21 Selected topics from 2017 Criticism on human rights grounds and the health authorities’ measures ECT administered on the basis of the principle of necessity provision in the General Civil Penal Code has incurred criticism from international human rights bodies. In its Concluding Observations to Norway in 2013, the UN Committee on Economic, Social and Cultural Rights advised Norway to stop administering ECT without consent.5 Following a country visit to Norway in 2015, the Council of Europe Commissioner for Human Rights questioned whether administering ECT on the basis of the legal principle of necessity was in keeping with human rights standards.6 The Commissioner also highlighted the importance of obtaining an accurate overview of the scope of ECT therapy, and making it publicly available. In a letter to the Ministry of Health and Care Services of June 2016, the Directorate of Health questioned whether the principle of necessity is a sufficient legal basis, pointing out that repeated treatments are required for ECT to be effective.7 The directorate recommended that the use of ECT on grounds of necessity be considered further by the committee appointed by the government to conduct an overview of the regulation of coercion in Norwegian legislation (Tvangslovutvalget). The committee will submit its recommendations in September 2018.8 The Norwegian Directorate of Health published national guidelines on the use of ECT in June 2017. It was emphasised that it is only relevant to consider administering ECT on grounds of necessity in situations where a patient with a serious mental disorder is in an acute situation, and there is an immediate and serious risk to the patient’s life, or a serious risk of harm to their health if they do not receive adequate health care.9 According to the directorate, ECT must be seen as the only satisfactory treatment option available to avert acute risk, and no other less invasive treatments are considered to be options, and the intervention must be in accordance with proportionality requirements. The directorate has also set out documentation requirements for each case in which ECT is administered without consent. Patients who believe that ECT was administered unlawfully on grounds of necessity, can submit a complaint to the County Governor pursuant to the Patient and User Rights Act Section 7-2. In the Ombudsman’s opinion, the current application of the principle of necessity as an independent legal basis for intervention/competence base for administering ECT without the consent of the patient is problematic in relation to the Norwegian Constitution’s requirement that infringement of the authorities against the individual must be founded on the law.10 The legal authority requirement is stricter for very invasive measures.11 5 UN Committee on Economic, Social and Cultural Rights, Concluding Observations – Norway, 13 December 2013, E/C.12/NOR/CO/5. 6 Report by Nils Muiznieks, Commissioner for Human Rights of the Council of Europe, following his visit to Norway, 19 to 23 January 2015, CommDH (2015) 9. 7 The Directorate of Health, Concerning use of ECT in grounds of necessity, letter of 4 July 2017 to the Ministry of Health and Care Services. 8 On 17 June 2016, the Government appointed a legislative committee to conduct an overall review of the regulation of coercion in the health and care services sector. The committee is chaired by professor Bjørn Henning Østenstad. 9 The Directorate of Health (June 2017): National guidelines for the use of electroconvulsive therapy (ECT), page 26–28. 10 Article 113 of the Norwegian Constitution. 11 See, inter alia, Norwegian Supreme Court Reports Rt. 1995 p. 530 and Rt. 2001 p. 382.