8.4. Information to Be Conveyed

8.4.1. General Considerations

a) Information describing ECT (see below) should be conveyed in a written consent document. This document and/or a summary of general information related to ECT should be given to the consentor to keep (examples are provided in Appendix B). The use of a separate consent document may be required for anesthesia with ECT in certain settings.

b) The use of appropriate video format patient information on ECT is encouraged.

c) In addition to the written consent document an overview of general information on ECT and individual-specific data should be presented orally by the attending physician, treating psychiatrist, or other knowledgeable physician. Further information may also be provided by other staff members.

d) The consentor should be informed if substantial alterations in the treatment procedure arise that may have a major effect upon risk-benefit considerations.

e) Significant discussions with the consentor regarding these issues should be documented in the clinical record.

f) All information should be provided in a form understandable to the consentor, and should be sufficient to allow a reasonable person to understand the risks and benefits of ECT and to evaluate the available treatment options.

g) The consentor should have an opportunity to ask questions relevant to ECT or treatment alternatives.

8.4.2. Specific Information Provided

The consent document should provide:

a) a description of ECT procedures including:

1) when, where, and by whom the treatments will be administered

2) a range of the number of treatment sessions likely

3) a brief overview of the ECT technique itself.

b) a statement of why ECT is being recommended and by whom, including a general consideration of treatment alternatives.

c) a statement that, as with any treatment modality, therapeutic (or prophylactic) benefits associated with ECT may be absent or transient.

d) a statement indicating the need for continuation therapy.

e) a statement as to the likelihood and severity (in general terms) of the risks related to anesthesia and seizure induction: including mortality, cardiac dysfunction, confusion, acute and persistent memory impairment, musculoskeletal and dental injuries, headaches, and muscle pain.

f) a statement that, as with any other procedure involving general anesthesia, consent for ECT also implies consent to perform appropriate emergency medical interventions in the unlikely event that this proves necessary during the time the patient is not fully conscious.

g) a statement that consent is voluntary and can be revoked at any time before or during the treatment course.

h) a statement that the consentor is encouraged to ask questions at any time regarding ECT, and whom to contact for such questions.

1) a description of any restrictions on patient behavior that are likely to be necessary before, during,, or following ECT.

8.5. Capacity to Provide Voluntary Consent

8.5.l. General Considerations

a) The use of ECT requires voluntary consent from an individual with capacity to make such a decision.

b) Individuals with mental illness are considered to have the capacity to consent to ECT unless the evidence to the contrary is compelling. The presence of psychosis, irrational thinking, or involuntary hospitalization do not in themselves constitute proof of lack of capacity.

c) Unless otherwise specified by statute, the determination of capacity to consent should generally be made by the patient's attending physician, with use of an appropriate physician consultant not otherwise associated with the patient's care in cases where the attending physician is uncertain as to whether capacity to consent is present.

d) In the event of refusal or withdrawal of consent to ECT, the attending physician and/or treating, psychiatrist should inform the consentor of anticipated effects of this action upon clinical course and treatment planning.

8.5.2. Patients Having the Capacity to Provide Consent

In this case, ECT should only be administered in the presence of voluntary patient agreement, including signing of a formal consent document.

8.5.3. Patients Lacking the Capacity to Provide Consent

State and local law covering consent to treatment for patients lacking the capacity to provide such consent should be followed, including statutes pertinent to emergency situations where a delay in treatment may lead to death or serious impairment in health. Applicable legal requirements vary considerably by jurisdiction and are subject to revision over time. Surrogate decision makers should be provided with the information described above. Consideration should be given to any positions previously expressed by the patient when in a state of determined or presumed capacity, as well as to the opinions of major significant others.

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