| Sammendrag | The Norwegian Mental Health Act allows involuntary treatment for patients who lack consent capacity, however
it allows only administration of pharmaceutical treatment and nutrition and not ECT. In lack of specific regulations,
the legal access to ECT without valid consent has been grounded on the general rule of necessity in the
Norwegian Penal code. This restriction and lack of legal regulation has implications for patients' rights and legal
security.
The study's aim was to assess the documented consent provided by patients for electroconvulsive therapy
(ECT), whether ECT was administered without valid consent or under coercion, and the documented reasons, and
ultimately compare practice with the legal requirements. We analysed systematically all the relevant medical
records for hospitalised patients and outpatients receiving ECT during 2011–2016. We categorized data from
these two groups into seven defined categories describing the attitude and quality of the consents to the ECT (or
lack thereof).
378 patients received 498 ECT series´. The noted consents varied from treatment based on request (54 treatments),
consent upon recommendation (209 treatments), consent after hesitation (88 treatments), consent
presumed or noted without specification (114 treatments), to no consent (21 treatments) whereof the majority
with documented coercion applied (19 treatments). All cases of ECT without consent referred to a “plea of necessity”.
The remaining treatments (12) lacked notifications specifying the consent (or attitude) expressed.
Specific notes on the patient's capacity to consent for the respective ECT were generally lacking.
This study indicates a large spread in patients´ acceptance and valid consent to ECT. The main reason for
administering ECT without consent and/or against patients' will was for life-saving reasons. Such treatments
were justified legal under a plea of necessity in the Penal Code or lacked noted legal justification. The legal
vacuum for ECT without a valid consent needs to be addressed as this kind of disputed treatment is used in some
cases.
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