[candiodari]

Psychiatrists are medical doctors because they need to responsibly prescribe medication. That's all.

That doesn't mean it is considered medicine.

You still haven't explained why the threat of force (and thus force) was used against this patient ... to enforce an elective treatment that results in permanent cognitive damage. I am very curious how you'll explain that one.

(I would like to point out that any treatment that does not prevent death or long-term injury is one that's considered elective)

[mattkrause]

“Force” is a mischaracterisation.

Medicine generally relies on “informed consent”: you have the right and responsibility to know and understand the treatments you are receiving and their possible effects.

Mental illness is tricky because the condition itself impairs patients’ ability to provide this consent. Maybe you’ve got extreme lassitude and refuse everything, for example, even contradictory options. Maybe you clearly do not understand the options presented to you.

Nevertheless, we also don’t want doctors making decisions unilaterally, so the next best thing is to involve a third party. If the patient has a guardian, it’s their call. If you don’t, a court can act as one temporarily, with the idea being that they’ll get you to a state where you can take over. Obviously, this isn’t ideal, but it’s not clear what would be a better approach.

[candiodari]

This article VERY clearly states that the patient REFUSED, and then was forced to let it happen under threat of force:

The actual quote: "her husband was alarmed when the doctor suggested ECT. But he acquiesced when told that if he resisted, the hospital would seek a court order to overrule him." (note: author is talking about herself in the third person)

So I really do not "feel" force is mischaracterized. The threat was explicitly made AFTER the patient "was alarmed" (which means refused, let's get real). And threats are use of force, of course. (if I threatened to shoot you unless you did X, you would certainly call that force regardless of whether I actually shoot you, not even if I say "please". You would strongly disagree with me calling that "informed consent", rightly so)

And it's not just force. This is forcing a treatment that does permanent cognitive damage to the patient against their will. This was done knowing full well that given enough time, odds are pretty high it will disappear by itself (most suicidal patients "recover", very few actually commit suicide. I did a quick Google search and we're talking 4% apparently. Unfortunately, public opinion REALLY punishes any hospital where it happens. But that doesn't change that there was a 96% chance this patient would get cured without any action, never mind permanently crippling them)

Let's not pretend this is a moral grey area. It's not. This is far over the line.

How do you even know that this article isn't positive because the patient fears being readmitted (again with force) into the psychiatric facility and/or resumption of convulsive "therapy" ? (where she would be locked up in dismal conditions).

[mattkrause]

When I was an infant, I (apparently) struggled valiantly to avoid getting shots or having blood drawn. It hurt and the benefits of (e.g.) vaccines don't really make sense to a kid who has just learned to string a few words together. Nevertheless, my parents forced me to get them, and, as an adult who does not have several debilitating diseases, I'm glad for it. The idea is pretty similar here: the patient herself can be in a state where she's (not) making decisions that their unaffected self would. I'm a little surprised at the lack of deference to her husband, but 'alarmed' can cover a lot from "NO, NEVER" to "My God, is it really that bad?"

As I wrote above, I don't think ECT is great, but the evidence indicates it is one of the better options for drug-resistant depression. The side effects, especially for older approaches, can be pretty bad, but so is depression (and newer approaches seem to have weaker effects on memory).

I think you pretty much have to take her at her word here that she eventually appreciated the treatment. There's no way in hell someone is getting recommitted due to an article, especially not 30-40 years later.

[candiodari]

Would you feel even remotely the same if the treatment was not vaccination, but let's say you already had the measles. A bad case.

The odds would be 99%+ that you would get better on your own (essentially nobody stays depressed, after all), BUT the process of getting better would involve 2 weeks nausea, painful pimples all over, and of course generally feeling very bad. You would need to be locked up during that time to prevent spread of the disease. In < 1% of cases it would feed back onto itself, and those weeks would repeat, progressively getting worse.

The treatment is amputation, say of a foot (because ECT does permanent cognitive damage). And, even though they can give you something to prevent you from remembering the pain or the process afterwards, they can't actually sedate you. This has a decent chance of making you better in a shorter time "without" (visible) pain/issues. They may need to redo it several times, taking off some more every time. Let's say they start with a few toes, but progressively they'll take off more, and you can reasonably expect to lose at least all your toes, with your entire foot being a possibility. Of course, there's also odds you'll lose your foot, but remain ill. (there is widespread disagreement on what those odds are, so let's leave it at "not zero, and not very small either, so >10%, but not 90% like some claim either"). And there's a tiny chance you die.

Would you still feel as positive about the treatment ? What if your parents got threatened while making this decision with having you taken away by social services and having this imposed on you ? (with some small odds of you never getting returned to them, ever)

The ethical issue is more complex than you present it. You conveniently leave out that it mutilates the patient, just not visibly. You leave out that there's extreme pain involved, and they can't sedate you (that would defeat the treatment, because the point is that the brain learns to associate absolutely extreme pain and stress with "the problem"), but they can give you the date rape drug (yes, really). You won't remember. You'll still be mutilated though. Cognitive impairment. You won't remember how it happened. Usually you won't, that is. There may be some lingering trauma, and PTSD. So there's a 10% chance (it's pretty high for ECT) that you'll have extreme (fear or violent) reactions to things you associate with the treatment room.

> I'm a little surprised at the lack of deference to her husband.

Really ? What do you think about the "doctor thinking of his career" explanation ? Can you at least agree it's pretty consistent, that some doctors might think like that ?

As in, can you at least agree that giving psychiatrists that option at all presents a "moral hazard" ?