NYS Office of Mental Health

Position Statement – Electronic Convulsive Therapy (ECT)

Electronic Convulsive Therapy (ECT), as a controversial treatment, has received considerable Legislative attention in New York over the past several years.  This document is intended to clarify OMH’s position and practices related to court ordered ECT treatment. 

As a practice, OMH limits the ability of facilities to seek court orders for ECT administration.  Such court orders may only be sought under the following conditions (all of which must apply):

1.                  The individual for whom an order is sought must be an involuntary patient; AND

2.                  The individual must lack the capacity to legally consent to the administration of ECT.  In contrast, individuals who do have capacity have the right to consent or reject approval of ECT treatments; AND

3.                  OMH regulations prohibit the use of ECT as an emergency procedure under all circumstances; AND

4.                  Pursuant to Rivers v. Katz, (67 N.Y. 2d 485 1986) the patient's right to self-determination is deemed paramount to a physician's obligation to provide medical treatment, as is a competent patient's right of refusal for treatment; AND

5.                  Under the ruling in Rivers v. Katz, the New York Court of Appeals delineated a two step process in order to provide psychiatric treatment for a non-consenting incapable patient.

a.      First, the proponent of the treatment must establish by clear and convincing evidence that the patient lacks capacity to make treatment decisions.

b.      Secondly , the court must then determine that clear and convincing evidence establishes that:

                                                               i.       "the proposed treatment is narrowly tailored to give substantial effect to the patient's liberty interests, taking into consideration all relevant circumstances: including

1.      the patient's best interests;

2.      the benefits to be gained from the treatment;

3.      the adverse side effects associated with the treatment;  AND

4.      any “less intrusive alternative treatment."