Approval of electroconvulsive therapy by Guardianship-Court according to 1904 German Civil Code (BGB)

If patients who need electroconvulsive therapy are unable to consent, it is necessary to gain the guardian's permission to carry out the treatment. It remains unclear if,due to possible side effects, it is necessary to gain a n additional approval from the Guardianship Court according to 1904 of Germ an Civil Code (BGB). The high court of Hamburg (Landgericht Hamburg) decide d that legal permission is necessary as a result of the risk of persisting retrograde amnesia and the ensuing danger of permanent damage to the patien t's health. This paper points out however, that electroconvulsive therapy, even considering the contraindications, is a safe and effective treatment f or depression and schizophrenic psychoses. Application of unilateral short- pulse stimulation reduces the frequency and intensity of cognitive side eff ects. In particular, retrograde amnesia is very rare with regard to frequen cy and intensity and is negligible when compared with the dangers of the il lness itself. Therefore, it is not necessary to apply for approval from the Guardianship Court.