İbrahim BALCIOĞLU, Filiz Ekim CEVİK, Yasin Hasan BALCIOĞLU

Psikiyatrinin etkin biyolojik tedavisi olan elektrokonvülsif tedaviye tıp etiği ve hukuku açısından güncel bir bakış

Elektrokonvülsif terapilEKT] birçok psikiyatrik hastalığın tedavisindekullanılan etkili bir biyolojik sağaltım yöntemidir. Butedavinin etik ve hukuki boyutu, ruhsal hastalıkların tedavisindekullanılmaya başlandığından beri tartışılmaktadır. Uzun sü-redir kullanılan bir tedavi olmasına rağmen, elektrokonvülsifterapi alan hastaların olumsuz ifadeleri, sağlık çalışanları vekitle iletişim araçlarının uygulamayı "şok tedavisi" olarak nitelendirmeleri,tedaviyle ilgili çesitli konularda standart yaklaşımlarınnet olmaması, uygulamanın yöntemsel sorunlarıelektrokonvülsif terapinin toplum nezdinde tedaviden ziyadeceza yöntemi olarak görülmesine ve önyargı oluşmasına sebepolmuştur. Psikiyatrik bozukluğu olan hastaların klinik araş-tırma ve tedaviye katılma konusundaki karar verme yeterliğihem yasal hem de tıp etiği zemininde hala tartışılan bir konuolmakla birlikte yaygın bir şekilde araştırılmaktadır. Psikiyatrikhastaların zorunlu ve istemsiz şekilde yatırılarak tedavi edilmegerekliliği birçok ülkede müstakil ruh sağlığı yasalarıylagüvence altına alınmıştır. Ancak, ülkemizde farklı yönetmelikve yasa maddelerinin varlığı bu hastaların gözlem ve tedavilerihususunda sağlık profesyonellerini çoğu zaman zaman ikilemdebırakmaktadır. Ülkemizde 2006 yılında yürürlüğe giren EKTyönergesi uygulamanın esaslarını belirtse de, hukuki açıdangeçerliği ve Hasta Hakları Yönetmeliği ile çelişen içeriği, benzerikilemlerin EKT uygulamalarında da kimi zaman yaşanmasınaneden olmaktadır. Bu yazıda, elektrokonvülsif terapininetik ve hukuki boyutu güncel yaklaşımlar ve bilgiler ışığındairdelenmiştir.

Current ethical and medicolegal perspectives on electroconvulsive therapy, an effective biological treatment of psychiatry, at glance

Electroconvulsive therapy [ECT] is an effective biological treatment method used in the treatment of many psychiatric disorders. The ethical and legal aspects of the aforementioned treatment have been discussed since it began to be applied in the treatment of mental illnesses. Although it has been used for long time, negative feedback of patients about ECT, derogatory definition of ECT as ”shock therapy" by health professionals and the mass media, the lack of clear standards and well defined scientific approach of the various issues related to the treatment and methodological problems regarding the treatment caused prejudice for the society, and therefore ECT is considered as punishment rather than treatment. Decision-making competence of patients with psychiatric disorder in clinical research and their participation in the treatment process are still matter of discussion in terms of both legal and medical ethics and the aforementioned issues are still being investigated. The necessity of hospitalization of psychiatric patients in forced and involuntary way is assured by extensive mental health laws in many countries. However, most of the time the existence of different regulations and legal provisions in our country leave the health professionals in dilemma regarding observation and treatment of these patients. In our country, ECT directive that came into force in 2006 define the principles of the treatment, nevertheless, legal validation and contradictory context of the legal framework with respect to the Patients' Rights Directive cause similar dilemma. In this paper, the ethical and legal aspects of electroconvulsive therapy were examined in the light of current scientific approaches and knowledge.

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