Note: This resource provides legal information only. It is intended to provide readers with a better understanding of State of California and federal laws related to Convulsive Treatment, such as Electroconvulsive Therapy (“ECT”), including a person’s right to informed consent to treatment. This resource does not provide legal or medical advice about your individual situation. Please consult a lawyer or doctor if you have questions about how this information applies to your individual situation.

1. What is Convulsive Treatment?
2. What is Electroconvulsive Therapy and how is it regulated?
3. Who is licensed to perform Convulsive Treatment?
4. Does Convulsive Treatment require written informed consent?
5. What does written informed consent mean?
6. If a person gives written informed consent to Convulsive Treatment, how long does consent last?
7. How many treatments can a person consent to? 
8. Can a person ever be given Convulsive Treatment beyond the “excessive” limits?
9. Can a person revoke their written consent? 
10. Can a person refuse Convulsive Treatment?
11. What does “capacity” mean?
12. Can a person have “capacity” to refuse Convulsive Treatment if they have a mental illness, developmental disability, or physical illness?
13. What happens if someone thinks that a person lacks the capacity to make a decision about Convulsive Treatment?
14. Can a person with a conservator refuse Convulsive Treatment?
15. Can a person regain capacity?
16. Can a doctor perform Convulsive Treatment on a child?
17. Can a doctor perform Electroconvulsive Treatment on a regional center client?
18. Can a doctor perform Electroconvulsive Treatment on a person in prison?
19. Do any committees review the use of Convulsive Treatment?
20. What reporting requirements apply to Convulsive Treatment?
21. What can someone do if a doctor violated their rights?
22. Can someone file a lawsuit if they believe their rights involving Convulsive Treatment were violated?

1. What is Convulsive Treatment?

California law defines Convulsive Treatment as “the planned induction of a seizure through electrical or chemical means for therapeutic purposes.”1

2. What is Electroconvulsive Therapy and how is it regulated?

The most common type of Convulsive Treatment is Electroconvulsive Therapy (“ECT”). ECT is administered with an ECT device, which is “a prescription device, including the pulse generator and its stimulation electrodes, used for treating severe psychiatric disturbances by inducing in the patient a major motor seizure by applying a brief intense electrical current to the patient's head.”2 ECT is also known as “shock therapy.”3

The Food and Drug Administration (“FDA”) does not regulate ECT treatment, but it does regulate ECT devices, and it requires that all ECT devices be labeled with the following disclaimer: “Warning: ECT device use may be associated with: disorientation, confusion, and memory problems.”4 Absent performance data demonstrating a long-term beneficial effect, ECT devices must also include the following label: “Warning: When used as intended this device provides short-term relief of symptoms. The long-term safety and effectiveness of ECT treatment has not been demonstrated.”5

3. Who is licensed to perform Convulsive Treatment?

In California, only medical doctors licensed to practice in California can perform Convulsive Treatment.6

4. Does Convulsive Treatment require written informed consent?

Yes. If a person has the “capacity” (the ability to understand information the doctor gives them) to give written informed consent, then the person must actually provide written informed consent prior to Convulsive Treatment.7

If a court determines that a person does not have the capacity to provide written informed consent, then the person who has legal authority to make decisions for them must give written informed consent before treatment.8

All uses of Convulsive Treatment, even when given involuntarily, should preserve a person’s right to dignity, privacy, and humane care.9

5. What does written informed consent mean?

Written informed consent means that a person knowingly and intelligently, without duress or coercion, consents to the proposed therapy by their doctor in writing.10 Before someone can consent, their doctor must explain important and specific details about Convulsive Treatment in a clear manner.11 Specifically, a doctor must talk about:

• The nature of the patient’s condition and the reason that the doctor is suggesting Convulsive Treatment;
• The procedures to be used in Convulsive Treatment, including how many times a person may receive Convulsive Treatment and for how long;
• The likelihood of improvement or remission expected with or without Convulsive Treatment, including whether any improvement in a person’s symptoms is likely to be temporary or permanent;
• The nature, degree, duration, and probability of side effects and significant risks of Convulsive Treatment, “especially noting the degree and duration of memory loss (including its irreversibility) and how and to what extent they may be controlled, if at all”;
• That there are mixed opinions about whether Convulsive Treatment is effective, why and how it works, and its commonly known risks and side effects;
• The reasonable alternative treatments, and why the doctor is recommending Convulsive Treatment instead of other treatments; and
• That a person has the right to accept or refuse Convulsive Treatment, and that if they consent, they have the right to revoke consent for any reason, at any time prior to or between treatments.12

A doctor must also give someone the “Electroconvulsive Treatment (ECT), Informed Consent Form” and:

• Give them at least 24 hours to decide whether to sign the form;
• Cannot pressure them into signing the form by offering extra privileges—such as returning home—or threatening to place them in a more restrictive facility if they refuse treatment.13

If a person agrees to Convulsive Treatment, they must sign the form before a doctor can administer Convulsive Treatment. A copy of the form and a note that a doctor has explained Convulsive Treatment to the patients and considers it to be the “least drastic alternative available” is put into the patient’s record.14

6. If a person gives written informed consent to Convulsive Treatment, how long does consent last?

Written informed consent to Convulsive Treatment can only cover a limited number of treatments and cannot last more than 30 days.15 Therefore, if a doctor wants to give a person more treatments after 30 days, they must get the patient’s written informed consent again.

