For a small country (population about 5.5 million), Denmark uses a lot of electroconvulsive therapy (ECT) – about 20,000 individual treatments a year. Now news emerges from Denmark that people are being denied social security benefits if they do no agree to undergo ECT. One article describes how a woman was refused sickness benefits because she would not have ECT, which even her psychiatrist did not recommend. And another features a man who had agreed to ECT in spite of his concerns about memory loss because unless he did so he would be refused a fleksjob (presumably some sort of flexible working arrangement for disabled people in Denmark). In this case, his psychiatrist was in favour of the treatment.*
It is not clear from these brief articles whether the authorities consider ECT to be a treatment that is likely to restore someone to the state where they can work, or whether the threat of ECT is being used as a deterrent to claiming benefits.
Mette Hartlev, a professor of law at the University of Copenhagen, has commented on the ethical issues raised by these instances. She wonders whether consent can be said to be freely given when someone, for example, has been told that they will lose the right to a fleksjob if they don’t consent to treatment. She acknowledges that treatment choice may often be limited by non-clinical factors, but wonders when this influence crosses the border into coercion. She also points out that with ECT there is no guarantee that the treatment will work and that it may have side effects.
Last year Ekstra Bladet featured the story of one woman who was left worse off after ECT. After just one treatment, during which she had a prolonged seizure, she was left with brain damage and epileptic seizures.
Is similar pressure being put on people to undergo treatment with ECT by the authorities in other countries? I found two websites where social security lawyers in the United States were discussing ECT.
In answer to someone who was concerned that he would be penalized for not undergoing ECT, Atlanta attorney Jonathan Ginsberg says:
“I think that Social Security expects claimants to pursue all reasonable courses of treatment. This does not extend to invasive procedures (such as surgery), or therapy that involves powerful medications or treatments. In my view, therefore, your refusal to continue with ECT treatments because of undesireable side effects would not be held against you.”
Charles Hall, a Social Security attorney in North Carolina, takes a rather different line on the Charles T Hall Law Firm website. There is a picture of Jack Nicholson in One Flew over the Cuckoo’s Nest before some text saying that ECT isn’t like that nowadays and that it works. This is followed by the advice: “If you have had or are now having ECT for depression, almost certainly should be applying for Social Security disability benefits.” That raises the question: if ECT works, why should having had it in the past qualify someone for disability benefits?
* I found these two Danish articles via the blog Adventures and Japes