This page covers:
Making an informed choice and giving consent
You have the right to make an informed decision about whether or not to accept the treatment a doctor suggests. To consent properly you need enough information to be able to weigh up the risks and benefits of having it.
You should be given full information, in language you can understand, about:
- the expected benefits
- any side effects and the risk of harm
- how the treatment will be given
- alternative treatments
- the alternative of having no treatment at all
It can be hard to take in a lot of new information in one go, so you can ask for medical staff to explain it to you more than once if necessary.
You should be given 24 hours to think about it and ECTAS recommends that you have a friend, relative or advocate with you, when you are given the information, so that they can go over it with you again. ECTAS also recommends that, if your relatives or close friends disagree with your treatment, this should be recorded in your notes, together with the reasons for going ahead with it.
If you agree to the treatment you will have to sign a written consent form.
Once you have signed a consent form, you should be informed that you can change your mind at any stage in the treatment and that, if you do, the treatment will be stopped. You should also be told how you can tell staff if you have changed your mind. At each stage of the treatment, the doctor should confirm with you that you are continuing to consent.
Questions for your doctor
If ECT is recommended, you (or your friend or relative) might want to ask the following questions:
- What is the reason for suggesting ECT?
- What are the risks of ECT?
- How could ECT help?
- What are the side effects?
- Are there any long-term effects?
- Have I been offered every available alternative treatment?
- What treatment will I be offered in addition to, and after, ECT?
- What is the risk that I will feel worse afterwards?
- How many treatments are suggested?
- How will the dosage be decided?
- What will happen to me if I refuse this treatment?
If you are subject to the Mental Health Act 1983, ECT can normally be given only if you consent to it and a second opinion appointed doctor (SOAD) or approved clincian (i.e. approved by the Welsh Ministers) certifies that you've consented (and have the capacity to do so).
Treatment without consent
You may be given ECT without your consent if you need emergency treatment or if you don't have capacity to consent to it.
The Mental Health Act sometimes allows ECT to be given without your consent in an emergency, but only if the treatment is immediately necessary for any of the following:
- to save your life
- to prevent your condition seriously worsening (and the treatment doesn't have unfavourable physical or psychological consequences that can't be reversed)
If you do not have capacity
If you cannot give consent, treatment may be given under the Mental Health Act or (less commonly) under the Mental Capacity Act.
Under some sections of the Mental Health Act
You can be treated without your consent if:
- you are unable to understand the information about ECT and cannot give informed consent
- you have not previously made an advance decision or there is a decision made by an attorney, deputy or the Court of Protection refusing ECT treatment, and
- a second opinion specialist who is not involved in your care also agrees that it should be given
Under the Mental Capacity Act 2005
You may be treated without your consent if:
- you are assessed as lacking capacity to consent (under the Mental Capacity Act 2005), and
- you have not previously made an advance decision refusing ECT treatment, and
- it is considered to be in your best interests to receive the treatment
Advance decisions about ECT
If you are clear you do not wish to receive ECT even if your life is in danger, your advance decision needs to meet special conditions. If you have already made a valid and applicable advance decision refusing ECT, or your attorney under a Lasting Power of Attorney, or a court-appointed deputy, or a Court has refused ECT on your behalf, then the ECT should not be given to you.
In all cases your family should also be consulted if appropriate.
This information was published in June 2016. We will revise it in 2019.