Electroconvulsive therapy and psychiatrist's autonomy

Medico-legal and ethical issues about Circular n. 33/94 of the Lazio Region (Italy).

The subject of consent for psychiatric therapy seems to have become an important area of specialists' ethical considerations recently, with opinions held that are far from the old patemalism that seemed to be part of psychiatry perhaps more than in other fields of medicine. In fact there is the question of the right to the refusal and the choice of therapy by the patient. Moreover, the recent conclusions of the scientific debate on the psychiatric patient's consent seem to have only been acknowledged to a very small extent outside the cultural context they came from. As an example of the difficulty in creating regulations for ethical principles, the Circular n. 33/94 of the Lazio Region's Health Committee was taken into examination, since it contains the recommendations regarding electroconvulsive therapy. Apart from the formal aspect, some points can be criticized. First of all the assimilation of the electroshock with insulin-shock therapy; the possibly excessive bureaucracy in collecting the patient's consent; the possibility that consent provided by others (relatives or Menta! Health Center officers) may be valid; giving very different areas of intervention, such as psychotherapy, psycho-pharmacological therapy and electroshock, the same status. The conclusion confirms the fact that the best protection of the patient's freedom and dignity, and in particular that of the psychiatric patient, can be achieved through a strong reaffirmation of the physician's individuai responsibility.