Ethical Issues in Electroconvulsive Therapy - Research Paper Example

?Running Head: Ethical Issues in Electroconvulsive Therapy Ethical Issues in Electroconvulsive Therapy [Institute’s Ethical Issues in Electroconvulsive Therapy Introduction This paper is an attempt to explore the ethical debate surrounding the use of Electroconvulsive Therapy (ECT). For the past few decades, its use has been on rise but at the same time, its opponents have also voiced their concerns loudly. Even the most reputable medical organizations have not been able to reach a consensus regarding its use. This paper would briefly explore the debate regarding Electroconvulsive Therapy and the major arguments presented by both the sides. More specifically, the paper would focus on the use Electroconvulsive Therapy on children with disabilities and autism. The paper would also shed some light on case study regarding the same, which would serve as a way to explore the subject. Discussion One of the biggest ethical issues related to the use of ECT for children with disabilities and autism lies in the fact that, as we know, that children are neurologically weak and their nerves and brain cells remain in the process of growth and development during their early ages of life. Children continue to develop their cognitive and motor abilities during their childhood. There are various cases in the medical history where children receiving even a slight injury on their skill during childhood have gone to lose their ability to memorize, think or the injury ends up disturbing other functions performed their brain. This problem amplifies even further while dealing with children who have special needs or children with autism. Their brains and neurological structures are even weaker than that of adults and their ability to bear pain is lesser. Therefore, critics of ECT argue that it is not ethically and morally correct to put a child through so considering the fact that the child is already suffering from some imparity in the brain (Beyer, Weiner & Glenn, 1998). Until this point in time, there is no authentic and reliable controlled study, which could prove that ECT provides positive impact beyond four weeks on children suffering from autism or any other form of disability. A significant majority of these studies has shown no effect at all and the ones, which have shown positive impact, the impact was not dramatic or anywhere comparable to the energy and enthusiasm of the advocates (Kerridge, Lowe, & McPhee, 2005). Furthermore, as mentioned earlier, that the positive effect seems to waive off after four weeks. Important here to note is that four weeks is the minimum time required to recover from any induced acute organic brain syndrome, which confirms the risks of ECT. Most of the opponents of ECT put a lot of emphasis on this effectiveness period of four weeks in calculating the cost benefit ratio of ECT (Ottosson & Fink, 2004). Furthermore, even if there are any studies or individual instances where ECT has worked for autistic and disabled children then those studies or instances are not reliable or credible enough. A study conducted in Larue D. Carter Memorial Hospital and Indiana University School of Medicine in the year 2004 confirms the opinion that Electroconvulsive Therapy may have a slight impact on preventing suicides with patients in the short term but there was no evidence that it has any impact at all in the long run (Kerridge, Lowe, & McPhee, 2005). The study targeted “1494 adult hospitalized psychiatric patients for 5-7 years. During this time, 76 people out of this population die and 21 percent out of these people committed suicide” (Kerridge, Lowe, & McPhee, 2005; Green & Bloch, 2006). The study showed that 16 people who had committed suicide out of this population were more opt to receiving ECT treatments as compared to others. Treatments of ECT may have ensured their short-term survival but in long run, these people were even more likely to commit suicide. It is also important to note here that it is extremely difficult to find out “impact of ECT” in these cases because the patients treated with Electroconvulsive Therapy are already at the risk of suicide. In particular, most of these patients have already tried suicides in the recent past, and that is why they receive ECT treatment (Bush & American Academy of Clinical Neuropsychology, 2007). This is one of the biggest problems with the use of ECT in children. Parents of children with disabilities and suffering from autism may find themselves in the situation where their children may be able to recover from the self-injury and shyness phase for a short term but in the end, it goes on to translate into repeated ECT treatments. Furthermore, when children with autism having comparatively weak minds are subjected to high electronic currents they remain at a great risk of memory loss. This is one of the reasons that autistic children become a bit calm after ECT because they are unable to recall their past events. For the next few weeks, the child develops a quietness and calmness in himself or herself because he or she is starting from the start and trying to recover the old memories. The child is most likely to have lost all the memories of self-injury, which ultimately delays those behaviors for a while. However, these do not mean permanent erosion of behaviors (American Psychiatric Association Committee on Electroconvulsive Therapy, & Weiner, 2001). Therefore, towards the end of the day, parents have to come repeatedly for shock treatments and every time when they leave, they are not with the same child with which they had came. The brain and the memory of the child slowly are impaired and at times, these signs remain