7. How many treatments can a person consent to?

Anything more than 15 treatments in 30 days or 30 treatments in a year is considered “excessive.”16

8. Can a person ever be given Convulsive Treatment beyond the “excessive” limits?

A doctor can give someone Convulsive Treatment beyond the “excessive” limits only if the doctor receives approval from a review committee at the facility or county where the patient resides.17 The request for approval for additional Convulsive Treatment must include:

• The patient’s diagnosis;
• Why the doctor is recommending extra treatments;
• Whether the doctor considered other treatments;
• Whether additional Convulsive Treatments are less risky than the alternatives; and
• A maximum number of extra treatments.

Even if the review committee approves additional Convulsive Treatment, the doctor and facility must still follow all applicable informed consent procedures.

9. Can a person revoke their written consent?

Yes, a person can revoke consent at any time, for any reason, even if they’ve already had some of the scheduled Convulsive Treatment procures.18 A person can take back their consent either verbally or in writing and the revocation must take effect immediately.19 If a person consents to Convulsive Treatment, but then changes their mind, their doctor must get their written informed consent again before administering Convulsive Treatment.20

10. Can a person refuse Convulsive Treatment?

Yes. If a person has “capacity,” they have a right to refuse Convulsive Treatment.21 This includes people committed or admitted to a state hospital, community care facility, or health facility.22

If a person refuses Convulsive Treatment against a doctor’s advice, the doctor must note their refusal in their treatment record and explain to the patient that they are responsible for anything that may happen to them because they refused the treatment.23

The right to refuse Convulsive Treatment, including ECT, is important because there are potentially serious side effects of Convulsive Treatment. Please refer to Appendix A for a description of potential side effects of ECT. Please also see Appendix B for a list of questions a patient may want to ask their doctor before consenting to Convulsive Treatment.

11. What does “capacity” mean?

A person is deemed to have the “capacity” to make a voluntary decision if they understand and can act upon the information provided by a doctor about Convulsive Treatment (described above in #5).24 Specifically, it is important that a person understand the potential benefits and risks of the proposed treatment, including the following:

• The patient’s condition;
• What Convulsive Treatment is, including information about side effects and risks such as memory loss;
• How long and how often the patient will receive Convulsive Treatment;
• Whether Convulsive Treatment will change their cognitive, psychological and physiological functioning for a little while or a long time;
• Whether they will improve without Convulsive Treatment;
• Other treatments they could be given and why their doctor thinks Convulsive Treatment is best;
• That some doctors disagree with the use of Convulsive Treatment because of risks and side effects;
• That they have the right to consent or refuse Convulsive Treatment; and
• That if the patient agrees to receive Convulsive Treatment, they can change their mind later, for any reason, and ask that the treatment be stopped.

An advance health care directive, such as a Psychiatric Advance Directive (“PAD”), cannot be used to authorize Convulsive Treatment for a patient.25

12. Can a person have “capacity” to refuse Convulsive Treatment if they have a mental illness, developmental disability, or physical illness?

Yes. A person with a diagnosis of a mental illness, developmental disability or a physical illness maintains the right to refuse Convulsive Treatment,26 unless a court takes that right away.

13. What happens if someone thinks that a person lacks the capacity to make a decision about Convulsive Treatment?

If a patient’s doctor or attorney thinks they lack the capacity to make an informed decision about Convulsive Treatment, then the attorney or doctor can file a petition in Superior Court asking the court to determine the patient’s capacity to make an informed decision.27

The court will schedule a hearing where evidence will be presented. If the court believes the attorney who expressed a doubt about the patient’s capacity has a conflict of interest, the court will appoint a different attorney to the patient. The patient has the right to be present at the hearing and to present evidence about why they do have capacity.28

The court will make a ruling only on whether the patient has the capacity to give written informed consent to Convulsive Treatment. The court will not decide whether the person will be given Convulsive Treatment. If the court determines that the patient does not have capacity, the decision to consent to Convulsive Treatment must be made by the responsible relative, guardian, or conservator appointed to them.29

14. Can a person with a conservator refuse Convulsive Treatment?

If a person has a conservator and the court that ordered the conservatorship determined that the patient lacked capacity to make medical decisions, then the patient does not have the right to refuse Convulsive Treatment. However, even then, a conservator must give written informed consent before Convulsive Treatment can be given to the person on a conservatorship.30

