So it seems to me that these authors’ objection to “a legal and community perspective intervening in clinical decision making” is actually what is frequently required as a rational strategy of amelioration.

They also object that “even the most reckless or indifferent intravenous drug user or alcohol dependent person does not face such state paternalism, or violation of civil rights.” My response to this is that perhaps it would be better if they did.

I agree that this is a profound issue with major consequences for medicine and the law. But psychiatric conditions are not, and so cannot be treated as, entirely medical in the traditional sense of a disease process confined within the body of a person. In fact this old medical model is breaking down in other areas as well, such as chronic diseases in general where there is increasing recognition of the interaction between bodily disease and behaviour (eg smoking). These also raise issues of “individual freedom” in the context of public health measures such as anti-smoking legislation.

All illness is a matter for the community in terms of health care and loss of contribution. So just as the recent financial meltdown has illustrated for the field of economics, so in the field of health there is balance to be found between freedom and state regulation. There is little freedom to be had either in financial poverty, or in debilitating illness and death.

There are “emergency” provisions in certain states whereby the doctor can order ECT if in their judgment the patient is “at risk”. I am aware of cases where patients, having been involuntarily committed following a manic episode, are subjected to ECT without consent, despite presenting no physical danger to anyone, including themselves. This is particularly the case with bipolar patients who refuse to acknowledge their illness and are dismissive towards treatment.

I’m surprised by the authors’ assertion that: “There are many, far more perilous interventions in medicine which are not routinely constrained by the opinions of lawyers or members of the community.” Let’s be clear: we are talking about restraining the patient, placing them under anaesthetic and inducing seizures by passing electric current through the brain. Can the authors offer examples of “more perilous interventions” which can, legally, be forcibly carried out on non-consenting patients?

Treatment of non-consenting individuals requires the highest level of oversight. To imply that this equates to paternalism is fatuous, and even hints at some other agenda. ECT, like DST, lobotomy and trepanation before it, is barbaric pseudo-medicine that should be consigned to the pages of some macabre journal of medieval quackery.