Electroconvulsive therapy without consent.

Area of Science:

• Psychiatry
• Medical Ethics
• History of Medicine

Background:

• Electroconvulsive therapy (ECT) generally requires patient consent.
• Exceptions exist for non-consenting patients under specific necessity provisions.
• Historical documentation of consent for ECT is crucial for ethical and legal review.

Purpose of the Study:

• To determine the extent of consent documentation in ECT patient records from 1960-1995 at Dikemark Hospital.
• To analyze the outcomes for patients who received ECT without providing consent.

Main Methods:

• Review of ECT protocols and patient records from three psychiatric wards at Dikemark Hospital (1960-1995).
• Documentation of consent status for 241 ECT series involving 141 patients.
• Analysis of patient demographics, diagnoses, and treatment indications for non-consenting cases.

Main Results:

• Consent was documented in 107 of 241 ECT series.
• Seven patients received ECT against their wishes, all diagnosed with depressive psychosis.
• These patients, aged 56-82, received ECT due to insufficient nourishment, a vital indication under necessity.
• All seven showed improvement post-treatment, with survival ranging from 3 to 19 years.

Conclusions:

• ECT administered without consent during the study period was exclusively a life-saving intervention.
• Documentation of consent is vital for ethical ECT administration.
• Historical data indicates ECT can be a critical intervention in severe, life-threatening psychiatric conditions.