ECT and ethical psychiatry.

The author discusses the right to receive ECT and describes voluntary and involuntary patients for whom the treatment seemed both ethical and humane. The right to refuse ECT must be respected in competent patients. However, problems arise when patients' decision-making ability is compromised by their illness. Informed consent questions include how much and what type of information patients should receive and how much those with disordered cognitive functioning can be expected to understand. The author believes that ECT should be fully voluntary whenever possible and that a court-appointed guardian should make such treatment decisions for incompetent patients.