Consent, competency and ECT: a psychiatrist's view.

This is the third essay on consent to electroconvulsive therapy (ECT) in this issue of the Journal of Medical Ethics. It contains a psychiatrist's criticisms of the lack of procedural guidelines, in Britain's recently amended Mental Health Act, for obtaining consent to ECT from involuntarily committed patients and her comments on preceding articles by Richard Sherlock and Harry Lesser. Taylor discusses practical approaches to obtaining informed consent, as well as dilemmas in assessing competency and in the use of proxy consent. She concludes by raising the question of whether refusal of ECT in cases of severe depression can ever be a competent decision.