Clinical Ethics in the Practice of Electroconvulsive Therapy: Between Beneficence, Autonomy, Personal Identity, and...

Electroconvulsive therapy (ECT), although proven effective in the treatment of severe, treatment-resistant psychiatric disorders, remains the subject of persistent ethical controversy. When ECT is proposed to elderly patients with severe psychiatric illness who refuse treatment, ethical uncertainty is particularly acute. Drawing on a Clinical Ethics Consultation (CEC), a qualitative clinical-ethical analysis was conducted using an interdisciplinary approach and the four principles of bioethics: beneficence, non-maleficence, autonomy, and justice. The analysis focused on the case of an elderly patient with Cotard's syndrome who refused care. The case of Ms B. brought to light four major axes of ethical reflection: (1) the balance between beneficence and justice in the pursuit of a proportionate therapeutic benefit; (2) tensions between autonomy and consent when illness impairs decisional capacity; (3) the question of personal identity in the context of a treatment that acts on memory and self-awareness; and (4) the enduring weight of the social and historical taboo surrounding ECT. Clinical ethics emerges as a privileged space for collective reflection and discernment, articulating care, responsibility, and humanity. Far from trivializing ECT, clinical ethics helps restore its moral legitimacy, provided that prudence, transparency, and shared deliberation are ensured.