Informed consent and ECT: how much information should be provided?

Obtaining informed consent before providing treatment is a routine part of modern clinical practice. For some treatments, however, there may be disagreement over the requirements for 'informed' consent. Electroconvulsive therapy (ECT) is one such example. Blease argues that patients 'should surely be privy to the matters of fact that: (1) there is continued controversy over the effectiveness of ECT; (2) there is orthodox scientific consensus that there is currently no acknowledged explanation for ECT and (3) there is a serious (mainstream) debate over whether the response to ECT may be a placebo response.' Before embracing these suggestions, two key questions must be asked. Are these claims a reasonable representation of current ECT research? And if so, will this information be of benefit to patients? The evidence-based support for ECT from both National Institute for Health and Care Excellence and the Royal College of Psychiatrists appears to undermine the validity of claims (1) and (3), and therefore the rationale for providing this information. Concerning assertion (2), it is true that the mechanism by which ECT has its therapeutic effect is not yet established, although the importance of conveying this fact to the patient is questionable. Of greater certainty is that the same irresolution surrounds the mechanism of action of pharmaceutical antidepressants, and so a double standard in patient care should be mindfully avoided if provision of this information is deemed a prerequisite for proper 'informed' consent.