Electroconvulsive therapy without consent.

BACKGROUND In principle, electroconvulsive therapy (ECT) can only be administered to patients who consent to the treatment. If the patient does not consent, the treatment can be given in exceptional cases, in situations where a plea of necessity can be made. The purpose of this study was to investigate whether the issue of consent was documented in the patient records at Dikemark Hospital in the period 1960-95, and to study the outcomes for patients who were given ECT treatment without having consented. MATERIAL AND METHOD The article is based on a review of the ECT protocols and the records of patients who were given this treatment during the period 1960-95 in three psychiatric wards at Dikemark Hospital. We registered whether the issue of consent had been documented, and if so, whether consent had been provided or not. The material encompasses 241 ECT series administered to 141 patients. RESULTS The issue of consent had been documented for 107 of a total of the 241 series. Seven patients were given the therapy against their wishes. The median age of these seven was 68 years (range 56-82 years). All of them had been diagnosed with depressive psychosis and were given electroconvulsive therapy on a vital indication under a plea of necessity. Insufficient intake of nourishment was described as the main reason for the vital indication in all the seven patients. According to their records, they showed signs of improvement on the day after the first treatment. Their lifespan after the treatment varied from three to 19 years. INTERPRETATION On the basis of the records in which it was documented that the patient had not provided consent, electroconvulsive therapy was administered exclusively as a life-saving intervention.