Electroconvulsive therapy (ECT) is a highly efficacious treatment in psychiatry (Crowe, Abrams), and yet there is ethical controversy about its use. Some have claimed that
ECT should be outlawed because it seriously impairs memory; others, that ECT is best viewed as a crude form of behavior control that psychiatrists frequently coerce patients to accept. Still others claim that, even if coercion is not employed, depressed patients are rarely, if ever, competent to give valid consent to the treatment (Breggin). The complaint is also sometimes voiced that ECT is given more frequently to women patients than to men. There is also ample evidence that, in earlier years, ECT was given in ways that are not used today: higher amounts of electrical current, and sometimes daily or several-times-daily treatments. Undoubtedly, this harmed some patients (Breggin). Probably because of concerns like these, one state, California, has passed legislation making it difficult for psychiatrists to employ ECT without satisfying many administrative regulations (California Welfare and Institutions Code). There also exist several activist groups that are opposed to all ECT and have even tried to criminalize the administration of ECT. Daniel Smith provides an excellent summary of these groups's arguments and activities in his 2001 article "Shock and Disbelief."
The nature of the treatment itself understandably frightens some persons, and there have been gruesome depictions of it in popular films and novels (Kesey). The notion of passing an electrical current through the brain, stimulating a cerebral seizure and causing unconsciousness, may seem forbidding, particularly in view of the fact that ECT's therapeutic mechanism of action remains largely unknown. There are, however, many effective treatments in medicine whose mechanisms are unknown, and there are probably many surgical treatments that would seem equally forbidding if they were observed by a layperson. In appraising the ethical legitimacy of ECT as a treatment, it is important to ask the same questions about ECT that are asked about any treatment: Of what does it consist, what is the likelihood that it will help, what kinds of harm can it cause; and how does its spectrum of benefits and harms compare with those of alternative plausible treatments?
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