Thursday, 25 September 2014

Reblog: Discursive of Tunbridge Wells: Electroconvulsive Therapy: Whose decision is it?

Discursive of Tunbridge Wells: Electroconvulsive Therapy: Whose decision is it? 24 September 2014 by
@steweatherhead & @THEAGENTAPSLEY 

What does consent to treatment mean?
"Lisa is a 42 year-old woman. She has had a difficult life. She has experienced multiple traumas and has at times struggled with her emotions. 
Lisa has a few close family members and a small social circle, though she does at times feel a bit oppressed by them. In 2010 Lisa contracted HIV. She has been treated medically and was stable for some time, however in 2013 she started to deteriorate.  She was seen by a psychologist as well as by medics. 
After a further twelve months she had had enough of interventions and decided she wanted to live the remainder of her life in her own way. Her family and friends objected as they could see she would rapidly deteriorate. However with support from professionals, Lisa utilised the Mental Capacity Act (MCA) to set some advanced directives. She was found to be capable of making these decisions under the MCA, and was legally allowed to refuse further intervention. 
Lisa did indeed deteriorate, and died a few months later in her own home with her family and friends around her.
Alternative ending:
Lisa did indeed deteriorate, and the professionals over-ruled Lisa’s decision and treated her with Electro-Convulsive Therapy (ECT)."
"These are fictional stories but according to our current systems, this is how they could (and probably would) play out. The only difference between them is that with one there is a medical diagnosis and with the other there is a mental health diagnosis. However, this detail leads to a wholly different intervention. In the first, Lisa is permitted to die in her own way, in the other her decisions are over-ruled. So why the difference?

An ECT machine. Should consent
always be required?
In medical settings a person can give an advanced instruction that they do not want further treatment even if their life is at risk. If they lose the ability to make decisions, the MCA protects their right not to be treated. In mental health settings a person’s similarly expressed preference can be over-ruled if two doctors agree that the person’s life is at risk and appropriate emergency treatments  (ECT  is deemed  as one) can be implemented. 
The Mental Capacity Act gives people the right to refuse treatment, even if that treatment may save a person’s life. That’s unless that person has been given a psychiatric diagnosis. In the case of a mental health problem a range of treatments (including ECT) can potentially be given without their consent.

This issue has come to the fore because of a recent report which showed that of the 832 people who received ECT whilst detained, in 2012-13, 695 were found to lack the capacity to consent to that treatment."
Read complete blog post
[My comment on this post, published:
"I am also concerned about NMD (anterior cingulotomies or brain surgery for mental disorder) that is the final stage for people who have had drug treatment and courses of ECT that "didn't work". They are deemed "treatment resistant" and in desperation ask for the brain surgery as a last resort.

In Scotland the anterior cingulotomy is performed at Ninewells Hospital, Dundee, under the auspices of the Advanced Interventions Service.

funded by NHS Scotland. People are referred to this service and a percentage each year get NMD. Small numbers so far. Eg in year ending May 2013 there were 40 actual assessments, 5 planned anterior cingulotomies and I carried out. 20% of referrals from England.

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