Fresh controversy over ECT proposal - Ireland

[Guest guest]

http://www.imt.ie/features-opinion/2011/03/fresh-controversy-over-ect-proposal.html/comment-page-1#comment-29806

Fresh controversy over ECT proposal

March 30, 2011

Aoife Connors examines both sides of the

continuing debate over ETC and a proposal to amend the Mental

Health Act in relation to consent.

The College of Psychiatry of Ireland has proposed that the ad

should amend section 59(1)( on Electroconvulsive Therapy (ECT)

in the Mental Health Act 2001, rather than simply deleting the

words “or unwilling”.

The section states that a detained person can be given ECT with

their written consent, or when “unable or unwilling” to give

consent, if their consultant psychiatrist, along with another

second-opinion psychiatrist, jointly approve a programme of

treatment.

In March 2010, the College made a submission to an all-party

ad briefing recommending an amendment to the Mental Health Act

2001 to delete “or unwilling” from Section 59(1)(. It also

recommended enhanced oversight of ECT by the Mental Health

Commission (MHC), which regulates ECT in Ireland. This included:

improving data collection for audit and research; reviewing the

second opinion process so that the second psychiatrist is

nominated from an MHC panel, i.e. independent of the treating

psychiatrist; and including consultation with another member of

the multidisciplinary team.

Last week, the College stated that about 40 people each year are

treated with ECT and are some of the most severely ill patients in

the country, usually, but not invariably, with impaired capacity.

It supports retaining Section 59(1)( with deletion of the words

“or unwilling” in order to ensure that this small group of

patients can continue to receive the treatment with the protection

of the Mental Health Act. Without this provision, doctors could

only treat someone with ECT under “common law”.

On March 23, a ad debate took place on the Mental Health

(Involuntary Procedures) (Amendment) Bill 2008, sponsored by

Senators Déirdre de Búrca, Norris and Dan Boyle. Opening the

debate, Senator Boyle said that the Bill was originally envisaged

as dealing with two involuntary procedures in the area of mental

health, one of which was known as ‘psycho-surgery’ or, more

popularly, ‘lobotomy’.

Senator Niall Ó Brolcháin said he personally believed ECT was

“absolutely barbaric” and that it was time we got rid of it

completely. “However, I accept the premise of the Bill, which is

that at this stage we should abolish involuntary or forced

administration of ECT specifically. This is a good Bill and I will

join my colleague in opposing the section under discussion.”

There was a clear principle involved, said Senator Norris,

who added that he was passionate about the issue because he was

old enough to have dealt with people within the gay community who

were subjected to it.

Senator Phil Prendergast said she was cognisant of the human

rights issues involved and of the many diverse views on ECT,

because it was possible to hear arguments on each side. “In my

professional career, I have met people who have benefited greatly

from it and, therefore, consider it to be a positive option in a

very limited number of cases. It is important for me to say I have

seen the outcomes. I understand there are situations where people

do not have full information, a person is perceived to have

received the treatment without consent, or a person is not able to

consent.”

According to Senator Norris, however, to pass an electric shock

through the brain tissue of a human being was a very blunt

instrument: “They do not understand the neurochemistry or the

neurophysics of it, nor can they guarantee it will be successful,

and it damages memory. There is no doubt about that. It can have

more serious complications, and no-one who has witnessed it, as I

have on video — never in person, I am glad to say — can have any

view other than it has a very brutal impact on a human patient.

However, I have also spoken to people who have said, in effect,

that they did not want or welcome this, but it brought them out of

a very dark place.

“I understand that the situation can be addressed by reverting,

simply, to common law,” he added. “At the moment, two

psychiatrists can decide that this treatment must be inflicted on

a patient without his or her consent. They are protected in some

reputational and legal sense from any recourse afterwards by the

patient if the treatment is negative. My understanding is that

this is already covered under common law. If this is the best

practice or treatment, then that acts as a common law defence, so

that what may be behind the briefings of my esteemed friends in

the Royal [sic] College of Psychiatrists is protecting a patch.

Perhaps I am wrong about this, and in the event I apologise to

them, as I do not mean to misconstrue the motivation.”

Quoting Dr Agnes Higgins, Trinity College, he concluded: “I am

aware that people are making the argument that to remove 59(1)(

is to leave some patients vulnerable if they require it as a last

resort.

