Ethics Considerations in Laws Restricting Incapacitated Patients' Access to ECT

Ana S Iltis; Reese Fortier; Noah Ontjes; William V McCall

doi:10.29158/JAAPL.220029-21

Ethics Considerations in Laws Restricting Incapacitated Patients' Access to ECT

J Am Acad Psychiatry Law. 2023 Mar;51(1):47-55. doi: 10.29158/JAAPL.220029-21. Epub 2023 Jan 16.

Authors

Ana S Iltis¹, Reese Fortier², Noah Ontjes², William V McCall²

Affiliations

¹ Dr. Iltis is Professor of Philosophy, Carlson Professor of University Studies, and Director, Center for Bioethics, Health and Society; Ms. Fortier is an undergraduate student; and Mr. Ontjes is a graduate student, Wake Forest University, Winston-Salem, NC. Dr. McCall is Department Chair, Case Distinguished University Chairman, Department of Psychiatry and Health Behavior, and Executive Vice Dean, Medical College of Georgia, Augusta University, Augusta, GA. iltisas@wfu.edu.
² Dr. Iltis is Professor of Philosophy, Carlson Professor of University Studies, and Director, Center for Bioethics, Health and Society; Ms. Fortier is an undergraduate student; and Mr. Ontjes is a graduate student, Wake Forest University, Winston-Salem, NC. Dr. McCall is Department Chair, Case Distinguished University Chairman, Department of Psychiatry and Health Behavior, and Executive Vice Dean, Medical College of Georgia, Augusta University, Augusta, GA.

PMID: 36646453
DOI: 10.29158/JAAPL.220029-21

Abstract

Electroconvulsive therapy (ECT) is a safe and effective treatment used for numerous psychiatric conditions. While many patients for whom ECT is indicated are able to give voluntary informed consent, some lack decision-making capacity (DMC), at least temporarily. Case reports from numerous countries involving ECT for patients who lack DMC indicate overall positive outcomes and high patient satisfaction with results comparable with those of consenting patients; some patients regain DMC with ECT. Laws and regulations pertaining to ECT vary widely around the world and across the United States. Many United States jurisdictions over-regulate ECT relative to other interventions with comparable risks and potential benefits. While laws restricting whether and under what circumstances patients who lack DMC may receive ECT likely are aimed at protecting incapacitated persons, such laws sometimes undermine important ethics obligations and should be re-evaluated.

Keywords: decision-making capacity; electroconvulsive therapy; informed consent; involuntary treatment; nonvoluntary treatment.

MeSH terms

Electroconvulsive Therapy* / methods
Electroconvulsive Therapy* / psychology
Humans
Informed Consent
Mental Disorders* / therapy
Treatment Outcome
United States