Madam, - In their letter of June 28th, Drs M.C. Walsh, Siobhan Barry and Paul O'Connell note the therapeutic benefits of electroconvulsive therapy (ECT) in response to Dr Michael Corry's article of June 25th.
However, even accepting these views, an important question still arises: is it appropriate for the law to permit the provision of ECT to a legally competent, resistant adult? While some patients with mental disorders may not have the competence to make treatment decisions, many do. Section 59 of the Mental Health Act 2001 currently allows ECT to be administered to "unwilling" patients regardless of their legal competence.
In recent years, mental health legislation in other countries has moved towards a position where ECT may be provided to a legally competent patient only with her or his consent. This now applies in England, Wales and Scotland, as well as in most states in the United States and Australia. Even if one does not regard ECT as "barbaric", it is, by any standards, an invasive treatment, especially for an "unwilling" patient.
The protections afforded to patients under the Mental Health Act 2001 in this respect are inadequate. While the imposition of ECT on an "unwilling" or "incapable" patient requires a second opinion, the Act specifies that the second opinion must be obtained from a consultant psychiatrist to whom the matter has been referred by the patient's own consultant psychiatrist (who prescribed the treatment in the first place). At a very minimum, an independent review of the treatment decision should be guaranteed.
Mental health legislation has a fundamental impact on individual rights and it is important that this legislation be kept under close scrutiny . What was considered acceptable in 2001 may not remain appropriate in 2008. It is time for the Government to follow the lead set in the recent Private Member's Bill on involuntary treatment and revisit the treatment provision aspects of the Mental Health Act 2001. - Yours, etc,
Dr MARY DONNELLY,
Law Faculty,
University College Cork.