20 NORWEGIAN PARLIAMENTARY OMBUDSMAN National Preventive Mechanism ANNUAL REPORT 2017 ECT administered on grounds of necessity In 2017, the National Preventive Mechanism (NPM) has especially examined the practice at mental health care institutions where ECT is administered without the patient’s consent. Administering ECT without consent is prohibited, but in some cases, the treatment is given on grounds of necessity. Findings were made during a number of visits in 2017 that highlight that patients are subject to a high risk of inhuman or degrading treatment. Background Electroconvulsive therapy (ECT, also known as electroshock therapy) is a form of treatment whereby short, low-voltage electric shocks are administered to the patient’s brain. The treatment is administered 2–3 times a week (the total number of ECT treatments is usually between six and twelve), and it is administered under anaesthetic together with a muscle relaxant. Although the treatment is permitted in Norway, experts in the field disagree about the use of ECT and whether it can lead to permanent brain damage.1 Some patients have experienced serious side effects after ECT (such as memory loss), and a number of them have been awarded compensation from the Norwegian System of Patient Injury Compensation (NPE).2 In the preparatory works to the Mental Health Care Act of 1999, the Ministry stated that the principle of necessity can constitute grounds for administering ECT without the patient’s consent, if the patient’s life is at risk, or if there is a risk of serious harm to the patient's health.4 The Ministry made reference to the provision on the principle of necessity in the General Civil Penal Code (Section 47 of the General Civil Penal Code of 1902). Pursuant to Section 17 of the current General Civil Penal Code, an act that would otherwise constitute a criminal offence is lawful when it is done to save life, health, property or another interest from a danger that cannot be averted in any other reasonable manner, and the danger far exceeds the risk of harm from the action. As ECT is considered to be a serious intervention, it may not be administered without the patient’s consent.3 The Norwegian authorities nonetheless allow ECT to be administered without consent on grounds of necessity in special situations. 1 Aslak Syse, Gyldendal Rettsdata annotated version of the Mental Health Care Act, Section 4-4, last revised on 5 November 2016. 2 See overview: https://www.npe.no/nn/pasientsikkerhet-og-statistikk/Temaartiklerogfaktaark/Psykisk-helsevern. 3 The Patient and User Rights Act Section 4-1 and the Mental Health Care Act Section 4-4 second paragraph. 4 Proposition No 11 (1998–1999) to the Odelsting page 108–109.