Autonomy and consent assessment for electroconvulsive therapy (ECT). A retrospective study of medical records.

The Norwegian Mental Health Act allows involuntary treatment for patients who lack consent capacity, however it allows only administration of pharmaceutical treatment and nutrition and not ECT. In lack of specific regulations, the legal access to ECT without valid consent has been grounded on the general rule of necessity in the Norwegian Penal code. This restriction and lack of legal regulation has implications for patients' rights and legal security. The study's aim was to assess the documented consent provided by patients for electroconvulsive therapy (ECT), whether ECT was administered without valid consent or under coercion, and the documented reasons, and ultimately compare practice with the legal requirements. We analysed systematically all the relevant medical records for hospitalised patients and outpatients receiving ECT during 2011-2016. We categorized data from these two groups into seven defined categories describing the attitude and quality of the consents to the ECT (or lack thereof). 378 patients received 498 ECT series´. The noted consents varied from treatment based on request (54 treatments), consent upon recommendation (209 treatments), consent after hesitation (88 treatments), consent presumed or noted without specification (114 treatments), to no consent (21 treatments) whereof the majority with documented coercion applied (19 treatments). All cases of ECT without consent referred to a "plea of necessity". The remaining treatments (12) lacked notifications specifying the consent (or attitude) expressed. Specific notes on the patient's capacity to consent for the respective ECT were generally lacking. This study indicates a large spread in patients´ acceptance and valid consent to ECT. The main reason for administering ECT without consent and/or against patients' will was for life-saving reasons. Such treatments were justified legal under a plea of necessity in the Penal Code or lacked noted legal justification. The legal vacuum for ECT without a valid consent needs to be addressed as this kind of disputed treatment is used in some cases.

Seventy patients treated for COVID-19 by Østfold Hospital Trust. / 70 pasienter med covid-19 innlagt ved Sykehuset Østfold.

BACKGROUND: There is a need for further data on the COVID-19 situation in Norway. Our aim was to describe the patients admitted to our local hospital with COVID-19 in the spring of 2020. MATERIAL AND METHOD: Data were retrieved retrospectively from our local quality register for COVID-19 and include all patients admitted to Østfold Hospital in the period 10 March 2020-31 May 2020. RESULTS: A total of 70 patients were admitted, of whom 47 (67 %) were men. The mean age was 59 years (range 18-95). The most common comorbid conditions were obesity (n = 22, 31 %), chronic coronary artery disease (n = 21, 30 %) and diabetes (n = 17, 24 %). Thirteen patients (19 %) had no comorbidities. The most common symptoms were cough (n = 56, 80 %), dyspnoea (n = 51, 73 %) and fever (n = 48, 69 %). The most frequent complications were cardiac manifestations (n = 18, 26 %), acute respiratory distress syndrome (n = 14, 20 %) and acute kidney injury (n = 9, 13 %). Four (6 %) patients developed venous thromboembolism. Twenty patients (29 %) became critically ill. Thirteen (19 %) received treatment in the intensive care unit, and seven (10 %) died while in hospital. INTERPRETATION: Most of those admitted were middle-aged men. Many had no comorbidities. The most frequent non-respiratory complications were cardiac manifestations and kidney injury. A large proportion of patients became critically ill secondary to acute respiratory distress syndrome.