California experience

Press, 26 May 1977, Page 17

California experience

No country has banned E.C.T., although legislation has been passed to restrict its use. Amendments to California’s Welfare and Institutions Code, which became effective on January 1, outline strict guidelines for informed consent which must be followed before E.C.T. or psychosurgery is given to any patient, voluntarily or involuntarily. The latest laws are a revision of similar legislation rejected by the California State Court of Appeal in 1974. However, the court ruled that “regulation of intrusive and possibly hazardous forms of medical treatments is a proper exercise of the State's police power. Public health and safety protection in the field of ethical practice is an acknowledged legitimate function of police power.” The court considered

that mental patients were distinct from other ill patients because of the question of their ability to give consent and voluntarily accept treatment It held that these circumstances required the patient’s right to refuse treatment. “The special regulation of psycho-surgery and E.C.T. is also a reasonable classification because these procedures, associated with mental illness, present a great danger of violating the patient’s rights.” Californian psychiatrists believe that one result of legislation is that E.C.T. may never be carried out if the patient is thought to be capable of informed consent and refuses to give it. They believe that the use of E.C.T. could well be limited to voluntary patients, as questionable cases will become involved in a legal wrangle

between lawyers and psychiatrists — usually a lengthy battle. Some psychiatrists talk of watching their patients “die with their rights on.” “Society has not imposed requirements for concurring opinions with regard to surgical procedures with much greater risk of death (e.g. hysterectomy) or for diagnostic procedures with greater risk of disability (e.g. carotid arteriography) said three New York doctors in a medical journal. “The nublic interest would best be served by a careful scientifically based review of the evidence regarding the indications, efficacy and risks of E.C.T. followed by recommendations for public policy and research,” they said. “Our prior experiences with public hysteria and political prejudices have taught us that these are unreliable guides to medical treatment," they said.