Journal of Humanistic Psychology, Winter2000, John Breeding

Abstract: Informed consent is a vital issue in all forms of medicine, especially in psychiatry, where patients are often in extremely vulnerable states of mind, customary practice involves high risk to patients, and the law allows for abrogation of traditional civil rights based on judgments of perceived mental incompetence. This article addresses informed consent related to the practice of electroshock. The author argues that genuine informed consent for electroshock is nonexistent because psychiatrists deny or minimize its harmful effects and, as long as the threat--overt or covert--of involuntary treatment exists, there can be no truly voluntary informed consent. The author discusses four primary ways psychiatry violates informed consent in electroshock practice and presents an outline of important information to know about electroshock. An annotated review of the research is provided to back up each of the author's assertions about medical effects and lack of efficacy of electroshock.

ELECTROSHOCK AND INFORMED CONSENT

Summary

Informed consent is a vital issue in all forms of medicine, especially in psychiatry, where patients are often in extremely vulnerable states of mind, customary practice involves high risk to patients, and the law allows for abrogation of traditional civil rights based on judgments of perceived mental incompetence. This article addresses informed consent related to the practice of electroshock. The author argues that genuine informed consent for electroshock is nonexistent because psychiatrists deny or minimize its harmful effects and, as long as the threat--overt or covert--of involuntary treatment exists, there can be no truly voluntary informed consent. The author discusses four primary ways psychiatry violates informed consent in electroshock practice and presents an outline of important information to know about electroshock. An annotated review of the research is provided to back up each of the author's assertions about medical effects and lack of efficacy of electroshock.

Genuine informed consent for electroshock is nonexistent because electroshock psychiatrists deny or minimize its harmful effects. For example, the American Psychiatric Association (APA) (1990) states, "In light of the available evidence, `brain damage' need not be included [in the consent form] as a potential risk" (p. 68). In addition, in all but one state, electroconvulsive therapy (ECT) may be legally forced on nonconsenting individuals who are adjudicated mentally unqualified to give their consent.

The undergirding of psychiatry is coercive. Society generally respects the right of citizens to refuse treatment of physical illnesses, however life-threatening, except for "mental illness." As long as the threat (overt or covert) of involuntary treatment exists, there can be no truly voluntary informed consent.

There are many ways in which informed consent is violated; I will mention four. First, there is denial and minimization of harmful effects. The official APA literature and the typical hospital brochure are both travesties of truth. The consent form example provided by the APA (1990) in The Practice of Electroconvulsive Therapy states that the death rate for ECT is "approximately one per 10,000 patients treated" (p. 157). Publicly available statistics collected between 1993 and 1996 by the Texas Mental Health Department show that the rate is 50 times higher. As noted above, the APA suggests that patients need not be advised of ECT's potential risk. The APA gives no credence to the numerous human autopsies, brainwave studies, animal studies, clinical observations, and reports from ECT subjects clearly demonstrating ECT's brain-damaging effects (see Appendix B). In 1994, St. David's Hospital in Austin, Texas, gave an information sheet to ECT candidates that stated ECT was safe for pregnant women.

The second reason I argue that informed consent exists only in name is that even minimal and inadequate guidelines for the administration of ECT are routinely and systematically violated. For example, a report by the Wisconsin Coalition for Advocacy (1995) thoroughly documents pervasive and systematic violations of that state's informed consent guidelines on ECT. A study by Benedict and Saks (1987) of the regulation of professional behavior with regard to ECT in Massachusetts showed that "approximately 90% of ECT patients received treatment inappropriately, suggesting that the regulation of ECT administration is ineffective" (p. 247). It is interesting that the authors also reported that "the more familiar a psychiatrist was with threatened or instituted lawsuits involving ECT, and the more likely a lawsuit was thought to be, the greater was his or her departure from the guidelines" (p. 252).

A third point with regard to how informed consent principles are violated is rarely mentioned. Dr. Fred Baughman, a retired neurologist, in a letter to United States Attorney General Janet Reno, points out that the legal obligation under informed consent is to provide patients with all the information relevant to their decision making--not just about the treatment in question but also about their condition. Psychiatric patients are never told that their alleged disease is theoretical or metaphorical. To quote Baughman (personal correspondence, September 10, 1998),

To say or even imply that what the patient has is biologic and a disease when there is no such proof (as in all psychiatric "diseases") is conscious deception and abrogates informed consent. That this has become the standard of practice in psychiatry does not excuse it. The abrogation of informed consent is de facto medical malpractice.

Fourth, and pragmatically crucial, is simply that people become victims of this so-called "treatment" at a time in life when they are extremely vulnerable. At vulnerable times, individuals desperately need to trust and rely on others for help. Reaching out, they need complete safety and support. Their only hope, in this desperate state, is to trust the wisdom and guidance of the professionals to whom they turn for help. Informed consent is a superlative principle, but, in practice, it is not a protection. Nevertheless, for educational purposes, I provide here an example of what authentic informed consent would involve. I encourage you to copy and share this form with others. An annotated review of the research by Moira Dolan, M.D., provided to back up each of my assertions about medical effects and lack of efficacy, is in Appendix B.