A Realistic Informed Consent Form for ECT

     British psychiatrist Bob Johnson says that mental disorders are “a software problem, not a hardware problem.” He’s opposed to psychiatric medication, psychosurgery, and electroconvulsive therapy.

     In 2003, to prepare for his being called as an expert witness in a dozen different trials involving claims of damage from electroconvulsive therapy, he did as thorough a study as he could of the existing literature about the effects, positive, neutral, or negative from ECT.

     He concluded, among other things, that patients were seldom given a full informed consent briefing before receiving ECT and were therefore unaware of the potential harmful effects of their receiving that treatment. He created a new informed consent form for ECT which covered all of the omissions he had found in the informed consent process of the time.

     Many of those “omissions” exist today.

     He states that his form “follows the available scientific evidence more faithfully than those currently used.” It is composed of six statements that each must be signed off, in writing, by a prospective ECT patient.

    These are the six points:

     Point 1: The scientific evidence proving that ECT helps with depression and with suicide has always been either weak or seriously flawed.

     Point 2: ECT is still controversial, medical opinion has always been divided – some doctors being strongly in favour, others strongly against, then as now.

     Point 3: ECT can be fatal, with one estimate being as high as 1 death in every 2000 patients.

     Point 4: ECT always disrupts the memory, sometimes briefly, sometimes permanently.

     Point 5: ECT always causes mental confusion, known as ‘cognitive impairment’. This means that normal mental activities such as reading, calculating, planning, learning something new, telling the time, telling who
you are – any or all of these can become hard or impossible to do, following ECT. Sometimes this impairment is brief, sometimes it is permanent. In its first 20 years, this was commonly used to justify the use of ECT.

     Point 6: ECT always damages brain cells, as animal studies amply prove. Again, in the early

decades, this was regarded by some as justification for using it (cf lobotomy).

     Johnson’s six points are a no-holds-barred exposure of the risks involved with undergoing ECT, but each point is based solely on the results of his painstaking research on the ECT literature of the time. Johnson argues that by not revealing these six risks, true informed consent is not being offered or obtained.

     Today’s opponents of continued, unregulated delivery of ECT argue that there are only two reasons psychiatrists would not use a standard informed consent form such as this for their ECT patients.

     First, they fear that informing patients so honestly about the risks of ECT would open them up to an onslaught of lawsuits over the harm being done to ECT recipients. This is a rational objection, even if not a particularly ethical one.

     Second, they believe these horrific risks are justified by the “value” the patient receives from the treatment. One could argue this is an ethical objection – if they really believe that – but it is hardly a rational one. No ECT studies have ever been done that show that there are more benefits from ECT than there is damage from it.

     State legislators have not done well – except in Texas, Tennessee, Colorado, and California – in regulating the use of ECT to protect their citizens. Passing legislation mandating the use of this informed consent form for ECT patients is at least one step they could take to protect their public from harm.