Ethics in Electroconvulsive Therapy

Evidence‐based electroconvulsive therapy

“…Choosing bitemporal stimulation in the treatment for psychotic and life-threatening depression implies an ethically reasonable prioritization of maximal and fast symptom reduction above minimal memory impairment (64). The opposite priority by choosing unilateral stimulation in less urgent cases is defensible provided that grand mal seizures are induced.…”

Access to Electroconvulsive Therapy Services in Canada

“…21 In many developed countries, ECT has come to be less available to economically disadvantaged groups, and prejudice against ECT is particularly evident in the reduced availability of this treatment for certain groups of patients: the elderly, young people, those with intellectual disabilities, the chronically mentally ill, and forensic patients. 5 Four principles guide medical ethics: beneficence (the treatment is helpful), nonmaleficence (it is not harmful), autonomy (there are proper procedures for consent to treatment, including substitute decision making when the patient's judgment is impaired), and justice (all persons have equal access to good medical care). Although it is acknowledged that ECT can lead to cognitive adverse effects, these are generally short-lived and can be minimized by appropriate attention to electrode placement, stimulus waveform, and electrical dose.…”

Patient with Prolonged Psychosis after Electroconvulsive Therapy

“…2,3 The main indications for ECT include psychotic depression, depression with risk of suicide, delirious mania, catatonic stupor, postpartum psychosis, cycloid psychosis, lethal catatonia, and neuroleptic malignant syndrome.…”