Electroconvulsive Therapy Background Paper - Electroconvulsive Therapy Background

Written by RESEARCH-ABLE, INC.

As with all medical treatments, administration of ECT is governed by State laws and regulations. Some States permit "substitute consent" by a spouse, a guardian, or an attorney-in-fact through a power of attorney. Other States take a more restrictive approach requiring that only the patient can give consent for treatment. (50)

Courts generally have ruled that a patient who has been involuntarily committed does not, per se, lack capacity to provide informed consent. Only under the most extreme conditions have the courts ruled that the right to refuse treatment is compromised by a depressive condition. The courts also generally do not permit a "substituted judgment" either by the court or a guardian. (51)

V. RESEARCH PRIORITIES IDENTIFIED BY 1985 NIMH CONSENSUS CONFERENCE

The National Institute of Mental Health Consensus Development Conference on Electroconvulsive Therapy, convened in June 1985, identified five priority research tasks : (52)

1. Initiation of a national survey to assemble basic facts about the manner and extent of ECT use, as well as studies of patient attitudes and responses to ECT;
2. Identification of the biological mechanisms underlying the therapeutic effects of ECT and the memory deficits that may be associated with the treatment;
3. Better delineation of the long-term effects of ECT on the course of affective illnesses and cognitive functions, including clarification of the duration of the therapeutic effectiveness of ECT;
4. Precise determination of the mode of electrode placement (unilateral vs. bilateral) and the stimulus parameters (form and intensity) that maximize efficacy and minimize cognitive impairment;
5. Identification of patient subgroups or types for whom ECT is particularly beneficial or toxic.

While many studies of ECT have been undertaken since the 1985 Consensus Development Conference on ECT, the issues regarding brain damage and memory loss have not yet been fully explored or understood. Consumer groups continue to express a strong desire for broader surveys of patients' experiences with ECT because the few published studies to date have relied on small and/or self-selected samples.

SUMMARY

This report describes the current situation concerning ECT, and has attempted to capture the broad spectrum of opinions and views about its use.

APPENDIX A

INTERVIEWS WITH REPRESENTATIVES OF ORGANIZATIONS

In order to present a broad range of opinions about ECT, representatives of five citizen/consumer organizations with particular interest in ECT were interviewed. The interviewees were all asked the following questions:

• What position does your organization hold on the use of ECT?
• What do you think about involuntary administration of ECT?
• What is your position on the effectiveness of ECT?
• What do you feel about ECT as a treatment option?
• In general terms, how has your organization been involved with ECT since 1985?
• Can you tell me some of the experiences of your members?
• From the perspective of the consumer, what do you think are the overall benefits and risks of ECT?
• What would you say are the key issues for this report?
• Specifically, what should be done in terms of future research?
• What alternative treatments would you recommend?
• What do you see should be looked at in terms of the education for health care personnel involved with ECT? For the consumer? For the family of the consumer?

Response of Organizations

Support Coalition International (David Oaks).

"Our by-laws state that we are against coercion. Many of our members are outright opposed to the use of ECT. We are a coalition of 45 groups in six countries opposed to fraudulent informed consent... We feel there is a high rate of forced electroshock. The treatment is so intrusive. No means no. We are pro-choice, but insist on informed choice."

"Doctors should offer empowering sustainable options such as peer groups, emphasizing real life needs of persons -- housing, community and employment Our position on ECT is that if the patient wants it, it's his or her decision, but they must understand there is no proof of sustained efficacy ... (The treatment) is unproven, unsustained and unregulated by the government."