Consent, competency and ECT: some critical suggestions.

In the first of several articles on refusal of electroconvulsive therapy (ECT) in this issue of the Journal of Medical Ethics, an American ethicist refutes the contention that it is morally appropriate to respect the irrational decision of a competent, depressed patient to refuse ECT. He argues that, when the likelihood of benefit is great and the only alternative is prolonged suffering, the physician has a moral obligation to use ECT to foster the patient's autonomy by relieving the impediments to that autonomy resulting from the depressive illness.