The 1984 Scottish Mental Health Act (and its counterpart in England and Wales) invoked unique restrictions in medical practice in this country. For the first time certain standard treatments could not be given to particular patients unless an independent second opinion doctor authorised that treatment. Fortunately, in respect of drug treatment and ECT the second opinion doctors are themselves practising clinicians. Second opinion doctors are asked to give their opinion about the suitability of a proposed treatment using the following guidelines: “the appointed doctor will have in mind his/her understanding of practice accepted as proper by a responsible body of medical men skilled in this particular art in Scotland at this time and should avoid any idiosyncratic view of treatment however firmly held”.
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