title: Electroconvulsive therapy against the patients' will: A case series.
abstract: Electroconvulsive therapy (ECT) is the most effective therapy for severe depressive and psychotic disorders. As patients may be subject to legal incapacity and lack of insight, treatment may be administered against the patient's will. There is only limited evidence on the use of ECT against the patient's non-autonomous will.
  
  
  
  We report a series of eight patients who received ECT against their will in two German university medical hospitals between 2014 and 2016. The effectiveness, tolerability and patients' perspective are described.
  
  
  
  Seven of eight patients were much or very much improved according to the Clinical Global Impression Scale. Capacity to consent was restored in seven patients. Transient side effects occurred in four patients. Seven patients agreed to receive further ECT in the treatment course.
  
  
  
  This case series suggests that ECT may (and sometimes should) be administered to severely ill, non-consenting patients against their will with good effectiveness. Potential and mostly moderate and transient side effects have to be weighed up against the potentially life-saving character of ECT in patients with, e.g., suicidality and food refusal. Most importantly, the patients' retrospective appraisal also justifies the administration of ECT in situations of severe mental illness and legal incapacity.
authors.affiliation: a Department of Psychiatry and Psychotherapy , University Medical Center Göttingen , Göttingen , Germany.
authors.forename: Isabel
authors.initials: I
authors.lastname: Methfessel
authors.affiliation: b Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim , Central Institute of Mental Health, University of Heidelberg , Heidelberg , Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Sartorius
authors.affiliation: a Department of Psychiatry and Psychotherapy , University Medical Center Göttingen , Göttingen , Germany.
authors.forename: David
authors.initials: D
authors.lastname: Zilles
mesh_terms: D000328:Adult; D003866:Depressive Disorder / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000009:adverse effects / Q000941:ethics / Q000379:methods / Q000523:psychology; D005260:Female; D005858:Germany; D006801:Humans; D007258:Informed Consent / Q000941:ethics; D008297:Male; D016743:Mental Competency; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011618:Psychotic Disorders / Q000628:therapy*
keywords: Electroconvulsive therapy; consent; ethics; legal incapacity