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Consent, competency and ECT: a philosopher's comment.
  1. H Lesser


    By way of comment, I suggest: 1) That the definitions of 'competence' and 'rationality' require some modification. 2) That Professor Sherlock is right to argue that a competent but irrational decision to refuse beneficial treatment ought to be overruled; but in practice it is extremely difficult to be sufficiently sure that the decision is really irrational and the treatment really will be beneficial, except when the patient's life is in danger or he is refusing basic necessities. 3) That in practice the issue is further complicated by such questions as whether there are alternative treatments, whether persuasion is possible, what the doctor's or institution's legal obligations are, and what resources are available. 4) That the presumption should be against coercion, and the patient--however irritating this may be to some doctors--should be considered 'rational until proved irrational'.

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