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Information, consent and perceived coercion: patients' perspectives on electroconvulsive therapy
Diana S Rose1, Til H Wykes, Jonathan P Bindman
1Service User Research Enterprise, PO 34, Health Services Research Department, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. d.rose@iop.kcl.ac.uk
Background:
Electroconvulsive therapy (ECT) is a procedure that attracts special safeguards under common law for voluntary patients and under both current and proposed mental health legislation, for those receiving compulsory treatment.
Aims:
To review patients' views on issues of information, consent and perceived coercion.
Method:
Seventeen papers and reports were identified that dealt with patients' views on information and consent in relation to ECT; 134 'testimonies' or first-hand accounts were identified. The papers and reports were subjected to a descriptive systematic review. The testimony data were analysed qualitatively.
Results:
Approximately half the patients reported that they had received sufficient information about ECT and side-effects. Approximately a third did not feel they had freely consented to ECT even when they had signed a consent form. Clinician-led research evaluates these findings to mean that patients trust their doctors, whereas user-led work evaluates similar findings as showing inadequacies in informed consent.
Conclusion:
Neither current nor proposed safeguards for patients are sufficient to ensure informed consent with respect to ECT, at least in England and Wales.