Opinion ID: 1318692
Heading Depth: 1
Heading Rank: 2

Heading: right to refuse ect

Text: Our conclusion that a court does not need to appoint a guardian for an ECT hearing does not mean that a court does not need to consider a patient's wishes about ECT. This court has recognized the fundamental principle that competent adults have a right to determine what shall be done to their own bodies. See Smith v. Shannon, 100 Wn.2d 26, 666 P.2d 351 (1983). See also RCW 7.70.050. This right is grounded in both common law and constitutional principles. In re Ingram, supra ; In re Colyer, 99 Wn.2d 114, 119, 660 P.2d 738 (1983). See also People v. Medina, 705 P.2d 961, 967 (Colo. 1985); Holmes v. Silver Cross Hosp., 340 F. Supp. 125 (N.D. Ill. 1972). In In re Ingram, supra , we ruled that a court asked to make a substantive medical treatment decision for an incompetent individual must attempt to decide as that individual would if competent. An individual's right to refuse ECT is an especially important issue because of the nature of ECT. Electroconvulsive therapy is a highly intrusive medical procedure. Adverse side effects of ECT are documented in both the record and scholarly articles. Memory loss [both short- and long-term] has long been recognized to be a prominent effect of electroconvulsive therapy (ECT). American Psychiatric Ass'n, Task Force Report 14, Electroconvulsive Therapy 57 (Sept. 1978). Impairment of ability to learn new material is cumulative with successive treatments, and it has been demonstrated that bilateral ECT (the type administered to Schuoler) produces a greater impairment of new learning capacity than right unilateral ECT. Schuoler's counsel argues that the constitutionally protected right to privacy recognized by both this court and the United States Supreme Court includes privacy of the mind and freedom from unwanted ECT. We agree. [3] This court has decided that an individual found incompetent retains the right to choose one type of medical treatment over another, or to refuse medical treatment altogether. In re Ingram, supra . We extend the reasoning of Ingram to conclude in this case that a person involuntarily committed due to a mental disorder retains a fundamental liberty interest in refusing ECT. [3] A court asked to order ECT for a nonconsenting patient must therefore consider the patient's desires before entering an order. The court should consider previous and current statements of the patient, religious and moral values of the patient regarding medical treatment and electroconvulsive therapy, and views of individuals that might influence the patient's decision. If the patient appears unable to understand fully the nature of the ECT hearing  as severely mentally ill patients often are  the court should make a substituted judgment for the patient that is analogous to the medical treatment decision for an incompetent person. See In re Ingram, supra at 838-42. Finally, the court should enter a finding on the nature of the patient's desires. In this case, both doctors testified that discussing ECT with Schuoler was futile. The court thus should have made a substituted judgment for Schuoler. However, the court made no attempt to inquire into the views of individuals close to the patient. The court apparently accepted Dr. McCarthy's hearsay testimony that Schuoler's family was not interested in her treatment, and the court refused to provide Schuoler's counsel sufficient time to attempt to call Schuoler's family to testify. The court made no findings about the desires of Schuoler or her family members. We conclude that the court failed to conduct the investigation necessary to make a substituted judgment for Schuoler.