“This is not the case, as doctors can still give ECT and resort

to a ‘duty to care’ argument and common law.”

Senator Joe O’Toole believed the proposal protected doctors and

ignored patients. “We should not allow this to become a debate for

or against ECT. There is nothing in what we are discussing that

comes to a value judgment on ECT. We are simply opposing the idea

that it can be performed on patients unwilling to receive it.”

He added: “If the duty of care overrides other issues or common

law is the basis on which a decision is taken, it is arguable in

court. However, it is not very attractive to professionals.

Doctors prefer the existing legislation rather than what we

propose. It leaves them swinging and they must make the arguments

in favour of their professional decision.”

The new Minister of State with responsibility for Disability,

Equality and Mental Health, Kathleen Lynch, said: “I will need

some time to fully understand both sides of this very emotive

debate. I want to examine the reputed benefits and reputed

limitations of the treatment before I make any legislative

changes,” she said, as she asked the House to “give me that time”.

The Minister plans to meet the College of Psychiatry of Ireland

so that it can reassure her about the efficacy and safety of ECT,

and provide the evidence that ECT should continue to have a place

in a psychiatric service.

[Guest guest]

http://www.imt.ie/features-opinion/2011/03/fresh-controversy-over-ect-proposal.html/comment-page-1#comment-29806

Fresh controversy over ECT proposal

March 30, 2011

Aoife Connors examines both sides of the

continuing debate over ETC and a proposal to amend the Mental

Health Act in relation to consent.

The College of Psychiatry of Ireland has proposed that the ad

should amend section 59(1)( on Electroconvulsive Therapy (ECT)

in the Mental Health Act 2001, rather than simply deleting the

words “or unwilling”.

The section states that a detained person can be given ECT with

their written consent, or when “unable or unwilling” to give

consent, if their consultant psychiatrist, along with another

second-opinion psychiatrist, jointly approve a programme of

treatment.

In March 2010, the College made a submission to an all-party

ad briefing recommending an amendment to the Mental Health Act

2001 to delete “or unwilling” from Section 59(1)(. It also

recommended enhanced oversight of ECT by the Mental Health

Commission (MHC), which regulates ECT in Ireland. This included:

improving data collection for audit and research; reviewing the

second opinion process so that the second psychiatrist is

nominated from an MHC panel, i.e. independent of the treating

psychiatrist; and including consultation with another member of

the multidisciplinary team.

Last week, the College stated that about 40 people each year are

treated with ECT and are some of the most severely ill patients in

the country, usually, but not invariably, with impaired capacity.

It supports retaining Section 59(1)( with deletion of the words

“or unwilling” in order to ensure that this small group of

patients can continue to receive the treatment with the protection

of the Mental Health Act. Without this provision, doctors could

only treat someone with ECT under “common law”.

On March 23, a ad debate took place on the Mental Health

(Involuntary Procedures) (Amendment) Bill 2008, sponsored by

Senators Déirdre de Búrca, Norris and Dan Boyle. Opening the

debate, Senator Boyle said that the Bill was originally envisaged

as dealing with two involuntary procedures in the area of mental

health, one of which was known as ‘psycho-surgery’ or, more

popularly, ‘lobotomy’.

Senator Niall Ó Brolcháin said he personally believed ECT was

“absolutely barbaric” and that it was time we got rid of it

completely. “However, I accept the premise of the Bill, which is

that at this stage we should abolish involuntary or forced

administration of ECT specifically. This is a good Bill and I will

join my colleague in opposing the section under discussion.”

There was a clear principle involved, said Senator Norris,

who added that he was passionate about the issue because he was

old enough to have dealt with people within the gay community who

were subjected to it.

Senator Phil Prendergast said she was cognisant of the human

rights issues involved and of the many diverse views on ECT,

because it was possible to hear arguments on each side. “In my

professional career, I have met people who have benefited greatly

from it and, therefore, consider it to be a positive option in a

very limited number of cases. It is important for me to say I have

seen the outcomes. I understand there are situations where people

do not have full information, a person is perceived to have

received the treatment without consent, or a person is not able to

consent.”

According to Senator Norris, however, to pass an electric shock

through the brain tissue of a human being was a very blunt

instrument: “They do not understand the neurochemistry or the

neurophysics of it, nor can they guarantee it will be successful,

and it damages memory. There is no doubt about that. It can have

more serious complications, and no-one who has witnessed it, as I

have on video — never in person, I am glad to say — can have any

view other than it has a very brutal impact on a human patient.

