[Access to electroconvulsive therapy for people lacking decision making capacity and as nonvoluntary treatment : Expert consensus and statement of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN)].

Abstract

Electroconvulsive therapy (ECT) is a clinically well-established, evidence-based procedure for the treatment of particularly severe or treatment-resistant psychiatric and neuropsychiatric disorders. A considerable number of patients who require ECT are unable to provide informed consent due to their medical condition. Both international and national studies show that restrictive laws and legal rulings can hinder or even prevent the use of ECT in patients lacking the capacity to provide informed consent or in cases of nonvoluntary treatment (coercive treatment). Patients with indications for ECT who lack the capacity to consent constitute a vulnerable group, often with no viable alternative therapy available. The decision to administer ECT to individuals lacking the capacity to consent, particularly as a nonvoluntary treatment, is highly complex in terms of legal and medical ethics aspects because depending on the circumstances, both administering and withholding ECT can profoundly impact the patient's fundamental rights. The available evidence shows that patients initially treated against their will exhibit good overall response rates, with equally high retrospective and prospective approval for therapy compared to patients who initially consented to treatment.Together with the medical ethics considerations the authors conclude that the use of ECT should adhere to the same ethical and normative standards as all other medical interventions. This also applies to cases involving involuntary treatment. Adopting a more restrictive approach to ECT compared to other medical measures is neither medically nor ethically justified. Structural and legal barriers restricting access to necessary treatment for patients with severe and potentially life-threatening conditions should be critically reviewed and, when possible and necessary, removed.