such patients, 38 ECT showed a similar effectiveness 39 and survival rate 40 in both patients with/without the capacity for consent. In addition, patients who lack the capacity for consent showed a similar satisfaction with ECT, compared with those with the capacity for consent.…”

Editor’s Roundup for Issue #3 of 2021

“…The literature is uniform in its agreement that ECT is therapeutic when it is applied after receipt of surrogate consent. In this issue, Takamiya et al 3 provide further evidence that ECT is just as helpful with surrogate consent as with consent directly from the patient. Although the relief of suffering is the principal rationale for providing ECT, including under surrogate consent, Yamazaki et al 4 remind us that early strategic administration of ECT can hasten discharge from the hospital.…”