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Section 58A ECT Protection — MRCPsych Paper B MCQ

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HardMental Health LawSection 58A ECT ProtectionMRCPsych Paper B

In England, a 42-year-old patient detained under section 3 of the Mental Health Act 1983 has capacity to decide about electroconvulsive therapy (ECT) and refuses it. She has also made a valid advance decision refusing ECT if she subsequently loses capacity. Which statement correctly describes the legal position?

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Reveal the answer and explanation

Correct answer: B — Section 58A does not permit ECT against the current capacitous refusal; section 62 may permit it despite either refusal only if immediately necessary to save life or prevent serious deterioration.

Section 58A gives ECT stronger safeguards than ordinary treatment for mental disorder: a detained patient who has capacity cannot receive ECT under section 58A unless they consent. If capacity is subsequently lost, a SOAD cannot certify ECT under section 58A where it conflicts with a valid and applicable advance decision. However, neither form of refusal is absolute in a qualifying emergency. Section 62 permits immediately necessary ECT only to save life or to prevent serious deterioration, with no irreversible unfavourable consequences under the latter limb. Section 63 cannot bypass section 58A. A SOAD cannot authorise non-emergency ECT against a capacitous refusal, and neither hospital managers nor the Mental Health Tribunal supply the required authority.

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