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Re: Last resorts - the Canadian policy on ECT

Posted by Squiggles on December 2, 2005, at 9:26:44

In reply to Last resorts, posted by Squiggles on December 1, 2005, at 10:47:55

OK - I found the blurb on the Canadian site:

MENTAL HEALTH INTERNET -

"Informed Consent

When the physician has determined that clinical indications justify the administration of ECT, the law requires, and medical ethics demand, that the patient's freedom to accept or refuse the treatment be fully honored. An ongoing consultative process should take place. In this process, the physician must make clear to the patient the nature of the options available and the fact that the patient is entitled to choose among those options.

No uniform "shopping list" can be drawn up regarding the matters that should be discussed by patient and physician to assure a fully informed consent. They should discuss the character of the procedure, its possible risks and benefits (including full acknowledgement of posttreatment confusion, memory dysfunction, and other attendant uncertainties), and the alternative treatment options (including the option of no treatment at all). Special individual needs may also be relevant to some patients, for example, a personal situation that requires rapid remission to facilitate return to work and to reduce family disruption. In all matters, the patient should not be inundated with technical detail; the technical issues should be translated into terms meaningful and accessible to the patient.

It is not easy to achieve this ideal of "informed consent" in any aspect of medical practice; and there are special difficulties that arise regarding the administration of ECT. In particular, the patients for whom this procedure is medically appropriate may be suffering from a severe psychiatric illness that, although not impairing their legal competency to consent, may nonetheless cloud judgment in fully weighing all of the available options. Such judgmental distortion does not justify disregarding the patient's choices; rather it makes it all the more important that the physician strive to identify and clarify the options that the patient alone is entitled to exercise.

The consent given by the patient at the outset of treatment should not be the final exchange on this issue but should be reexamined with the patient repeatedly throughout the course of the treatment. These periodic reviews should be initiated by the physician and not depend on patient initiative to "rescind" consent.

There are several reasons for this repeated consenting procedure: because of the relatively rapid therapeutic effect of the procedure itself, the patient after initial treatments is likely to have enhanced judgmental capacities; the risks of adverse effects increase with repeated treatments, so that the question of continued treatment presents a possibly changed risk/benefit assessment for the patient; and because of the short-term memory deficits that accompany each administration of ECT, the patient's recollection of the prior consenting transaction might itself be impaired, so that repeated consultations reiterating the patient's treatment options are important to protect the patient's sense of autonomy throughout the treatment process. Moreover, if the patient agrees, the family should be involved in each step of this consultative process.


N.B.*********************

[This statement seems legally vague to me
but I think it says, they will go ahead in
cases of incapacity for consent in Canada]:

In a small minority of cases, a patient will lack adequate legal capacity to consent to the proposed procedure. In such cases, timely court proceedings are necessary if treatment is to be provided. Legislation in a few states dictates that ECT may in no circumstance be provided to an involuntarily committed patient. The panel believes that such absolute bans are unduly restrictive and make treatment impossible for patients who might obtain more benefit, at acceptable levels of risk, from ECT than from alternative treatments.

***************************

It may be desirable for physicians with patients for whom the prospect of ECT is a foreseeable but not immediate possibility to discuss this in advance with the patient when his or her judgment appears least compromised by the underlying disease process. Such advance discussion would serve as a nonbinding guide both to the patient and physician and would be another means to enhance the patient's autonomous choice in weighing the risks and benefits of this procedure and its alternatives."


/Squiggles


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poster:Squiggles thread:584162
URL: http://www.dr-bob.org/babble/20051126/msgs/584476.html