Electroconvulsive Therapy for Patients With Depression Who Lack Capacity for Consent: Doing Good and Doing No Harm : The Journal of ECT

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Electroconvulsive Therapy for Patients With Depression Who Lack Capacity for Consent

Doing Good and Doing No Harm

Takamiya, Akihiro MD∗,†,‡; Bouckaert, Filip MD, PhD†,‡; Sienaert, Pascal MD, PhD§; Uchida, Takahito MD, PhD; Kudo, Shun MD; Yamagata, Bun MD, PhD; Kishimoto, Taishiro MD, PhD; Mimura, Masaru MD, PhD; Hirano, Jinichi MD, PhD

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The Journal of ECT 37(3):p 171-175, September 2021. | DOI: 10.1097/YCT.0000000000000764



Electroconvulsive therapy (ECT) is provided in real-world clinical settings for patients lacking capacity for consent. The aim of this study was to investigate the clinical characteristics and clinical effectiveness of ECT in this population.


A retrospective chart review was conducted to collect data from patients who received ECT to treat their depressive episodes between April 2012 and March 2019. Differences in clinical characteristics and short-/long-term clinical outcomes between patients who received ECT with their relatives' consent and patients who received ECT by their own consent were examined. The short-/long-term clinical outcomes were determined by clinical global impression scores and readmission rate, respectively.


Of 168 patients with depressive episodes, 34 (20.2%) received ECT with their relatives' consent. Those patients were older, had lower body mass index, and had shorter episode duration. They also exhibited more frequent psychotic, melancholic, and catatonic features. The main indication for ECT in this population was the need for rapid recovery. Patients lacking capacity for consent showed similar remission (61.8%) and response (82.4%) rates to those with capacity for consent. Readmission rate was not significantly different between groups.


There were no significant differences in short-/long-term ECT effectiveness between patients with/without capacity for consent. Electroconvulsive therapy is the only established and effective treatment in clinical settings for the most severe cases, wherein patients are incapable of giving consent but need rapid recovery. A general rejection of this practice due to concerns surrounding consent may be unethical under the ethical principles of medical care.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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