CLRP

Challenges to ECT

Nearly 70 years after its introduction, ECT (also known as electroshock, electro-convulsive therapy, and shock therapy) is still widely regarded as the most controversial treatment in psychiatry.

Electroshock is a psychiatric procedure involving the induction of a grand mal seizure, or convulsion, by passing electricity through the brain. Proponents call it a safe and highly effective way to address various kinds of mental disorders and certain medical conditions. Opponents and critics say the treatment causes brain damage and memory loss, that it is sometimes administered by means of coercion or outright force and seldom with genuine informed consent, and that it has been used an instrument of social control. Both groups include prominent neurologists and psychologists, as well as individuals who have undergone ECT.

CLRP's role is focused on assuring that there is genuine informed consent including a serious discussion of adverse effects, and alternatives; assisting clients for whom the procedure has been recommended who wish to refuse it or who desire further information on ECT and alternatives; and to see that the rights set forth in the Patients' Bill of Rights concerning informed consent are respected.

The National Institutes of Health has characterized ECT as the "most controversial" psychiatric treatment, and a government report issued by the National Council on Disability described it as being "unproven and inherently inhumane." (The complaint heard most often from recipients of the treatment relates to lasting memory loss, an effect that consent forms under-emphasize.) As legal advocates, we are concerned about the accuracy of information imparted to clients, and the right of clients to decline a highly invasive procedure without fear that well-intentioned government officials will override their decision.

There are serious concerns relating to informed consent and the accuracy of information provided clients and others about electroshock (also referred to as electro-convulsive therapy or ECT). Electroshock devices are classified by the FDA as Class III ("pre-market approval") medical devices - the most stringent regulatory category for medical devices. They were placed in this category because of their potential to cause unreasonable risk of illness or injury. These devices can be marketed under current regulations only because they have been "grandfathered" by virtue of being marketed prior to 1976, when the medical device classification and regulation system was put into place. The manufacturers of these devices have yet to submit required evidence that the pre-market approval process mandates for all devices introduced after 1976 (pre-market approval is a process of scientific and regulatory review to ensure the safety and effectiveness of class III devices). Until such studies are conducted, there is insufficient scientific evidence that any electroshock devices - old or new - are safe, as claimed (despite impressive public relations and marketing by proponents of the procedure).

Given this background, and CLRP’s mandate to support clients’ right of self-determination, any ECT performed over a client’s stated objection is of particular concern.

Section 17a-543(c) of the Connecticut General Statutes provides:

"No psychosurgery or shock therapy shall be administered to any patient without the patient's written informed consent, except as provided in this subsection. Such consent shall be for a maximum period of thirty days and may be revoked at any time. If it is determined by the head of the hospital and two qualified physicians that the patient has become incapable of giving informed consent, shock therapy may be administered upon order of the Probate Court if, after hearing, such court finds that the patient is incapable of informed consent and there is no other, less intrusive beneficial treatment. An order of the Probate Court authorizing the administration of shock therapy pursuant to this subsection shall be effective for not more than forty-five days."

The position of the World Health Organization is that "ECT should be administered only after obtaining informed consent. Modified ECT should be utilized. Legislation should prohibit the use of ECT on minors."