The debate about ECT in Ireland in recent times has been vibrant and often polarised. The uniqueness of the Irish situation is that the psychiatric profession is protected by legislation whereby ECT treatment can be authorized by two consultant psychiatrists without the consent of the patient. This paper will consider if ECT is ever ethically justified, and if so, under what circumstances. The proposal is to investigate ECT from an ethical perspective with reference to the UNESCO Universal Declaration on Bioethics (...) and Human Rights. The enquiry will begin with an historical context to the origin and development of ECT as a treatment for severe mental illness. The application of various ethical principles will be considered in conjunction with the relevant literature before arriving at a conclusion. (shrink)

This is a response to Dr Charlotte Rosalind Blease's paper ‘Electroconvulsive Therapy (ECT), the Placebo Effect and Informed Consent’, written by Julie K. Hersh who has had ECT. Hersh argues that placebo effect is impossible to prove without endangering the lives of participants in the study. In addition, informing potential ECT patients of unproven placebo effect could discourage patients from using a procedure that from experience has proven highly effective.

Obtaining informed consent before providing treatment is a routine part of modern clinical practice. For some treatments, however, there may be disagreement over the requirements for ‘informed’ consent. Electroconvulsive therapy (ECT) is one such example. Blease argues that patients ‘should surely be privy to the matters of fact that: (1) there is continued controversy over the effectiveness of ECT; (2) there is orthodox scientific consensus that there is currently _no_ acknowledged explanation for ECT and (3) there is a serious (mainstream) (...) debate over whether the response to ECT may be a placebo response.’ Before embracing these suggestions, two key questions must be asked. Are these claims a reasonable representation of current ECT research? And if so, will this information be of benefit to patients? The evidence-based support for ECT from both National Institute for Health and Care Excellence and the Royal College of Psychiatrists appears to undermine the validity of claims (1) and (3), and therefore the rationale for providing this information. Concerning assertion (2), it is true that the mechanism by which ECT has its therapeutic effect is not yet established, although the importance of conveying this fact to the patient is questionable. Of greater certainty is that the same irresolution surrounds the mechanism of action of pharmaceutical antidepressants, and so a double standard in patient care should be mindfully avoided if provision of this information is deemed a prerequisite for proper ‘informed’ consent. (shrink)