forever. Children with disabilities and autism feel rejection from the society. Before even they learn much of the important stuff from the society, they learn the fact that they are not a part of the society. People think that they are different but not in a good way. Putting them into electric shocks would be in line of reinforcing the same idea of rejection and mistreatment. It is better that treatment options of music therapy, increased attention, massage therapy, acupuncture and others must be tried to heal their hearts and souls for effective and long lasting treatment. Richard Abrams, who has been a prominent proponent of ECT, wrote abnormalities such as impaired thinking, feeling, behaving, disturbed memory, impaired comprehension, motor restlessness and others are common in patients recovering from ECT (American Psychiatric Association Committee on Electroconvulsive Therapy, & Weiner, 2001). Without any doubts, this description clearly tells, even to a nonprofessional that a person who would go through this therapy procedure would suffer from a serious head trauma. Furthermore, studies have shown and various authors have indicated that the potential for a full recovery is doubtable. In addition, with repetition of this process, the chances of a full recovery decrease significantly (Abrams, 1997). Experts have also indicated that sometimes the children with autism will remain so neurologically impaired after the shocks that the subject would remain incontinent to urine and feces. Furthermore, the risk of retrograde amnesia is always there. Even the proponents of ECT have also cited that it may lead not only to memory loss but also “perceptual, language and other cognitive functions” (Bush, & American Academy of Clinical Neuropsychology, 2007). Furthermore, there have been many researches in the past three decades that have shown that ECT treatment can cause memory loss, which may erase a significant portion of the memories created during the period of one year before the Electroconvulsive Therapy. Furthermore, the subjects faced many difficulties in remembering and recalling the events that took place 6-8 months down the road of ECT (Bush & Drexler, 2002). An important aspect of ethics of ECT is related to the informed consent to the patient. Since ECT puts patients into a lot of stress, pain, and tension, the first choice should be take the permission regarding the same from the subject. If the patient has the ability to respond and take decisions for himself then he or she should be given the chance to know about all possible treatment options, risk benefit ratio of ECT, and the side effects that the patient could encounter. Since the focus here is the children suffering with autism and disabilities, it is highly likely that these children will not understand the full weight of their decisions. Furthermore, due to their disabilities they may not be able to communicate well with the doctors. In these conditions, usually, parents or guardians have the authority to decide over the treatment options. However, there are questions over the fact that whether or not parents or guardians would be able to understand the amount of maximum current bearable by the children. They think that a specific amount of current may be bearable for their child but due it autism and disability, that current may exceed the tolerable amount for the children which then goes on to create side effects for the child. Case Study Charlie screamed loudly and his voice echoed in that room. Despite the fact that not all his words were that recognizable but his father knew that he was begging for mercy from the electric shocks that were waiting for him. This was the 39th time in less than 5 years that he was receiving the same therapy. Charlie who celebrated his 14th birthday a couple of months back suffer from autism. His single father identified the first symptoms of autism when Charlie was only two and a half years old. Since then, problems with Charlie have been increasing. His father James accepts that much of his son’s problems have compounded because of the fact that he could not be around his son to provide him with the affection and care that he deserved and needed as a child. After the death of Charlie’s mother within three months of birth, James believes that it was his responsibility to invest all possible time and energy into the development and care of his little angel but he could not do the same because of financial problems and James’s job. Charlie spent most of his days with baby sitters, his grandmother, James’s friends, baby care centers, and others. However, as a child suffering from autism, Charlie never appreciated this much change around him and always wanted to stick with some place and person, however, the same never happened. Charlie had to play with new toys and sleep on new beds when he was clearly in love with his own bed and his own toys. With the passage of time, Charlie developed the habit of hurting himself with banging his head on the walls, hand biting, eye poking, and others (Freckelton, 2006). He also became more and more aggressive towards the people around him and refused to accept anyone who was new or came from the outside. This ultimately led to physically aggressive behavior either towards the people around him or himself. When he was nine that Charlie’s father decided after consultation with a doctor that ECT treatment could be a possible solution for Charlie’s problems of self-injuring himself. It was painful for Charlie but his father found that Charlie’s behavior with others and himself improved greatly. There was a lot of more calmness and relaxation that took place into Charlie’s personality (Fink, 2008). However, disappointment knocked