"opinion, law and electroconvulsive thrapy"

About: Greater Manchester Mental Health NHS Foundation Trust

(as the patient),

I have been informed by the Department of Health that from 1st October 2008 health authorities will no longer be able overrule advanced directives or ‘Living Wills’ stating an individuals refusal of electroconvulsive therapy [ECT]. I believe that this amendment to law should have taken place a long time ago, but now that it is to be part of statute I have supplied my local NHS health trust [Bolton] with a copy of my Living Will, outlining my wish not to receive ECT should I be sectioned or chronically ill.

The consultant psychiatrist who has replied to my correspondence has been unwilling to accept that come October my ‘Living Will’ will restrict the health authority from administering ECT to me in the future. Instead she has replied as follows:

“The Mental Health Act 2007 does discuss the interface between advanced directives and the Mental Health Act. The implication from this sub section is that the registered medical practitioner responsible for an individuals care would not be able to give ECT against the wishes of an individual if the advanced directive that they had agreed to was valid and applicable. For the registered medical practitioner to be convinced that the advanced directive was valid and applicable it would be likely that they would want to know what information an individual had had in order to enable them to make a decision to instruct about the advanced directive. i.e. were they in possession of the full facts about risks and benefits of the treatment as opposed to an alternative treatment or no treatment at all.”

I should make clear that this is the opinion of the consultant I have had contact with and I have yet to be told what Bolton Mental Health Services stance on this is. It has however always seemed to me to be rather strange that a medical practitioner should be able to overrule the instructions of an individual, who has, when sane, made a legal document signed by witnesses and a GP stating their wish not to receive ECT. I think perhaps this was also the view taken by government when they amended this law, and the fact that not doing so would invite an opportunity for ‘Human Right Law’ to step in. A doctor who happened to be an atheist could not overrule the wishes of a person in a coma who had made an advanced directive instructing that they would not wish to receive a blood transfusion because the patient’s directive had been a decision made on religious grounds. Even if the doctor took the view that the patient’s advance directive had been guided by superstition or unsubstantiated legends written in a book thousands of years ago, the doctor could not overrule it.

If at the time of making a Living Will refusing ECT a person is functioning in day to day life, and deemed sane enough to make such a judgment by their GP: and if that document is legal in its format, how can a consultant make a judgment as to whether a patient was ‘informed enough’. Can a psychiatrist be trusted to invent an objective version of objectivity?

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