This narrative is written with the intent to encourage physicians as well as other healthcare professionals to use judicial processes, such as those provided by the Ontario Consent and Capacity Board, to help resolve conflict with treatment decisions between care providers and decision-makers. Through the presentation of a fictional yet common case scenario, it is argued that after all attempts at mediation have been attempted that the timely use of a third party is in the patient's, the family's and the healthcare team's best interests.
To survey major aspects of obtaining informed consent to electroconvulsive therapy (ECT) in the countries of the European Union.
Leading professionals in the field of biological psychiatry in all European Union countries and Norway and Switzerland were approached by e-mail asking about the national practice of obtaining consent to ECT including the form of consent, the legality of consent by proxy, and consent to anesthesia and maintenance treatment.
A considerable diversity was found across Europe regarding consent to ECT. In Slovenia and Luxembourg, ECT is not available at all. Informed consent is needed in written form in most European countries except for Sweden, Denmark, Finland, and Slovakia, where verbal consent is sufficient. Italy, Ireland, and Latvia are stricter in their approach because separate written consent is required before each ECT session.
The practice of obtaining informed consent varies from country to country reflecting the individual European Union countries' jurisdiction and their sociocultural traditions as well as their different development of psychiatric services. In line with the increasing cooperation in health care, developing a unified way of obtaining consent for ECT is recommended.
As the number of older adults residing in continuing care facilities increases, mental health professionals will provide more services and conduct more research in this setting. Mental health professionals working with continuing care residents will find themselves regularly challenged by ethical issues, particularly obtaining informed consent. Characteristics of the continuing care setting and residents make obtaining informed consent especially challenging. Mental health professionals must overcome these challenges in order to fulfill the following three requirements of informed consent: (1) the client is competent, (2) the client is provided with sufficient information, and (3) the client has not been coerced and/or the consent is voluntary. This article will examine the issues surrounding the fulfillment of these requirements in a continuing care facility, and will provide suggestions and guidelines that mental health professionals can utilize during the informed consent process.