the doors within a couple of months when Charlie started exhibiting the same behaviors. His father decided to try to calm down the child with other means but nothing appeared to be working. With every second, there was a great risk that he would harm himself or get out of control. ECT was the only option. Once again, the effects started diminishing after 4 weeks and completed diminished after 6 weeks (Freckelton, 2006). The cycle continued and the results were disastrous. Charlie’s eyesight became poorer and his grades feel sharply. In fact, he was not even taking interest in anything not even in his toys. It appeared that as if he was suffering with amnesia because he could not remember most of the stuff. John was concerned and he knew that this was happening because of the ECT; nevertheless, he had no other option. Every time when Charlie used to scream aloud before he had even the slightest clue that he was going for the electric shocks, James would regret two things. First was the decision of not giving him the “son-time” as he deserved from his father. In addition, second was the decision of using Electroconvulsive Therapy as a source of treatment. The other day, when James was reading about Ernest Hemingway who found no other way than suicide after receiving Electroconvulsive Therapy, tears came to his eyes and those tears were of fear since he was afraid that if any such thing happens to his child then he would have nothing left to live for (Sadoff, 2011). This Nobel Prize winner received more than 15 shock treatments during the last months of his life, which made him believe that there is no use of such a life. He said to his biographer “Well, what is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business? It was a brilliant cure but we lost the patient” (Mankad, Beyer & Weiner, 2010). Hemingway did try to kill himself in March 1961 but the attempt failed and he was sent back to Mayo where he received more shocks. Rather than preventing his suicidal behavior, these shocks provided an even stronger motivation to him for killing himself. On the morning of June 2, 1961 when Ernest was sure that no one was going to stop him this time, he did it (Mankad, Beyer & Weiner, 2010). Conclusion Therefore, towards the end, it is understandable enough to conclude that the use of ECT is not acceptable for patients and especially in case of children with disabilities and autism. The cost benefit ratio in the long term clearly dictates that the use of ECT should be avoided under all cases. It appears that the use of Electroconvulsive Therapy is a vicious cycle or a circle of death from, which there is no escape. Children who receive ECT may calm down for a while but as the disastrous effects of ECT start affecting their thinking, sensing and memorization abilities, they seem to be needing more and electric shocks (Kerridge, Lowe, & McPhee, 2005). With each ECT treatment, the child loses more and more grip over his or her nervous system erasing all the chances or that child being an able and contributing citizen of the society. ECT may be considered, as a one-time option in extreme cases where nothing else appears to be working, however, the guardian will have to ensure that they do not use ECT ever again. There have bee plenty of recent researches which have shown the various alternative treatments with children with disabilities and autism and so far the evidence and results provide hope for the parents to believe (Mankad, Beyer & Weiner, 2010). Dietary supplements of Vitamin B, magnesium, lead, folic acid, omega 3 fatty acids, proteins, and others have generated positive results with children with autism. Hyperbaric oxygen therapy (HBOT) is another method, which has generated significant debate and attention amongst experts. Many experts are looking towards the currently pending studies on HBOT as the future of treating children with various disabilities and autism (Bush & Drexler, 2002). The process includes providing children with oxygen at a significantly higher atmospheric pressure. This oxygen with greater atmospheric pressure ensures that it could compensate for the decreased blood flow in the body (Mankad, Beyer & Weiner, 2010; Kerridge, Lowe, & McPhee, 2005). Therefore, one again, the point here is that ECT is not a possible treatment for autism and disabled children who are unable to give their proper consent. Their parents usually take the decision for them to receive these shocks, and as mentioned earlier in the paper as well that parents may not be able to understand the problem and expressions of the child fully. In fact, in most cases, the child himself may not be able to express himself completely and may fail to understand the full weight of his or her decisions. It is much better in the long term to use other ways of treatment for such children (Bush & Drexler, 2002; Sadoff, 2011). Most of all, these children deserve and remain in desperate need of attention, love and care, If they receive the same, there is very low probability that any situation for using ECT would arrive (Bush, & American Academy of Clinical Neuropsychology, 2007; Mankad, Beyer & Weiner, 2010). References Abrams, R. (1997). Electroconvulsive therapy. Oxford University Press. American Psychiatric Association Committee on Electroconvulsive Therapy, & Weiner, R. D. (2001). The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging: a task force report of the American Psychiatric Association. American Psychiatric Pub. Beyer, J. L., Weiner, R. D., & Glenn, M. D. (1998). Electroconvulsive therapy: a programmed text. American Psychiatric Press. Bush, S. S., & American Academy of Clinical Neuropsychology. (2007). 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