Electroconvulsive therapy in adolescence

The aim of this work is to discuss the ethical issues regarding the use of electroconvulsive therapy (ECT) in adolescents. Ethical implications of ECT in adolescents are analyzed in the light of general medical ethics, which include five prominent principles with respect to autonomy, nonmaleficence, beneficence, justice, and cautiousness. As adults, adolescents with acute psychotic impairment raise an inherent conflict between the respect for the patient's autonomy, on the one side, and the principle of beneficence on t he other. However, this age group presents particular dilemmas: (i) As any adolescent suffering from a psychiatric illness is a highly vulnerable subj ect, society asks for particular attention. The consequence of potential ov erprotection is that the adolescent may remain untreated because of unreali stic fears regarding ECT. (ii) Some of these fears are linked to the cognit ive secondary effects of ECT. Although preliminary data are reassuring, mor e empirical research on this population should be encouraged. (iii) Cautiou sness recommends the use of ECT in limited indications catatonia, mood diso rders, and intractable acute psychotic disorders. We conclude that there is no ethical reason to ban the use of ECT in adolescents. Ethical options in clinical practice must be evaluated empirically with respect to the conseq uences for the patient. Dogmatic views should be set aside.