This section amends section 58A (which currently only applies to electro-convulsive therapy) such that it is no longer the role of the second opinion appointed doctor to certify that the decision to administer electro-convulsive therapy is not in conflict with any valid and applicable advance decision, or a decision of an attorney or deputy or the Court of Protection. Instead, this will need to be established by the patient’s approved clinician, who will then decide if referral to a second opinion appointed doctor is applicable. This is different to the approach taken under section 57A, where the second opinion appointed doctor is required to certify the presence of valid and applicable advance decision, or decision of an attorney or deputy or the court, before treatment can be given. The main reason for this difference is that, in the case of section 57A, the contents of the advance decision or decision of an attorney or deputy or the court are integral to establishing if a certificate should be issued to permit the use of compulsory treatment, while in the case electro-convulsive therapy the simple presence of an advance decision, or decision of an attorney or deputy or court to refuse electro-convulsive therapy should prevent the use of this treatment.
	If the approved clinician finds that treatment would not conflict with any of the above, but that the patient lacks capacity to consent, then the second opinion appointed doctor must certify the following before treatment can be given: that the patient lacks capacity to consent; that the treatment is appropriate; and that the decision to give treatment was made in line with section 56A. Compared to the second opinion appointed doctor’s current role, following amendments made by the Act they will have to apply the new definition of appropriate medical treatment (see section 8), which puts a greater emphasis on ensuring therapeutic benefit to the patient, and they will need to ascertain if the treating approved clinician has followed the new clinical checklist in coming to their decision to administer electro-convulsive therapy, thereby helping to embed the guiding principle of choice and autonomy.
Treatment Section 15: Electro-convulsive therapy etc.