Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness by Edward Shorter;David Healy

Author:Edward Shorter;David Healy
Language: eng
Format: mobi
Published: 2014-04-12T16:07:00+00:00

Mitchell and Informed Consent

It is widely noted that with the rise of modern hospitals as sprawling institutions with corporate interests and the intrusion of ever more technology into the process of medicine, the relations between patients and physicians began to change. In the process, it became less acceptable for physicians to decide for patients without consulting them. But this new relationship did not come about simply because hospitals and machines were bigger; it stemmed in part from the availability of a new, public form of research evidence from randomized controlled trials (RCTs).

The issue came to a head in 1966 in a New England Journal of Medicine article on informed consent written by Henry Beecher, a professor of anesthesiology at Harvard University.26 Beecher outlined a series of research practices in some of the best-known hospitals in the country and undertaken by some of the most distinguished clinicians and researchers. In twenty-two separate research studies, patients who thought they were receiving normal clinical care were, in fact, research subjects and they were receiving clinical interventions that were quite problematic. No one study was singled out as involving poor practice as such, but their combined weight indicated that in some cases, treatmentrelated injuries had been inflicted on patients who were unaware of the risks. Patients who had trusted their physicians had become research subjects without being aware of it. There was an outcry. Within a year the FDA, NIH, and other federal bodies had put in place requirements for experimental subjects to be informed as to the nature of any care they might be receiving and the risks that any research element of that care might pose.27

Beecher's article had an even greater impact than the Salgo case. Once let out, the genie of informed consent could not be contained within the bottle of research. Nowhere was this clearer than in the treatment of breast cancer and the administration of ECT. In the case of breast cancer, for three-quarters of a century, women had undergone mutilating surgery at the hands of physicians on a mission to eradicate cancer.28 In the zeal of their mission, surgeons removed everincreasing amounts of tissue, including lymph nodes, the remaining healthy breast, and often the muscles of the chest wall. In the 196os, women became aware that some surgeons had been questioning such practices since the 195os, and that there was a great deal of evidence to show that less severe operations were just as successful. This was the era that gave rise to modern feminism, and the battle cry went up that male surgeons were inflicting their will on women's bodies. Women who had gained knowledge about alternative procedures and best outcomes found themselves dismissed with scorn and derision as simple housewives.

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