Table 1

Statutory Laws and Administrative Codes Concerned with ECT and Adults

StateVoluntary ECTInvoluntary PatientsInvoluntary ECTComments
Arkansas22,23Nothing includedTreatment restrictions outlinedProbate court; clear and convincing evidence
California24Requirements by treating physician articulated; must have three appointed physicians (two board-certified) who agree that patient has capacity to consent“… common knowledge mentally ill persons are more likely to lack the ability to understand the nature of a medical procedure and appreciate its risks. The special regulation of ECT is also a reasonable classification because procedures associated with mental illness, present a great danger of violating the patient’s rights.”
Colorado25Requirements by treating physician articulatedMust include written information regarding “that there is a difference of opinion within the medical profession on the use of electroconvulsive treatment”
Connecticut26Requires written consent that is valid for 30 daysNothing concerning involuntary patients. If patient is incompetent to consent: head of hospital, two physicians, and Court of Probate must agree that patient is incompetent and there is no other “reasonable alternative procedure.”
Delaware27Requires written informed consent for voluntary ECT. Nothing in statutory laws or administrative codes about involuntary patients or involuntary ECT
Illinois3337Voluntary ECT not covered in legislationInvoluntary ECT does not require written notice of risks and benefits
Minnesota47Nothing concerning voluntary ECTInvoluntary ECT requires that the person be found incompetent to make medical decisions. Court has ultimate decision-making capacity.
Missouri49Voluntary ECT requires verbal and written informed consentInvoluntary ECT requires court order after full evidentiary hearing
Montana50Consent to voluntary ECT must involve consent from patient and “… counsel, the legal guardian, if any, the friend of the respondent appointed by the court, and any other interested party of the patient’s choice….”
Nebraska51Only requirements for licensed physician (psychiatrist) specified to perform ECT
New York5659Detailed guidelines regarding voluntary administration of ECTPerson must be found incompetent by the court for involuntary ECT to be administered
North Carolina60Written, informed consent required for treatment
Ohio62“No patient shall be subjected to [convulsive therapy]… until both the patient’s informed, intelligent, and knowing consent and the approval of the court have been obtained, except that court approval is not required for a legally competent and voluntary patient in a nonpublic hospital.”
Oregon64Nothing in statutory laws or administrative codes about ECT and adultsInvoluntary patients specifically are not subject to ECT
Pennsylvania65Nothing concerning voluntary ECTPowers and duties only granted by court includes consent for involuntary ECT
South Dakota69,70Written infomed consent required for voluntary ECT“… court finds that the person is incapable of consenting to such treatment because the person’s judgement is so affected by the mental illness that the person lacks the capacity to make a competent, voluntary and knowing decision concerning such treatment, the court may exercise a substituted judgment on the administration….”
Texas7275Extensive requirements directed towards facilities (including registering the ECT machine) and physicians concerning informed consent. Two physicians are required to state that the procedure is medically necessary if the individual is older than 65 years.
Vermont77Established a commissioner to oversee the use of ECT.
Virginia79Nothing specific concerning voluntary ECTCourt may authorize ECT; clear and convincing evidence is the standard.
Washington80Mental health directive may include provisions for ECT. Nothing specific about voluntary/ECT evaluation and consent process
Alabama19; Alaska20; Arizona21; District of Columbia28; Florida29; Georgia30; Hawaii31; Idaho32; Indiana38; Iowa39; Kansas40; Kentucky41; Louisiana42; Maine43; Maryland44; Massachusetts45; Michigan46; Mississippi48; Nevada52; New Hampshire53; New Jersey54; New Mexico55; North Dakota61; Oklahoma63; Puerto Rico66; Rhode Island67; South Carolina68; Tennessee71; Utah76; Virgin Islands78; West Virginia81; Wisconsin82; Wyoming83Nothing in statutory laws or administrative codes about ECT and adults