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Capacity, compliance and electroconvulsive therapy (ECT): the practice of ECT among consultant psychiatrists

  • Richard Law-Min (a1) and John Patrick Stephens (a2)
Abstract
Aims and Method

The aim of this study was to seek the views of consultant psychiatrists on the legal framework they would use when considering treatment with electroconvulsive therapy (ECT). A questionnaire, consisting of three clinical vignettes, was sent to 70 consultants in the Wessex rotation (East Dorset/Hampshire region).

Results

A total of 56 questionnaires were returned; a response rate of 80%. Most consultant psychiatrists agree when giving ECT to capacitated and non-consenting patients. However, there was a lack of consensus when dealing with seemingly incapacitated but compliant patients.

Clinical Implications

More clarification in this area is needed. Trusts can assist clinicians by devising their own policies based on nationally agreed standards of best practice. The treatment of mentally incapacitated but compliant patients is an area of practice where uncertainty exists. If proceeding under common law in such cases, it is good practice to discuss with relatives/carers and obtain a second opinion from a consultant colleague. The most recent Bournewood judgement and the new Mental Health Bill will have further implications for clinical practice.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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General Medical Council (1998) Seeking Patients' Consent: The Ethical Considerations. London: GMC.
Jones, R. (2004) Mental Health Manual (9th edn). London: Sweet & Maxwell.
Mental Health Act Commission (2003) Tenth Biennial Report 2001–2003 Placed Amongst Strangers. London: Stationery Office.
National Institute for Clinical Excellence (2003) Guidance on the Use of Electroconvulsive Therapy. London: NICE.
Rethink (2004) Policy Statement 58. http://www.rethink.org/news+campaigns/policies/58-ect.htm
Robinson, R. (2003) ECT and the Human Rights Act 1998. Journal of Mental Health Law, July, 6670.
Rose, D., Wykes, T., Leese, M., et al (2003) Patients' perspectives on electroconvulsive therapy: systematic review. BMJ, 326, 13631365.
Royal College of Psychiatrists (2005) ECT Handbook. The Third Report of the Royal College of Psychiatrists' Special Committee on ECT (Council Report CR128). London: Royal College of Psychiatrists.
UK ECT Review Group (2003) Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet, 361, 799808.
HL v. UK, European Court of Human Rights (application no. 45508/99). Judgment Strasbourg, 5 October 2004.
R. v. Bournewood Community Mental Health NHS Trust, ex parte L[1998], 3 WLR 108, House of Lords, AllER 319.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Capacity, compliance and electroconvulsive therapy (ECT): the practice of ECT among consultant psychiatrists

  • Richard Law-Min (a1) and John Patrick Stephens (a2)
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