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Legislative Assembly for the ACT: 1998 Week 4 Hansard (25 June) . . Page.. 1133 ..

psychiatric registrar, who administered the ECT, and the anaesthetic registrar, who was intending to administer the general anaesthetic. During the mixed communication, when the psychiatric registrar asked the anaesthetic registrar "are you ready" the response was yes. The psychiatric registrar meant ready to induce the seizure, the anaesthetic registrar understood the question to be ready to administer the anaesthetic.

(2) The treating staff when assessing the capacity of a client to give informed consent for treatment, exercise their clinical judgement, based upon a thorough clinical assessment of the client's symptoms and their affect on his/her judgement behaviour at that time. In addition, a clinical judgement is made relating to his/her understanding of the treatment proposed as judged by discussion and questions regarding that treatment. The client is also advised of all alternative treatments reasonably available that may be of benefit to them and given a brochure explaining ECT. It is understood that informed consent is not passive acquiescence. If judged capable of deciding for him/herself a voluntary client must sign a special consent form which specifically states that the procedure has been explained to his/her satisfaction and that this consent may be withdrawn at any time. The consent form is witnessed by someone other than the doctor ordering or giving ECT. Clients in the Psychiatric Unit are seen virtually every day by medical staff and their mental status examined. Any deterioration, including the capacity to consent to treatment is considered. Informed consent at times can be difficult with a client who has a condition which impairs their thought process.

(3) Yes. The policies and procedures with regard to assessing and informing the client of the indications for ECT were adhered to. The preparation of the client for the procedure along with all the documentation specified in the policies and procedures were also adhered to.

(4) A client is informed that they have the right to obtain independent legal and medical advice and any other independent advice or assistance before giving informed consent. For voluntary clients, consent must be given in writing for a specific number of treatments, clients are no longer in the locked ward and the family/carer is involved in the decision making. On becoming an involuntary client the Mental Health Tribunal and the Office of the Community Advocate must be notified. ECT cannot be given without a Mental Health Tribunal Order and the family/carers are involved in the process.

(a) The improvement in mental state often means the client is no longer a risk to themselves or others and frequently have gained some insight into their particular mental state.

(b) Yes, the appropriate protocols and procedures were used in the case mentioned.

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