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Autonomy and consent assessment for electroconvulsive therapy (ECT). A retrospective study of medical records
International Journal of Law and Psychiatry ( IF 2.479 ) Pub Date : 2021-06-12 , DOI: 10.1016/j.ijlp.2021.101716
Jørgen Dahlberg 1 , Siri Øverstad 2 , Vegard Dahl 3 , Alina Coman 4
Affiliation  

The Norwegian Mental Health Act allows involuntary treatment for patients who lack consent capacity, however it allows only administration of pharmaceutical treatment and nutrition and not ECT. In lack of specific regulations, the legal access to ECT without valid consent has been grounded on the general rule of necessity in the Norwegian Penal code. This restriction and lack of legal regulation has implications for patients' rights and legal security.

The study's aim was to assess the documented consent provided by patients for electroconvulsive therapy (ECT), whether ECT was administered without valid consent or under coercion, and the documented reasons, and ultimately compare practice with the legal requirements. We analysed systematically all the relevant medical records for hospitalised patients and outpatients receiving ECT during 2011–2016. We categorized data from these two groups into seven defined categories describing the attitude and quality of the consents to the ECT (or lack thereof).

378 patients received 498 ECT series´. The noted consents varied from treatment based on request (54 treatments), consent upon recommendation (209 treatments), consent after hesitation (88 treatments), consent presumed or noted without specification (114 treatments), to no consent (21 treatments) whereof the majority with documented coercion applied (19 treatments). All cases of ECT without consent referred to a “plea of necessity”. The remaining treatments (12) lacked notifications specifying the consent (or attitude) expressed. Specific notes on the patient's capacity to consent for the respective ECT were generally lacking.

This study indicates a large spread in patients´ acceptance and valid consent to ECT. The main reason for administering ECT without consent and/or against patients' will was for life-saving reasons. Such treatments were justified legal under a plea of necessity in the Penal Code or lacked noted legal justification. The legal vacuum for ECT without a valid consent needs to be addressed as this kind of disputed treatment is used in some cases.



中文翻译:

电休克疗法 (ECT) 的自主权和同意评估。病历回顾性研究

挪威心理健康法案允许对缺乏同意能力的患者进行非自愿治疗,但它只允许进行药物治疗和营养治疗,而不允许进行 ECT。由于缺乏具体规定,未经有效同意而合法获得 ECT 的依据是挪威刑法典中的一般必要性规则。这种限制和法律监管的缺乏对患者的权利和法律安全产生了影响。

该研究的目的是评估患者对电休克治疗 (ECT) 提供的书面同意、ECT 是在未经有效同意的情况下还是在胁迫下进行的,以及记录的原因,并最终将实践与法律要求进行比较。我们系统地分析了 2011-2016 年接受 ECT 的住院患者和门诊患者的所有相关医疗记录。我们将来自这两组的数据分为七个定义的类别,描述了对 ECT 同意(或缺乏同意)的态度和质量。

378 名患者接受了 498 个 ECT 系列。注意到的同意从基于请求的治疗(54 次治疗)、推荐后同意(209 次治疗)、犹豫后同意(88 次治疗)、推定或未注明的同意(114 次治疗)到不同意(21 次治疗)。大多数采用记录在案的强制措施(19 次治疗)。所有未经同意的 ECT 案件都提到了“必要性辩护”。其余的治疗 (12) 缺乏说明所表达的同意(或态度)的通知。通常缺乏关于患者同意相应 ECT 的能力的具体说明。

这项研究表明,患者对 ECT 的接受和有效同意的广泛传播。在未经同意和/或违背患者意愿的情况下实施 ECT 的主要原因是出于挽救生命的原因。根据刑法典的必要性抗辩,这种待遇是合法的,或者缺乏明显的法律理由。需要解决未经有效同意的 ECT 的法律真空,因为在某些情况下会使用这种有争议的待遇。

更新日期:2021-06-13
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