David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Ezio Di Nucci
Jack Alan Reynolds
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Journal of Medical Ethics 39 (3):166-170 (2013)
Major depressive disorder is not only the most widespread mental disorder in the world, it is a disorder on the rise. In cases of particularly severe forms of depression, when all other treatment options have failed, the use of electroconvulsive therapy (ECT) is a recommended treatment option for patients. ECT has been in use in psychiatric practice for over 70 years and is now undergoing something of a restricted renaissance following a sharp decline in its use in the 1970s. Despite its success in treating severe depression there is continued debate as to the effectiveness of ECT: in some studies, it is argued that ECT is marginally more effective than sham ECT. In addition, there is still no clear explanation of how ECT works; among the range of hypotheses proposed it is claimed that ECT may work by harnessing placebo effects. In light of the uncertainties over the mechanism of action of ECT and given the risk of serious side effects that ECT may produce, I contend that the process of informed consent must include comprehensive accounts of these uncertainties. I examine the possible consequences of providing adequate information to potential ECT patients, including the consideration that ECT may still prove to be effective even if physicians are open about the possibility of it working as a placebo. I conclude that if we value patient autonomy as well as the professional reputation of medical practitioners, a fuller description of ECT must be provided to patients and their carers
|Keywords||info:mesh/Mental Competency info:mesh/United States info:mesh/History, 20th Century info:mesh/Informed Consent info:mesh/Decision Making info:mesh/Clinical Trials as Topic info:mesh/Cognition Disorders info:mesh/Deception info:mesh/Depressive Disorder, Major info:mesh/Great Britain info:mesh/Placebo Effect info:mesh/Uncertainty info:mesh/Humans info:mesh/History, 21st Century info:mesh/Italy info:mesh/Personal Autonomy info:mesh/Memory Disorders info:mesh/Truth Disclosure info:mesh/Electroconvulsive Therapy Humans Memory Disorders Uncertainty Truth Disclosure Deception Mental Competency Paternalism Decision Making Personal Autonomy Cognition Disorders Depressive Disorder, Major Electroconvulsive Therapy Placebo Effect Informed Consent History, 20th Century History, 21st Century United States Great Britain Italy Clinical Trials as Topic info:mesh/Paternalism|
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Citations of this work BETA
A. Gold & P. Lichtenberg (2014). The Moral Case for the Clinical Placebo. Journal of Medical Ethics 40 (4):219-224.
Jeremy Howick (forthcoming). The Relativity of ‘Placebos’: Defending a Modified Version of Grünbaum’s Definition. Synthese:1-34.
C. Blease (2014). The Duty to Be Well-Informed: The Case of Depression. Journal of Medical Ethics 40 (4):225-229.
Robert Torrance (2015). Informed Consent and ECT: How Much Information Should Be Provided? Journal of Medical Ethics 41 (5):371-374.
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