Electroconvulsive Therapy Essay Example for Free

Electroconvulsive Therapy Essay Chapter 578 of the 14th Edition Texas Laws Relating to Mental Health and Mental Retardation discusses in length the circumstances in which application of the electroconvulsive therapy is allowed, or possible. In the United States, electroconvulsive therapy or ECT as it is commonly called is generally practiced only for the treatment of severe depression. And treatment may only be applied with expressed consent of the patient. Under no other circumstance can ECT be used other than what is prescribed. The Texas Law qualifies this expressed consent agreement by outlining the types of patients who may provide such consent. It also identifies which patients who are not eligible for such treatment at any given circumstance. The law further provides a thorough detailing of what this consent should include. The consent must clearly be communicated to the patient and the following agreed upon: the nature and purpose of the procedure; the degree, duration and probable side effects; opinions of efficacy of the procedure; probable improvement or remission expectations (www. heuniversityhospital. com). Only the presences of all these four (4) important points hold constitute the validity of the consent agreement to ECT. Federal Health Laws of the United States leave the legal obligation for accomplishment of this consent agreement to the doctors. It is the doctors who guarantee the awareness of patients to the requirements of the agreement. Historical Background of the Policy Electroconvulsive Therapy (ECT) or sometimes referred to as â€Å"electric shock treatment† (Hollander, 2000) has been in existence for over 60 years in the medical field. The use of this procedure however and the conditions surrounding the need for this treatment has improved in recent years. The procedure is used more for the treatment of severe depression (Hollander, 2000) but may also be considered as treatment for schizophrenia and other similar disorders. The first use of this procedure was in 1938 (The University Hospital, 2007) by the Italian Neurologist Ugo Cerletti, aptly aided by his assistant Lucio Bini. They used the electric shock to induce convulsion and subsequently treat mood disorders. However it was only in the 1970’s in which ECT became accepted and was finally recognized by the APA and NIMH as a viable therapeutic procedure. Even with the recognition by the APA and NIMH as having important medical value, there are a number of concerns surrounding the procedure. In fact, ECT is one of the most highly debatable medical procedures around. One of the biggest concerns is with regards to unrecoverable memory loss (Stevens, 2007) after treatment. This is the reason why the governing policy on ECT primarily focuses on the agreement of the patient to the procedure before undergoing such. Description of the Problem that Necessitated the Policy One of the biggest concerns with regards to the use of ECT as a medical treatment is its suitability for minors. For over 40 years the treatment was designed for adults who suffer mental disorders, particularly severe depression. The growing number of minors with similar disorders and because of unsubstantiated side-effects of the procedure prompted the design of the policy. Minors (Baldwin and Jones, 1998) need to be specifically identified as a no-treatment zone in this area. Description of the Policy Policies governing the use of electroconvulsive therapy as a legitimate medical procedure for mental disorders, specifically for the treatment of severe depression are designed to protect the patient. The Texas Law on this particular issue is the most popular reference to identify the implementing guidelines of ECT. The policy aims to concretize the circumstances surrounding the use of ECT. The requirements are absolute and explicit. It assures safety and protection of the patient and the doctor. As a whole the policy addresses the implementing questions that surround ECT. The pre-treatment requirements are clearly stated and easily understood. There is no way around the points of consideration, thus, proving to be well-established. However, the issue on ECT is not necessarily about the policy governing the treatment. Controversy (www. antipsychiatry. org) is focused on the viability of the treatment itself, which unfortunately, is not addressed by the policy. In fact many organization constantly fight against the use of the procedure even for severe depression, as it is commonly applied. The question on electroconvulsive therapy is more on its effectiveness as a medical procedure. Although there are a good number of documented successes of ECT, there also are a good number of disputes raised. Since the existing policy governing ECT focuses on its implementing guidelines, many disputes are not addressed. Comparative and International Analysis In March 2006, the United Kingdom made a bold move to revise (Ruthen, 2006) their existing policy on electroconvulsive therapy. The changes in the provisions include the strengthening of guideline to safeguard its practice (Ruthen, 2006). They also include the ethical considerations pertaining to safety and effectiveness. Through these provisions, the policy became more comprehensive. It increased the level of safety and security for those which the particular policy is designed. In contrast, the Texas Law as earlier discussed does not provide a clear stand on its effectiveness, efficiency, and safety. Without dealing with the ethical considerations of