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<p>Electroconvulsive therapy (ECT) is an established treatment modality for severe mental disorders. Due to the severity of their condition, many individuals lack decision-making capacity at the onset of ECT. Deciding for or against ECT in a&#xa0;person who lacks decision-making capacity poses an ethical challenge for mental health professionals, particularly when the individual refuses the intervention based on their natural will. This article, drawing on the so-called combined supported decision-making model, outlines how an ethically well-founded decision for or against ECT can be made in individuals lacking decision-making capacity. First, approaches to supported decision-making and principles of substituted decision-making are presented. With regard to administering ECT against a&#xa0;person’s natural will, the ethical justification test of weak paternalism is introduced, and criteria are specified that constitute prerequisites for ethically justified involuntary treatment with ECT. Finally, the article discusses the extent to which clinical ethics consultation services can support mental health professionals in ethical decision-making.</p>

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Ethische Aspekte der Entscheidung für oder gegen eine Elektrokonvulsionstherapie bei Personen mit fehlender Einwilligungsfähigkeit

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年7月30日

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  • Jakov Gather,
  • Thomas Pollmächer,
  • Alfred Simon

摘要

Electroconvulsive therapy (ECT) is an established treatment modality for severe mental disorders. Due to the severity of their condition, many individuals lack decision-making capacity at the onset of ECT. Deciding for or against ECT in a person who lacks decision-making capacity poses an ethical challenge for mental health professionals, particularly when the individual refuses the intervention based on their natural will. This article, drawing on the so-called combined supported decision-making model, outlines how an ethically well-founded decision for or against ECT can be made in individuals lacking decision-making capacity. First, approaches to supported decision-making and principles of substituted decision-making are presented. With regard to administering ECT against a person’s natural will, the ethical justification test of weak paternalism is introduced, and criteria are specified that constitute prerequisites for ethically justified involuntary treatment with ECT. Finally, the article discusses the extent to which clinical ethics consultation services can support mental health professionals in ethical decision-making.