ECT: Legislation & consent

Dr. Dandaithapani Thyagarajan

Psychiatrist,
Hospital Kuala Lumpur
Many say it’s the most controversial treatment in medicine
 Why The Criticism?
• inhumane & morally wrong

• limited training at medical school

• no proper certification

• Invented in 1938 - anaesthesia not used yet for ECT (1951 – succinylcholine)

• books; Doctors of Deception by Linda Andre

• film; One Flew Over the Cuckoo’s Nest, 1975

Principles Of Medical Ethics

• Do good (Beneficence)

• Do no harm (Non-maleficence)

• Respect individual wishes (Autonomy)

• Serving across society, equal opportunity regardless of age, gender,

color, religion or wealth (Justice)
Mental Health Act 2001, Section 77

• ECT is a surgical procedure

• Requires same consent as any surgical procedure

Consent

“…consent is the voluntary acquiescence by a person to the proposal of

another; the act or result of reaching an accord; a concurrence of
minds; actual willingness that an act or an infringement of an interest
shall occur.”
Malaysian Medical Council, 2017
Informed consent

“Permission granted in full knowledge of the possible consequences,

typically that which is given by a patient to a doctor for treatment with
knowledge of the possible risks and benefits.”
Who gives consent ?

a) Patient himself

b) Guardian / relatives

c) 2 psychiatrist, one should be the attending psychiatrist

** Informed consent first obtained from patient

In cases of emergency…

• Guardian / relatives

• 2 medical officers / registered medical practitioners (one shall

preferably be a psychiatrist) if no guardian / relatives not traceable
immediately.
Guardian (for <18 years of age)

• Parent or parents of the minor

• A person lawfully appointed by will

• By court order to be guardian of the patient

• A person has a lawful custody

Malaysian Mental Health Act, 2001

Relative
• Husband / wife
• Son / daughter
• Father / mother
• Brother / sister
• Grandparents
• Grand child
• Maternal / paternal uncle / aunt
• Nephew / niece
Malaysian Mental Health Act, 2001
Duration of consent?
Documentation
Thank you