Saturday, 6 December 2003
AN INFORMED CONSENT FORM
for
ELECTRO CONVULSIVE THERAPY (ECT)
by Dr Bob Johnson
Consultant Psychiatrist, P
O Box 235 York YO1 7YW
UK
Email DrBob@TruthTrustConsent.com www.TruthTrustConsent.com
GMC speciality register for psychiatry reg.
num. 0400150
formerly Head
of Therapy, Ashworth Maximum Security Hospital, Liverpool
Consultant Psychiatrist, Special Unit,
C-Wing, Parkhurst Prison, Isle of Wight.
MRCPsych (Member of Royal College of
Psychiatrists),
MRCGP (Member of Royal College of General
Practitioners).
Diploma in Psychotherapy Neurology &
Psychiatry (Psychiatric Inst New York),
MA (Psychol), PhD(med computing), MBCS, DPM, MRCS.
Approved under Section 12(2) of the Mental Health Act 1983
Author of Emotional Health, ISBN 1-904327-00-1
____________________
contents of this report
preamble............................................................................................................................... 3
1 Informed
Consent Form for ECT.................................................................................... 4
Point 1 The scientific evidence proving that ECT helps with
depression and with suicide has always been either weak or seriously flawed............................................... 4
Point 2 ECT is still controversial, medical opinion has always
been divided Ð some doctors being strongly in favour, others strongly against,
then as now.......................... 4
Point 3 ECT can be fatal, with one estimate being as high as 1
death in every 2000 patients............................................................................................................................. 4
Point 4 ECT always disrupts the memory, sometimes briefly,
sometimes permanently...................................................................................................................... 4
Point 5 ECT always causes mental confusion, known as
Ôcognitive impairmentÕ.
This means that normal mental activities such as reading, calculating,
planning, learning something new, telling the time, telling who you are Ð 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................................................................................................... 4
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).......................................................................................................................... 5
2 Point
1 The scientific evidence..................................................................................... 5
2.1 Randomised
Trials................................................................................................ 5
2.2 ECT
& suicide........................................................................................................ 6
2.3 Conclusion
on the scientific evidence.................................................................. 7
3 Point
2 ECT is controversial and has
always divided medical opinion......................... 8
3.1 brain-damaging
therapeutics................................................................................ 8
3.2 controversial
today.............................................................................................. 10
3.3 the
publication of NCCHTA report has been delayed........................................ 10
4 Point
3 ECT can be fatal.............................................................................................. 11
5
Point 4 ECT always disrupts the
memory.................................................................. 12
6 Point
5 ECT always causes cognitive
impairment...................................................... 12
7 Point
6 ECT always damages brain cells,................................................................... 13
ÒEvidence for Permanent
Brain Damage............................................................. 13
ÒThe Damage Is the ÔCureÕ...................................................................................... 14
8 Conclusion................................................................................................................... 15
9 illustrations
of cognitive impairment............................................................................. 16
10 References
& bibliography...................................................................................... 17
I have now been asked to examine and prepare reports on a dozen or so cases where damage may have arisen from the receipt of Electro Convulsive Therapy (ECT). As part of my obligations regarding these reports, I undertook a more general review of the literature on the subject. This is an onerous and daunting undertaking and one which others better equipped than I, have already undertaken. One recent review scanned 1647 relevant documents [ref 2003, p 24 at 3.2.1]. A fresh bundle an inch thick or so seems to arrive on my desk every second month or so. This is a controversial area currently receiving quantities of medical scrutiny, so this report elects to follow an innovative strategy outlined in the next paragraph, thereby better clarifying the issues involved, in terms both of medical and of legal practice. Clearly extra material will need to be added to this report, as more evidence becomes available, or in the case of the extensive NCCHTA review (see below) as it is released into the public domain.
In order to respond to this growing inundation of documents in a coherent fashion, it has been concluded that the best strategy from a medico-legal viewpoint, is to compile a modified consent form, which would enable the legal obligation of Ôfully informed consentÕ to be more realistically fulfilled than it has been to date. This is to follow in the footsteps of the recent Texas Legislature, which provides the model for this approach. The Texan consent form is mandated for each recipient of ECT. A copy of that consent form is/will be appended.
Accordingly, this report starts with an Informed Consent Form which in my view, follows the available scientific evidence more faithfully than those currently used. Such a form should be or should have been presented to every recipient of ECT prior to treatment. The Informed Consent Form presented here, comprises 6 points, each of which is then commented upon in detail in later sections of this report, with extensive quotations from the literature on the subject.
To the patient Ð this is an important document. By signing it, you (or your near relative) are giving your consent to receive Electro Convulsive Therapy (ECT). There are 6 points in all. Read each point carefully in turn. It is important that you understand each point. If there is anything you do not understand, ask for an explanation. And do not sign until you have understood, agreed to, and ticked, every point.
I have had this point carefully explained to me, and I clearly understand its full implications for me. Yes [__] No [__]
I have had this point carefully explained to me, and I clearly understand its full implications for me. Yes [__]