Electroconvulsive therapy, the placebo effect and informed consent

Journal of Medical Ethics 39 (3):166-170 (2013)
Abstract
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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