Informed consent

In Shakespeare's comedy All's Well That Ends Well, Helena, the orphan daughter of a physician, heals the king of France and thereby earns her betrothal to Bertram. That she begs the king's consent before rendering treatment is evidence that even at the turn of the 17th century the royal treatment for patients embodied not only beneficence and nonmaleficence but also patient autonomy and the prior authorization of treatment. In a modern society in which so many live like royalty, the legal standard of informed consent applies to all, regardless of birthright or education. The outcome of electroconvulsive therapy (ECT) includes all that does and does not end well – including treatment failure, early relapse, and the possibility of significant adverse effects. Our duty as physicians has evolved into an artful balancing act. Because patients have a right to effective treatment, the ECT physician must be appropriately persuasive. Because patients have the right to refuse treatment, the doctor must provide an honest and reasonably full disclosure and avoid coercion. Because illness and medications may affect understanding, the standard of care requires an assessment of capacity of each patient to consent for treatment.