ECT and Capacitous Refusal — MRCPsych Paper B MCQ

Instant feedback + full explanation. One question, done properly.

HardMental Health LawECT and Capacitous RefusalMRCPsych Paper B

An adult patient detained under section 3 of the Mental Health Act 1983 has capacity to decide about electroconvulsive therapy (ECT) and refuses it. Which is the best statement about whether ECT may be administered?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — No, unless ECT is immediately necessary under section 62 to save life or prevent serious deterioration

The correct answer is A. ECT is subject to the specific safeguards in section 58A, rather than the general treatment authority in section 63. A detained adult who has capacity to decide about ECT cannot receive it under section 58A unless they consent. A SOAD certificate cannot override capacitous refusal. The narrow exception is urgent treatment under section 62: for ECT, it must be immediately necessary to save life or to prevent serious deterioration; in the latter case it must not have unfavourable physical or psychological consequences that cannot be reversed. The nearest relative has no authority to consent on the patient’s behalf, and court approval is not the routine statutory mechanism. A valid and applicable advance decision refusing ECT would also prevent SOAD authorisation if the patient later lacked capacity, subject to the urgent-treatment exception.

Reference: Department of Health, Mental Health Act 1983: Code of Practice, chapter 25, paragraphs 25.19–25.22 and 25.37–25.41, 2015. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/435512/MHA_Code_of_Practice.PDF