An Informed Consent form for ElectroShock Therapy

As seen in this report, which also includes documentation backing up the points made below

---

I have now been asked to examine and prepare reports on a dozen or so cases where damage may have arisen from the receipt of Electro Convulsive Therapy (ECT). As part of my obligations regarding these reports, I undertook a more general review of the literature on the subject.This is a controversial area currently receiving quantities of medical scrutiny, so this report elects to follow an innovative strategy outlined in the next paragraph, thereby better clarifying the issues involved, in terms both of medical and of legal practice. Clearly extra material will need to be added to this report, as more evidence becomes available, or in the case of the extensive NCCHTA review (see below) as it is released into the public domain.

In order to respond to this growing inundation of documents in a coherent fashion, it has been concluded that the best strategy from a medico-legal viewpoint, is to compile a modified consent form, which would enable the legal obligation of ‘fully informed consent’ to be more realistically fulfilled than it has been to date. This is to follow in the footsteps of the recent Texas Legislature, which provides the model for this approach. The Texan consent form is mandated for each recipient of ECT. A copy of that consent form is/will be appended.

Accordingly, this report starts with an Informed Consent Form which in my view, follows the available scientific evidence more faithfully than those currently used. Such a form should be or should have been presented to every recipient of ECT prior to treatment. The Informed Consent Form presented here, comprises 6 points, each of which is then commented upon in detail in later sections of this report, with extensive quotations from the literature on the subject.

---

Informed Consent Form for ECT

To the patient – this is an important document. By signing it, you (or your near relative) are giving your consent to receive Electro Convulsive Therapy (ECT). There are 6 points in all. Read each point carefully in turn. It is important that you understand each point. If there is anything you do not understand, ask for an explanation. And do not sign until you have understood, agreed to, and ticked, every point.

Point 1 The scientific evidence proving that ECT helps with depression and with suicide has always been either weak or seriously flawed.

I have had this point carefully explained to me, and I clearly understand its full implications for me.

Yes [__] No [__]

Point 2 ECT is still controversial, medical opinion has always been divided – some doctors being strongly in favour, others strongly against, then as now.

I have had this point carefully explained to me, and I clearly understand its full implications for me.
Yes [__] No [__].

Point 3 ECT can be fatal, with one estimate being as high as 1 death in every 2000 patients.

I have had this point carefully explained to me, and I clearly understand its full implications for me.
Yes [__] No [__].

Point 4 ECT always disrupts the memory, sometimes briefly, sometimes permanently.

I have had this point carefully explained to me, and I clearly understand its full implications for me.
Yes [__] No [__].

Point 5 ECT always causes mental confusion, known as ‘cognitive impairment’. This means that normal mental activities such as reading, calculating, planning, learning something new, telling the time, telling who you are – any or all of these can become hard or impossible to do, following ECT. Sometimes this impairment is brief, sometimes it is permanent. In its first 20 years, this was commonly used to justify the use of ECT.

I have had this point carefully explained to me, and I clearly understand its full implications for me.
Yes [__] No [__].

Point 6 ECT always damages brain cells, as animal studies amply prove. Again, in the early decades, this was regarded by some as justification for using it (cf lobotomy).

I have had this point carefully explained to me, and I clearly understand its full implications for me.
Yes [__] No [__].

---

illustrations of
cognitive impairment

	Main permanent symptom	Previous role
1	Cannot tell the time	Engineer
2	Cannot clean oven	Was keen book worm
3	Cannot balance books	Failed accountant
4	Cannot learn bridge/recall card dropped	Family broke down
5	Cannot write up night reports	was OAP carer – no more
6	Cannot recite alphabet	Ran a small business
7	Cannot drive outside familiar area	was an engineer
8	Cannot remember where car is parked, nor organise lessons	Failed headmistress
9	Cannot plan could recite Romeo & Juliet verbatim before ECT. Now cannot remember last Week
10	i) cannot read – only short books ii) cannot balance books - £60 aweek, daren’t vary it iii) cannot add 8 + 3 iv) cannot compare two lists v) used to be life and soul of party – ‘ a Leo’ now reclusive because too slow on the uptake vi) gets confused reading and listening – tip of the ice berg.	Had been a taxi driver for 20 years –now cannot calculate change.