However, I have also spoken to people who have said, in effect,

that they did not want or welcome this, but it brought them out of

a very dark place.

“I understand that the situation can be addressed by reverting,

simply, to common law,” he added. “At the moment, two

psychiatrists can decide that this treatment must be inflicted on

a patient without his or her consent. They are protected in some

reputational and legal sense from any recourse afterwards by the

patient if the treatment is negative. My understanding is that

this is already covered under common law. If this is the best

practice or treatment, then that acts as a common law defence, so

that what may be behind the briefings of my esteemed friends in

the Royal [sic] College of Psychiatrists is protecting a patch.

Perhaps I am wrong about this, and in the event I apologise to

them, as I do not mean to misconstrue the motivation.”

Quoting Dr Agnes Higgins, Trinity College, he concluded: “I am

aware that people are making the argument that to remove 59(1)(

is to leave some patients vulnerable if they require it as a last

resort.

“This is not the case, as doctors can still give ECT and resort

to a ‘duty to care’ argument and common law.”

Senator Joe O’Toole believed the proposal protected doctors and

ignored patients. “We should not allow this to become a debate for

or against ECT. There is nothing in what we are discussing that

comes to a value judgment on ECT. We are simply opposing the idea

that it can be performed on patients unwilling to receive it.”

He added: “If the duty of care overrides other issues or common

law is the basis on which a decision is taken, it is arguable in

court. However, it is not very attractive to professionals.

Doctors prefer the existing legislation rather than what we

propose. It leaves them swinging and they must make the arguments

in favour of their professional decision.”

The new Minister of State with responsibility for Disability,

Equality and Mental Health, Kathleen Lynch, said: “I will need

some time to fully understand both sides of this very emotive

debate. I want to examine the reputed benefits and reputed

limitations of the treatment before I make any legislative

changes,” she said, as she asked the House to “give me that time”.

The Minister plans to meet the College of Psychiatry of Ireland

so that it can reassure her about the efficacy and safety of ECT,

and provide the evidence that ECT should continue to have a place

in a psychiatric service.

[Guest guest]

http://www.imt.ie/features-opinion/2011/03/fresh-controversy-over-ect-proposal.html/comment-page-1#comment-29806

Fresh controversy over ECT proposal

March 30, 2011

Aoife Connors examines both sides of the

continuing debate over ETC and a proposal to amend the Mental

Health Act in relation to consent.

The College of Psychiatry of Ireland has proposed that the ad

should amend section 59(1)( on Electroconvulsive Therapy (ECT)

in the Mental Health Act 2001, rather than simply deleting the

words “or unwilling”.

The section states that a detained person can be given ECT with

their written consent, or when “unable or unwilling” to give

consent, if their consultant psychiatrist, along with another

second-opinion psychiatrist, jointly approve a programme of

treatment.

In March 2010, the College made a submission to an all-party

ad briefing recommending an amendment to the Mental Health Act

2001 to delete “or unwilling” from Section 59(1)(. It also

recommended enhanced oversight of ECT by the Mental Health

Commission (MHC), which regulates ECT in Ireland. This included:

improving data collection for audit and research; reviewing the

second opinion process so that the second psychiatrist is

nominated from an MHC panel, i.e. independent of the treating

psychiatrist; and including consultation with another member of

the multidisciplinary team.

Last week, the College stated that about 40 people each year are

treated with ECT and are some of the most severely ill patients in

the country, usually, but not invariably, with impaired capacity.

It supports retaining Section 59(1)( with deletion of the words

“or unwilling” in order to ensure that this small group of

patients can continue to receive the treatment with the protection

of the Mental Health Act. Without this provision, doctors could

only treat someone with ECT under “common law”.

On March 23, a ad debate took place on the Mental Health

(Involuntary Procedures) (Amendment) Bill 2008, sponsored by

Senators Déirdre de Búrca, Norris and Dan Boyle. Opening the

debate, Senator Boyle said that the Bill was originally envisaged

as dealing with two involuntary procedures in the area of mental

health, one of which was known as ‘psycho-surgery’ or, more

popularly, ‘lobotomy’.

