Martin B A, Peter A M
Can J Psychiatry. 1987 Feb;32(1):35-42. doi: 10.1177/070674378703200109.
Among the most contentious legal and ethical issues concerning the use of electroconvulsive therapy (ECT) are the criteria for obtaining a valid consent to treatment and its administration to involuntarily hospitalized patients, with or without consent. This paper reviews the consent process, in particular the assessment of competence, as it is affected by the symptoms and clinical circumstances, including civil status, of those patients for whom ECT is prescribed. The ECT caseload at one psychiatric facility was reviewed to determine the diagnosis and civil status of each patient and the source of consent for each course of ECT prescribed over a 10-year period. Significant differences were found in the diagnostic distribution and the source of consent by diagnostic group between the 1,042 courses administered to informal patients and the 249 courses to involuntary patients. The results are discussed in the context of relevant Ontario legislation and hospital policies. Recommendations are made for the improvement of procedural safeguards to protect the autonomy of all patients.
在与使用电休克疗法（ECT）相关的最具争议性的法律和伦理问题中，涉及获得有效治疗同意的标准以及在患者自愿或非自愿住院情况下对其实施该疗法。本文回顾了同意过程，特别是能力评估，因为它会受到那些被开具ECT治疗的患者的症状和临床情况（包括民事状况）的影响。我们审查了一家精神病机构的ECT病例量，以确定每位患者的诊断和民事状况，以及在10年期间为每位患者开具的每个ECT疗程的同意来源。在给予非自愿住院患者的1042个疗程和给予自愿住院患者的249个疗程之间，诊断分布和按诊断分组的同意来源存在显著差异。我们将在安大略省相关立法和医院政策的背景下讨论这些结果。我们提出了改进程序保障措施的建议，以保护所有患者的自主权。
