Electroconvulsive therapy (ECT) - Consent
Do I have to agree to have ECT?
In most cases you have to agree to ECT. Doctors should not pressure you to agree to ECT. If you want to stop ECT at any time, you usually can.
Health professionals should make sure you understand the treatment before you agree to it.
Sometimes doctors can give you ECT without you agreeing to it. This is only in very limited circumstances. These circumstances are:
- if you need emergency treatment, or
- if you lack the mental capacity to consent.
If you need emergency treatment
If you are in hospital under the Mental Health Act 1983 (MHA) you can have ECT without your consent if:
- there is a real risk to your life,
- to stop you from becoming seriously unwell, or
- to stop you becoming seriously unwell and a risk to yourself or others.
You can find out more about ‘The Mental Health Act’ here.
If you lack the mental capacity to consent
Doctors can give you ECT if you lack the mental capacity to agree. You would normally need to be in hospital under The Mental Health Act for this to happen. You could be given ECT under The Mental Capacity Act if you lack capacity. But this is very rare.
Under The Mental Health Act a Second Opinion Appointed Doctor (SOAD) must agree that you should have ECT if you lack capacity.
The SOAD must:
- interview you,
- talk about your treatment with the doctor in charge of your care, and
- talk to a registered nurse and a non-medical practitioner who are involved in your treatment.
The SOAD should tell you the reasons for treatment. They do not have to do this if they think it would cause mental or physical harm to you or anyone else.
There are two situations when the SOAD will not be able to agree that you need ECT:
- You have a valid advance decision refusing ECT.
- Someone has the right to make treatment decisions for you and they refuse it on your behalf.
You can find out more about mental capacity in our factsheet ‘Mental capacity and mental illness’ here.
An advance decision is a legal decision that you make about your wishes if you lose mental capacity.
You can make an advance decision if you do not want to get ECT. You can explain what treatment you do not want and when this would apply.
If you make a valid advance decision refusing ECT then doctors can only give you ECT in emergency situations under the Mental Health Act (see above).
To make a valid advance decision you have to:
- be over 18,
- have mental capacity to make the decision, and
- give details in writing about what treatment you do not want and what situations this applies to.
You can find out more about mental capacity in our factsheet ‘Planning your care - advance statements’ here.
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