title: [Electroconvulsive therapy in nonconsenting patients].
abstract: BACKGROUND
  Electroconvulsive therapy (ECT) is a potent and successful method for the treatment of severe psychiatric disorders. Severe depressive and psychotic disorders may lead to legal incapacity and inability to consent. In Germany, administration of ECT against the patient's will is feasible under certain constellations and is regulated under the terms of the guardianship law.
  
  
  OBJECTIVE
  This article outlines the prevalence, effectiveness and tolerability of ECT when applied in nonconsenting patients.
  
  
  METHODS
  Case report and literature review.
  
  
  RESULTS
  The literature on ECT as a treatment in nonconsenting patients is relatively sparse. In 2008 the prevalence in Germany was less than 0.5 % of all patients receiving ECT. Case reports and case series suggest a good and equal level of effectiveness when compared to consenting patients. In the course of treatment the majority of patients consented to receive further ECT and retrospectively judged ECT as helpful.
  
  
  CONCLUSIONS
  The use of ECT is a highly effective treatment in severe psychiatric disorders even when administered as treatment in nonconsenting patients. It can be lifesaving and lead to a rapid improvement of symptoms and relief from severe suffering also from the patients' perspective. Thus, it seems unethical not to consider ECT as a treatment against the nonautonomous will of legally incompetent patients in individual cases. Nevertheless, physicians should always seek to obtain the patients' consent as soon as possible for both legal and ethical reasons.
authors.affiliation: Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Von-Siebold-Str. 5, 37075, Göttingen, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Besse
authors.affiliation: Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Von-Siebold-Str. 5, 37075, Göttingen, Deutschland.
authors.forename: I
authors.initials: I
authors.lastname: Methfessel
authors.affiliation: Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Von-Siebold-Str. 5, 37075, Göttingen, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Wiltfang
authors.affiliation: Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Von-Siebold-Str. 5, 37075, Göttingen, Deutschland. david.zilles@med.uni-goettingen.de.
authors.forename: D
authors.initials: D
authors.lastname: Zilles
mesh_terms: D000328:Adult; D004565:Electroconvulsive Therapy / Q000941:ethics / Q000331:legislation & jurisprudence* / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D005858:Germany; D006801:Humans; D007258:Informed Consent / Q000941:ethics / Q000331:legislation & jurisprudence*; D007872:Legal Guardians / Q000331:legislation & jurisprudence*; D016743:Mental Competency; D011618:Psychotic Disorders / Q000175:diagnosis / Q000628:therapy*; D012307:Risk Factors; D020458:Third-Party Consent / Q000941:ethics / Q000331:legislation & jurisprudence*; D016896:Treatment Outcome
keywords: Depressive disorders; Electroconvulsive therapy; Ethics; Patient’s consent; Psychotic disorders