Electroconvulsive Therapy for Patients with Depression Who Lack Capacity for Consent: Doing Good and Doing No Harm

Akihiro Takamiya, Filip Bouckaert, Pascal Sienaert, Takahito Uchida, Shun Kudo, Bun Yamagata, Taishiro Kishimoto, Masaru Mimura, Jinichi Hirano

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

Objective Electroconvulsive therapy (ECT) is provided in real-world clinical settings for patients lacking capacity for consent. The aim of this study was to investigate the clinical characteristics and clinical effectiveness of ECT in this population. Methods A retrospective chart review was conducted to collect data from patients who received ECT to treat their depressive episodes between April 2012 and March 2019. Differences in clinical characteristics and short-/long-term clinical outcomes between patients who received ECT with their relatives' consent and patients who received ECT by their own consent were examined. The short-/long-term clinical outcomes were determined by clinical global impression scores and readmission rate, respectively. Results Of 168 patients with depressive episodes, 34 (20.2%) received ECT with their relatives' consent. Those patients were older, had lower body mass index, and had shorter episode duration. They also exhibited more frequent psychotic, melancholic, and catatonic features. The main indication for ECT in this population was the need for rapid recovery. Patients lacking capacity for consent showed similar remission (61.8%) and response (82.4%) rates to those with capacity for consent. Readmission rate was not significantly different between groups. Conclusions There were no significant differences in short-/long-term ECT effectiveness between patients with/without capacity for consent. Electroconvulsive therapy is the only established and effective treatment in clinical settings for the most severe cases, wherein patients are incapable of giving consent but need rapid recovery. A general rejection of this practice due to concerns surrounding consent may be unethical under the ethical principles of medical care.

Original languageEnglish
Pages (from-to)171-175
Number of pages5
JournalJournal of ECT
Volume37
Issue number3
DOIs
Publication statusPublished - 2021

Keywords

  • capacity for consent
  • depression
  • electroconvulsive therapy
  • medical ethics

ASJC Scopus subject areas

  • Neuroscience (miscellaneous)
  • Psychiatry and Mental health

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