Senator Niall Ó Brolcháin said he personally believed ECT was

“absolutely barbaric” and that it was time we got rid of it

completely. “However, I accept the premise of the Bill, which is

that at this stage we should abolish involuntary or forced

administration of ECT specifically. This is a good Bill and I will

join my colleague in opposing the section under discussion.”

There was a clear principle involved, said Senator Norris,

who added that he was passionate about the issue because he was

old enough to have dealt with people within the gay community who

were subjected to it.

Senator Phil Prendergast said she was cognisant of the human

rights issues involved and of the many diverse views on ECT,

because it was possible to hear arguments on each side. “In my

professional career, I have met people who have benefited greatly

from it and, therefore, consider it to be a positive option in a

very limited number of cases. It is important for me to say I have

seen the outcomes. I understand there are situations where people

do not have full information, a person is perceived to have

received the treatment without consent, or a person is not able to

consent.”

According to Senator Norris, however, to pass an electric shock

through the brain tissue of a human being was a very blunt

instrument: “They do not understand the neurochemistry or the

neurophysics of it, nor can they guarantee it will be successful,

and it damages memory. There is no doubt about that. It can have

more serious complications, and no-one who has witnessed it, as I

have on video — never in person, I am glad to say — can have any

view other than it has a very brutal impact on a human patient.

However, I have also spoken to people who have said, in effect,

that they did not want or welcome this, but it brought them out of

a very dark place.

“I understand that the situation can be addressed by reverting,

simply, to common law,” he added. “At the moment, two

psychiatrists can decide that this treatment must be inflicted on

a patient without his or her consent. They are protected in some

reputational and legal sense from any recourse afterwards by the

patient if the treatment is negative. My understanding is that

this is already covered under common law. If this is the best

practice or treatment, then that acts as a common law defence, so

that what may be behind the briefings of my esteemed friends in

the Royal [sic] College of Psychiatrists is protecting a patch.

Perhaps I am wrong about this, and in the event I apologise to

them, as I do not mean to misconstrue the motivation.”

Quoting Dr Agnes Higgins, Trinity College, he concluded: “I am

aware that people are making the argument that to remove 59(1)(

is to leave some patients vulnerable if they require it as a last

resort.

“This is not the case, as doctors can still give ECT and resort

to a ‘duty to care’ argument and common law.”

Senator Joe O’Toole believed the proposal protected doctors and

ignored patients. “We should not allow this to become a debate for

or against ECT. There is nothing in what we are discussing that

comes to a value judgment on ECT. We are simply opposing the idea

that it can be performed on patients unwilling to receive it.”

He added: “If the duty of care overrides other issues or common

law is the basis on which a decision is taken, it is arguable in

court. However, it is not very attractive to professionals.

Doctors prefer the existing legislation rather than what we

propose. It leaves them swinging and they must make the arguments

in favour of their professional decision.”

The new Minister of State with responsibility for Disability,

Equality and Mental Health, Kathleen Lynch, said: “I will need

some time to fully understand both sides of this very emotive

debate. I want to examine the reputed benefits and reputed

limitations of the treatment before I make any legislative

changes,” she said, as she asked the House to “give me that time”.

The Minister plans to meet the College of Psychiatry of Ireland

so that it can reassure her about the efficacy and safety of ECT,

and provide the evidence that ECT should continue to have a place

in a psychiatric service.

[Guest guest]

http://www.imt.ie/features-opinion/2011/03/fresh-controversy-over-ect-proposal.html/comment-page-1#comment-29806

Fresh controversy over ECT proposal

March 30, 2011

Aoife Connors examines both sides of the

continuing debate over ETC and a proposal to amend the Mental

Health Act in relation to consent.

The College of Psychiatry of Ireland has proposed that the ad

should amend section 59(1)( on Electroconvulsive Therapy (ECT)

in the Mental Health Act 2001, rather than simply deleting the

words “or unwilling”.

The section states that a detained person can be given ECT with

their written consent, or when “unable or unwilling” to give

consent, if their consultant psychiatrist, along with another

second-opinion psychiatrist, jointly approve a programme of

treatment.

In March 2010, the College made a submission to an all-party

ad briefing recommending an amendment to the Mental Health Act

2001 to delete “or unwilling” from Section 59(1)(. It also

recommended enhanced oversight of ECT by the Mental Health

Commission (MHC), which regulates ECT in Ireland. This included:

improving data collection for audit and research; reviewing the

second opinion process so that the second psychiatrist is

nominated from an MHC panel, i.e. independent of the treating

psychiatrist; and including consultation with another member of

the multidisciplinary team.

