未经病人同意的电休克疗法的实践：一项法国自然主义研究

Q3 Medicine

Ethics, Medicine and Public Health Pub Date : 2025-01-01 DOI:10.1016/j.jemep.2025.101051

L. Chevalier , S. Lespagnol , J. Charron , L. Cheval , S. Bulteau , A. Sauvaget , A. Laurin

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引用次数: 0

摘要

自由和知情的同意在护理中是必不可少的，尽管由于精神疾病造成的辨别障碍，在精神病学中可能无法获得这种同意。在这种情况下，法律授权强制治疗，包括电休克疗法（ECT），这是一种非常有效的治疗方法，至少可以部分恢复视力。然而，未经同意的电痉挛疗法的实践记录很少，在电痉挛疗法期间重新评估同意的问题也是如此。我们需要对形势进行评估，以便改进做法。方法我们在法国南特大学医院进行了一项基于单中心观察回顾性图表的研究，纳入了162例2018 - 2022年接受ECT治疗的患者。结果36%的患者未经本人同意接受电痉挛治疗，但有近亲属（32%配偶，31%子女）同意。未经患者同意的电痉挛治疗主要是在住院时受到约束、躁狂或混合状态、患有紧张性或痴呆综合征的患者中进行的。尽管有效率达到97%，但只有3%的患者在电痉挛疗法结束时表示同意。令人惊讶的是，21名患者未经其同意，在第三方的同意下，在开放式住院治疗中接受了ECT治疗，26名患者在其同意下，在限制住院治疗中接受了ECT治疗。结论电痉挛治疗过程中患者的同意能力需要重新评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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The practice of electroconvulsive therapy without patient consent: a French naturalistic study

Introduction

Free and informed consent is essential in care, though it may be impossible to obtain in psychiatry due to the impairment of discernment caused by mental illness. In this context, the law authorizes coerced care, including electroconvulsive therapy (ECT), a highly effective treatment that can at least partially restore discernment. However, the practice of ECT without consent is poorly documented, as is the question of reassessing consent during ECT. We need to take stock of the situation in order to improve practices.

Method

We conducted a monocentric observational retrospective chart-based study at Nantes University Hospital (France) involving 162 patients treated by ECT between 2018 and 2022.

Results

Our results showed that 36% of patients were treated by ECT without their consent, but with the agreement of a close relative (32% spouse, 31% child). ECT without the patient’s consent was mainly carried out in patients hospitalized under restraint, with a manic or mixed state, suffering from a catatonic or dementia syndrome. Despite an efficacy rate of 97%, only 3% of patients regularized their consent at the end of the ECT course. Surprisingly, 21 patients were treated with ECT without their consent, with the agreement of a third party, while in open hospitalization, and 26 patients were treated with ECT with their consent while in restricted hospitalization.

Conclusion

The ability to consent during ECT treatment must be reassessed.

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来源期刊

Ethics, Medicine and Public Health Medicine-Health Policy

CiteScore

2.20

自引率

0.00%

发文量

107

审稿时长

42 days

期刊介绍： This review aims to compare approaches to medical ethics and bioethics in two forms, Anglo-Saxon (Ethics, Medicine and Public Health) and French (Ethique, Médecine et Politiques Publiques). Thus, in their native languages, the authors will present research on the legitimacy of the practice and appreciation of the consequences of acts towards patients as compared to the limits acceptable by the community, as illustrated by the democratic debate.