What information is included in the informed consent for electroconvulsive therapy (ECT)?

Updated: Sep 24, 2019
  • Author: Mehul V Mankad, MD; Chief Editor: Dennis M Popeo, MD  more...
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Answer

Answer

Informed consent is an important part of the process for ECT. In a descriptive systematic review of papers and reports that included 134 testimonies, approximately half the patients reported that they had received sufficient information about ECT and adverse effects. In that review, approximately one third of patients did not feel they had freely consented to ECT, even when they had signed a consent form. [52]

No patient with a capacity to give voluntary consent should be treated with ECT without his or her written, informed consent. The capacity to consent has generally been interpreted as evidence that the patient can understand information about the procedure and can act responsibly on the basis of this information. [1, 53]

The use of involuntary ECT is uncommon but may be critical in life-threatening situations such as catatonia, severe mania, or psychosis. Clinicians must be familiar with local state laws about the use of ECT in patients lacking the ability to provide informed consent. [54]

The informed-consent process should be documented in the patient's medical record and should include a discussion of the disorder, its natural course, and the option of receiving no treatment. [53]  Printed literature and videotapes about ECT may be useful. The family of the patient should be included in the discussion. [55]

The consent form for ECT should include the following information: [1, 53]

  • A description of the ECT procedure with proposed benefits and potential risks

  • A description of treatment alternatives including a discussion of no treatment

  • A discussion of options regarding electrode placement and stimulus type

  • The typical range for the number of treatments

  • A statement concerning the need for continuation or maintenance treatment including pharmacotherapy and/or maintenance ECT

  • Discussion of the possible risks, including death, cardiac dysfunction, confusion, and memory impairment

  • A listing of patient requirements during the ECT course, such as taking nothing by mouth after midnight and stopping driving

  • A statement that consent is voluntary and can be withdrawn at any time


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