Last week, the College stated that about 40 people each year are

treated with ECT and are some of the most severely ill patients in

the country, usually, but not invariably, with impaired capacity.

It supports retaining Section 59(1)( with deletion of the words

“or unwilling” in order to ensure that this small group of

patients can continue to receive the treatment with the protection

of the Mental Health Act. Without this provision, doctors could

only treat someone with ECT under “common law”.

On March 23, a ad debate took place on the Mental Health

(Involuntary Procedures) (Amendment) Bill 2008, sponsored by

Senators Déirdre de Búrca, Norris and Dan Boyle. Opening the

debate, Senator Boyle said that the Bill was originally envisaged

as dealing with two involuntary procedures in the area of mental

health, one of which was known as ‘psycho-surgery’ or, more

popularly, ‘lobotomy’.

Senator Niall Ó Brolcháin said he personally believed ECT was

“absolutely barbaric” and that it was time we got rid of it

completely. “However, I accept the premise of the Bill, which is

that at this stage we should abolish involuntary or forced

administration of ECT specifically. This is a good Bill and I will

join my colleague in opposing the section under discussion.”

There was a clear principle involved, said Senator Norris,

who added that he was passionate about the issue because he was

old enough to have dealt with people within the gay community who

were subjected to it.

Senator Phil Prendergast said she was cognisant of the human

rights issues involved and of the many diverse views on ECT,

because it was possible to hear arguments on each side. “In my

professional career, I have met people who have benefited greatly

from it and, therefore, consider it to be a positive option in a

very limited number of cases. It is important for me to say I have

seen the outcomes. I understand there are situations where people

do not have full information, a person is perceived to have

received the treatment without consent, or a person is not able to

consent.”

According to Senator Norris, however, to pass an electric shock

through the brain tissue of a human being was a very blunt

instrument: “They do not understand the neurochemistry or the

neurophysics of it, nor can they guarantee it will be successful,

and it damages memory. There is no doubt about that. It can have

more serious complications, and no-one who has witnessed it, as I

have on video — never in person, I am glad to say — can have any

view other than it has a very brutal impact on a human patient.

However, I have also spoken to people who have said, in effect,

that they did not want or welcome this, but it brought them out of

a very dark place.

“I understand that the situation can be addressed by reverting,

simply, to common law,” he added. “At the moment, two

psychiatrists can decide that this treatment must be inflicted on

a patient without his or her consent. They are protected in some

reputational and legal sense from any recourse afterwards by the

patient if the treatment is negative. My understanding is that

this is already covered under common law. If this is the best

practice or treatment, then that acts as a common law defence, so

that what may be behind the briefings of my esteemed friends in

the Royal [sic] College of Psychiatrists is protecting a patch.

Perhaps I am wrong about this, and in the event I apologise to

them, as I do not mean to misconstrue the motivation.”

Quoting Dr Agnes Higgins, Trinity College, he concluded: “I am

aware that people are making the argument that to remove 59(1)(

is to leave some patients vulnerable if they require it as a last

resort.

“This is not the case, as doctors can still give ECT and resort

to a ‘duty to care’ argument and common law.”

Senator Joe O’Toole believed the proposal protected doctors and

ignored patients. “We should not allow this to become a debate for

or against ECT. There is nothing in what we are discussing that

comes to a value judgment on ECT. We are simply opposing the idea

that it can be performed on patients unwilling to receive it.”

He added: “If the duty of care overrides other issues or common

law is the basis on which a decision is taken, it is arguable in

court. However, it is not very attractive to professionals.

Doctors prefer the existing legislation rather than what we

propose. It leaves them swinging and they must make the arguments

in favour of their professional decision.”

The new Minister of State with responsibility for Disability,

Equality and Mental Health, Kathleen Lynch, said: “I will need

some time to fully understand both sides of this very emotive

debate. I want to examine the reputed benefits and reputed

limitations of the treatment before I make any legislative

changes,” she said, as she asked the House to “give me that time”.

The Minister plans to meet the College of Psychiatry of Ireland

so that it can reassure her about the efficacy and safety of ECT,

and provide the evidence that ECT should continue to have a place

in a psychiatric service.