Sunday, March 15, 2015

Forced ECT to capable patients is banned in Ireland

The Irish government is to amend the legislation to prohibit Electro-Convulsive Therapy (ECT) for the patients who refuse to take it.

The Irish Times: Forced use of ECT to end after review of mental health law

ECT is a therapeutic option for schizophrenia, depression, and some other mental illness. In this therapy, the patient is given an electric shock to the brain through the skull. Some patients experience rapid improvement of their mental status after taking an ECT. In a course of ECT, usually 4 to 6 times of the operation are carried out, with twice a week.

Although the source is still unsure, its efficacy has been proven by rich evidence. In addition, ECT is relatively safe procedure to the body, in spite of its horrible image. We have some therapeutic options other than ECT. However, psychotropic medication has side effects, and psychotherapy is time-consuming. We sometimes encounter the cases ECT is the best alternative to recovering the patient from severe mental illness.

Nevertheless, ECT has been broadly criticized. One of the reasons seems to be a discrimination against ECT. On the other hand, ECT had been used abusively in the history of clinical psychiatry. Temporary amnesia can occur after taking ECT. There is uncertainty regarding longitudinal adversity of ECT.

As ECT is recognized as a therapeutic option, whether it is adopted is the choice of the patient, as a principle. However, there are some patients who are not capable to make a decision due to their mental state. In such cases, some alternative decision makers are required to protect their right to take a treatment. Otherwise, the delay of treatment can be fatal.

According to this article, ECT might be administered when two consultant psychiatrists approved in Ireland. However, it is enigmatic that the case in which the patient is "unwilling" to give consent was included. In amended legislation, it seems possible that incapable patients can take ECT without their consent. I think that it is no doubt that a capable patient has a right to refuse treatment, unless their refusal potentially causes a harm to others.

By the way, there is no legislation regarding ECT in Japan. As far as I administered, capable patients have not been forced to take ECT. But the situations in other hospitals are unclear. On the other hand, some psychiatrists in Japan dislike ECT and never consider to adopt it for emotional reasons. It is also extreme, and potentially harmful to patients.

It will be unlikely to make a new legislation regarding ECT in Japan, unless there occurs a critical incident. It is fortunate that political conflict does not occur among this topic. Of course, further scientific research and discussion about pros and cons of ECT is needed.

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