Thousands of Australians are subjected to ECT annually, many without their consent. A recent ACT Collective investigation has found approval rates for ECT applications are shockingly high in every Australian state. This practice is sowing seeds of discontent by fostering an environment that undermines patient autonomy and human rights. The problem is as acute as this in states such as Victoria, New South Wales and the Northern Territory. In these areas, the majority of ECT applications are approved, frequently without receiving the required informed consent from patients.
Rebecca, a patient whose ECT treatment we follow in this form and across the series, lived through this disconcerting truth. Her treatment continued without court authorization, even though she was considered able to comprehend the process. By highlighting this regulation, this scenario points to a critical omission in the existing regulatory landscape for ECT applications in Australia. It poses specific risks to vulnerable populations, including children.
High Approval Rates Across States
In Victoria that number more than doubled to 87 percent of ECT applications approved during the most recent reporting period. In New South Wales, this is continuing. In fact, during the current 2023/24 year so far, 95 percent of the 749 ECT orders have been approved. The Northern Territory achieved a flawless approval rate, with every one of its 18 applications approved. Queensland approved 92 percent of ECT applications.
It’s statistics like these that illuminate the deeply ingrained racist pattern permeating our healthcare system. Providers are largely given free rein in administering ECT, rendering patients’ rights and autonomy an afterthought. The World Health Organization (WHO) has emphasized that “international human rights standards clarify that ECT without consent violates the right to physical and mental integrity and may constitute torture and ill-treatment.” This poses deep ethical questions about the appropriateness of such practices here in Australia.
Rebecca’s story is all too common, and the reality is that many women are going through these extensive treatments without truly informed consent. She shared about her powerlessness and horror when she understood that ECT could be given without her consent. “It felt unbelievable, getting my body back, getting my mind back,” she stated after the treatment. She stuck to her guns in defending her opposition to the procedure. “I have always been aware of what ECT is, and it is certainly something I would never have agreed to.”
Regulatory Framework and Minors
The current regulatory framework governing ECT exists in a patchwork varying immensely from state to state in Australia. Only Western Australia and the ACT have completely banned ECT for minors. In Western Australia, ECT is prohibited for children under 14 years old, while in the ACT, it is prohibited for those under 12.
That said, unlike Victoria, there are no specific legislative provisions governing ECT for minors in Tasmania. Nonetheless, tribunal approval is still necessary. Crucially, ECT treatment for patients under the age of 18 usually requires tribunal review to make sure that consent is properly handled. Even with these regulations in place, data has found that countless minors continue to be treated without adequate consent or oversight.
As explained by Dr. Colleen Loo, ECT can be profoundly positive for patients who do not have capacity. She calls for precautionary measures, including comprehensive bans, to protect highly susceptible groups. “Treating teams aren’t necessarily getting it right,” Dr. Loo added, highlighting the inconsistency in how healthcare providers approach consent and capacity assessments.
The Ethical Implications
How can such widespread approval of ECT applications not raise serious and ethical concerns about patient autonomy and informed consent? Advocacy organizations worry that under the current system individual rights are already trampled on and that abuse of mental health treatment could further damage communities MHS serves. “I think it’s an infringement on human rights,” Rebecca asserted, reflecting a broader concern among advocates for mental health reform.
The international health community, including the WHO, has long been very clear on this point. They unequivocally declare that ECT is “not recommended for children” and demand its ban by law. This guidance should serve as acknowledgment that patient consent and autonomy should be paramount, and administrative convenience should take a backseat.
According to the accumulation of research, ECT makes some patients—especially those who have difficulty with capacity—happier and more functional. We do have a moral obligation to make sure that every patient truly understands what they’re agreeing to and consents to these invasive treatments. Catherine Leslie, a mental health advocate, emphasized the importance of consent: “Treating teams aren’t necessarily getting it right.”
