Jaydip Sarkar the act (except when it is under common law in patients admitted under admission order), such detention cannot translate into indefinite treatment of the patient against his will. The patient must have the unalienable right to either allow or refuse another person to introduce what actually amounts to a foreign substance (a prescription drug) into his body. Treatment against the patient’s wishes should be possible when treatment (or emergency) orders have been issued but only for a specified period (say three months) in the act. Beyond this period if the patient continues to refuse treatment, a second opinion must be sought. Second opinions must come only from a psychiatrist, of sufficient seniority and experience, whose name belongs to a list that the local mental health authority can create for this express purpose. Second opinion should ideally not be sought from one who is a staff of the hospital where the patient is being treated. When second opinion is sought, then a written treatment plan can be made available to the second opinion doctor, which will specify the preferred group of drugs (antidepressants, antipsychotics, ECT), the number of drugs to be used, and the likely duration (number in case of ECT) of treatment. Ideally and where possible the second opinion doctor must speak with a qualified nurse, the treating doctor (or his nominated deputy), another professional who may have been involved in the patient’s care (psychologist, social worker, occupational therapist, etc) and review case notes, peruse the detention order and treatment plan and examine the patient. The need to seek second opinion is one of the mechanisms that MHA in developed countries have created to enforce duties on doctors, to ensure that proposed treatment is consistent with what a majority of professionals in that particular field would have recommended, and thereby remedy any abuse of power. It is conceivable that in the absence of such a mechanism, a patient is liable to be provided sub standard, experimental, out-dated or even harmful treatment by doctors who may either be negligent or overenthusiastic with an axe to grind, and thereby (in)advertently abuse their authority, as has been the view of many with the use of electroconvulsive therapy all over the world. Ethically based MHA are created in a manner such that more invasive and permanent a treatment and its effects are, the more stringent the objective tests needed to demonstrate the potential benefits of such treatments to patients. Thus, it is recommended that treatments like psychosurgery or hormonal implants should require both patient’s consent and second opinion. Drug treatment of mental disorder after the expiry of a pre-determined duration (either by law or through guidelines by mental health 112 authority) must require either consent of the patient or a second opinion. For all other forms of treatment mere consent should suffice. Recently it has been claimed that there is an avoidable overuse of electroconvulsive therapy in India and a public interest petition has been lodged which seeks banning of physical restraints and use of unmodified ECT in India (Mudur 2002). The petition is opposed by the Indian Psychiatric Society (Dutta 2003), perhaps so as it may be “often considered better to treat a severely ill, suicidal, psychotic, catatonic, or drug-resistant patient with a suboptimum form of ECT than to leave the patient with a prescription which is likely to be less effective, and with which he may not comply” (Andrade 2002). This view emphasises that a person potentially non-complaint with drug medication can be forcibly given ECT against his wishes. Any suggestion or attempts to do so is unethical and legally amounts to assault and battery even if the intention is to bring benefit to the patient. On an erroneous basis a further argument has been made that many physical procedures in other branches of medicine are “overenthusiastically conducted” with “proven adverse … consequences” , the implication being that if provision of such treatments are deemed just and proper, the same standards should apply to unmodified (my words) ECT, otherwise “dangerous legal precedents could be set” (Andrade 2002). Such concerns are based upon ignorance of the law and ethics of medical practice and tend to mislead. Decisions to undergo medical and surgical procedures, even if felt to be unnecessary by some, are made by patients who are deemed to be mentally capacitous to make such health related decisions. A severely mentally ill person who is arguably not capacitous cannot be equated with such a group of mentally sound patients and needs all the legal and ethical protection that a society can provide him for reasons that should be readily evident. A proposal that would allow use of ECT in a legally consistent manner is as follows. If a person requires ECT treatment, has demonstrably the mental capacity to make that decision and is consenting to it, then he can be provided this treatment even if it involves the use of unmodified ECT. If he is incapacitous and/or refuses treatment, then treatment can be provided under the ‘best interest’ principle in urgent cases only, if it can be demonstrated that the benefits far outweigh the consequent harm (primarily of possible muskulo-skeletal damage and cognitive deficits). Urgency can be defined as the need to save the patients’ life or for the safety of others. Treatment thus provided should be the minimum necessary (not more than two, for