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ECT Consent Provisions — MRCPsych Paper B MCQ

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HardMental Health LawECT Consent ProvisionsMRCPsych Paper B

In England, a 30-year-old man is detained for treatment under section 3 of the Mental Health Act 1983 with severe catatonic depression. ECT is clinically indicated. He lacks capacity to consent to ECT. The treatment is not immediately necessary under the emergency criteria in section 62, and there is no valid and applicable advance decision refusing ECT, no objection from a suitably authorised attorney or deputy, and no conflicting decision of the Court of Protection. Which provision governs the required authorisation before ECT is administered?

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Reveal the answer and explanation

Correct answer: D — Section 58A, requiring second-opinion certification for ECT

Explanation lettering: D = shown as B · B = shown as C · C = shown as D

C is correct. Section 58A specifically applies to ECT, including medication administered as part of ECT. For a detained adult who lacks capacity, non-emergency ECT requires a SOAD certificate confirming lack of capacity and that ECT is appropriate, with no valid and applicable advance decision refusing it, authorised attorney/deputy objection, or conflicting Court of Protection decision. Section 57 concerns treatments such as neurosurgery. Section 58 applies to medication after the relevant initial period and expressly does not govern medication given as part of ECT. Although section 63 is the general treatment authority for detained patients, it is subject to the special safeguards in section 58A. Section 62 can bypass these safeguards only where treatment is immediately necessary under its statutory emergency criteria, which the stem excludes.

Reference: Department of Health, Mental Health Act 1983: Code of Practice, Chapter 25, paragraphs 25.19–25.22 and 25.37–25.38, 2015. https://assets.publishing.service.gov.uk/media/5a80a774e5274a2e87dbb0f0/MHA_Code_of_Practice.PDF