Informed consent for special procedures: electroconvulsive therapy and psychosurgery.

Beloucif S. Source
Universit Paris 13, Sorbonne Paris Cit, EA 4569, e!art"ent of Anest#esiolo$% an& Critical Care 'e&icine, Avicenne Universit% (os!ital, 93))) Bobi$n%, *rance.

Abstract
PURPOSE O RE!IE": +nfor"e& consent #as beco"e t#e cornerstone of t#e e,!ression of !atient-s autono"% for et#ical an& soun& !atient.!#%sician relations#i!s. (o/ever, so"e severe !s%c#iatric &iseases "ar0e&l% #in&er t#e abilit% of selecte& !atients to ensure a !ro!er consent. Confronte& /it# "entall% &isable& in&ivi&uals /#ose con&ition "a% lea& to violence or inflictin$ it on ot#ers, societ% "ust carr% out its &ut% of !rotectin$ t#ose /#o are !articularl% vulnerable, /#ile res!ectin$ an& !rotectin$ t#ese &isable& in&ivi&uals. RE#E$% I$&I$'S: 1#e recent u!&ate in t#e in&ications an& "ore &etaile& un&erstan&in$ of electroconvulsive t#era!%, an& t#e tec#nical abilit% of obtainin$ less invasive or reversible tec#ni2ues of !s%c#osur$er%, #as rene/e& interest in t#ese i"!ressive an& efficient tec#ni2ues. S!ecificall%, t#e e"er$ence of ne/ an& !ro"isin$ cerebral neurosti"ulation tec#ni2ues for treatin$ Par0inson-s &isease #ave le& to consi&erin$ t#eir e,tension to severe !s%c#iatric &isor&ers. 1#is "et#o& can "i"ic t#e effects of -conventional- !s%c#osur$er%, but in a !otentiall% reversible an& a&a!table /a%, t#us avoi&in$ "an% un&esirable si&e.effects of lesional sur$er%. Ensurin$ an et#ical &ecision."a0in$ !rocess an& t#e a!!ro!riateness of consent beco"es of !ara"ount i"!ortance. SU((AR): Consent can be relativel% eas% to secure in selecte& !atients /#o are often full% a/are of t#eir tor"ents 3suc# as t#ose sufferin$ fro" severe refractor% &e!ression of obsessive.co"!ulsive &isor&ers4 /#ose sufferin$ "a% be suc# t#at t#e% are rea&% to acce!t, or for t#at "atter &e"an&, suc# actions. (o/ever, t#e &ut% of !#%sicians is to reali5e t#at !ains s#oul& al/a%s be ta0en to &o as "uc# $oo& 3an& as little #ar"4 as !ossible, /#ile res!ectin$ t#e free&o" of &ecision of t#ose /#o see0 to #el!.