the procedure, the law merely provides a procedural guideline for implementation. The law neither provides basis for Government action apart from its role on instrumentation. Social Thought and Ideology There are two very contrasting social thoughts on ECT. The first is that electroconvulsive therapy is a highly effective medical procedure for mental disorders. It is safe and effective more particularly for the treatment of severe depression, bipolar disorder and schizophrenia. This view highlights the credibility of the procedure and supports the existing policies for its implementation. In both the US Federal and Texas Laws, legal accountability is placed with the patient and the doctor. Because of substantiated success of the treatment over the course of more than 60 years, the policy is designed to provide implementing guidelines to safeguard its uses. In fact, the US Federal Law specifically states that it is the legal responsibility of the doctor to clarify all pre-treatment requirements with the patient. In no instance does Government interfere with the process. Medical decisions in this case are left between the two parties involved. The strongest evidence of Government involvement in the policy lies on the registration of equipment used in the procedure. On the other hand, the second school of thought questions the very validity of the procedure as a humane alternative to treat mental disorders. Many counterpoints are raised more precisely when it comes to its ethical considerations. This point of view questions the very role of Government in safeguarding the use of this procedure. The existing policy simply does not justify the existence of unsubstantiated side effects, most particularly that of memory loss after treatment. Those who support this view believe that in the more than 60 year history of ECT, there are still so many unanswered concerns surrounding the procedure. Considering this like any other medical solution simply reduces the opportunity to scrutinize the side effects more in-depth. However contradicting the two schools of thought in this matter, there are still points both agree upon. One of these points and probably the most important is that both sides acknowledge the unsuitability of the procedure for minors. The policy was designed to make sure that the protection of minors from this procedure is absolute, not withstanding the otherwise underlying differences in the two schools of thoughts. What Dynamics and Patterns of US Social Policy are Evident in the Policy? Historically (Amenta, Bonastia, and Caren, 2001) the US Social Policy has always been the subjected of much heated debates among policy makers. The major areas that cause quite a stir are in health care, welfare, social services, and employment. There have been many attempts to revise social policies but have failed. In other words, patterns and dynamics of social policies have remained constant for many years. The longstanding debates on social policies (Weir, Orloff, and Skocpol, 1988) affect the progression of other policies. One such policy is that which addresses the mental health care, more specifically the use of electroconvulsive therapy in treating mental disorders. In as much as the social policies go through quite a scrutiny, provisions that deal with ECT are equally scrutinized. The laws that govern the use of ECT do not even state the relevance of this procedure to social welfare or any other social policy. Even though ECT is recognized as a legitimate means to treat mental disorder, there remains indifference on how far Government would go to subsidize this procedure. Conclusion Electroconvulsive therapy is a recognized treatment procedure for mental disorders by both the American Psychological Association and the National Institute of Mental Health. Its more than 60 year track record documents numerous success. In fact, it has gained even greater momentum in recent times. While there is much acclaim for the procedure, there is also much concern. The questions on side effects have not been thoroughly addressed. Policies that govern the procedure do not provide enough assurance of its safety and efficiency. There is a constant fear of other unknown side effects materializing. And with the brain being a highly susceptible mass, there is no guarantee to its long standing recovery effects. The Texas Law does provide a sense of comfort by somehow solidifying pre-treatment requirements. However, after all these requirements have been accomplished, there are no subsequent provisions that address the other important considerations. Apart from the weaknesses in policy there is the constant nagging of unanswered ethical considerations. Even with the numerous reassurances that the procedure is with expressed consent, there is still the question of how humanely applicable is the entire procedure. The policy simply puts accountability to the patient itself. It does not actually define the surrounding qualifications of the entire process. It is therefore inferred that the Texas Laws, although having the beginnings of a solid reference to protect those who undergo ECT still need a great deal of work. It does not matter if it has been the reference of many similar policies. There are important issues about ECT that are not properly addressed, or even considered. True, that with the present policies governing ECT it is always the patient’s choice. Never the less, it is the responsibility of policy makers to provide for informed choices. The human brain is far too important for simple assumptions.