15. Can a person regain capacity?

Yes, at any time during Convulsive Treatment(s), a person can say they have regained “capacity.” Convulsive Treatment must be stopped immediately and the patient must be reevaluated.31

16. Can a doctor perform Convulsive Treatment on a child?

In California, Convulsive Treatment can never be given to a child under 12 years old.32

However, Convulsive Treatment can be given to children 12 years of age and older, but under 16 years old, if:

• It is an emergency situation and Convulsive Treatment is “deemed a lifesaving treatment;”33
• Three board-eligible or board-certified child psychiatrists all agree that: (1) it is an emergency, (2) Convulsive Treatment is “deemed a lifesaving treatment,” and (3) Convulsive Treatment is needed and appropriate.34
• It is performed in full compliance with the Department of State Hospitals;35 and
• It is documented and reported immediately to the Department of Health Care Services.36

Children who are either 16 or 17 years old and voluntary patients,37 or “emancipated” minors,38 may themselves grant or refuse consent for Convulsive Treatment just like adults who are voluntary patients.

For other children, the parent(s) or legal guardian has the right to make this decision (as long as all laws and procedures are followed).39

17. Can a doctor perform ECT on a regional center client?

Doctors cannot perform ECT on regional center clients unless ECT has been included as part of a treatment plan that the regional center’s ECT Review Committee has approved.40 The ECT Review Committee must unanimously agree to the ECT Treatment Plan.41 The approval is limited to 30 days.42 The ECT Treatment Plan must also clearly identify the methods to be used to determine and document the results of the treatments.43 The treatment plan must be followed exactly as written when approved or the approval is nullified.44

The requirements for approval of ECT for a regional center client do not supersede or replace the requirements for ECT administration for mental health clients but are instead an additional safeguard for regional center clients.45 Therefore, if a person has both a developmental disability and a mental illness and their treating physician wants to use ECT, the treating physician will have to comply with the regional center client requirements as well as the separate mental health requirements of demonstrating consent or a lack of capacity.46

18. Can a doctor perform ECT on an incarcerated person?

Rights of a person in prison who is competent and capable

If a person in prison is competent and capable of giving informed consent to ECT, doctors cannot perform ECT without the person’s informed consent.47 Even if a person is competent and consents to ECT, there are additional steps doctors must follow before administering ECT.

First, if a doctor believes ECT is necessary for a person’s health and safety, a committee of doctors must review the patient’s treatment record and determine whether (1) ECT is required and (2) whether the person has the capacity to give informed consent.48 If the committee of doctors does not unanimously agree that ECT is required or that the person has given informed consent, then ECT cannot be administered to the person.49

Second, prison officials must obtain authorization from a superior court to perform nonemergency ECT.50

However, a doctor can perform ECT as a lifesaving emergency measure without court authorization, so long as the competent person consents.51

Rights of a person in prison who is not competent and capable

For lifesaving emergencies, doctors can perform ECT on a person in prison who is notcompetent or capable of giving informed consent to ECT, even without prior court authorization.52

For nonemergency treatment, prison officials must obtain unanimous approval from a committee of doctors that ECT is necessary for a person’s health and safety.53 Then, the warden or superintendent must get approval from the prison’s Chief of Medical Services and the Secretary of the California Department of Corrections and Rehabilitation. The prison warden or superintendent must then file a petition with the superior court of the county in which the patient resides requesting a hearing.

The patient has a right to an attorney for the hearing, which is usually a Public Defender. Even if a court finds that a patient does not have capacity to give informed consent, the court should still take into consideration their wishes about ECT treatment when previously competent.54

In addition, the patient or their attorney, guardian, or conservator can also file a petition in the superior court of the county in which they reside requesting an order that prohibits the use of ECT on the patient.55

Rights of a person in a county jail or youth in a juvenile facility

There is no specific law or regulation that permits the use of ECT on a person in a county jail or juvenile facility. Generally, a person incarcerated in a county jail who is competent has a right to refuse non-emergency medical or mental health care.56 Youth also have a right to refuse non-emergency medical or mental health care.57

Absent informed consent in non-emergency situations, a court order is required before involuntary medical treatment can be administered to an incarcerated person. For minors or conservatees, informed consent of a parent, guardian or legal custodian applies where required by law.58

19. Do any committees review the use of Convulsive Treatment?

Yes. Facilities that perform Convulsive Treatment must have a committee to review all treatments to make sure they are necessary.59 The committees must review all Convulsive Treatments given in the facility. The local mental health director must also set up a committee to review Convulsive Treatments given outside a facility.60 Records of these review committees are treated in the same manner as records of hospital utilization and audit committees.61

20. What reporting requirements apply to Convulsive Treatment?

A doctor or facility that performs Convulsive Treatment must send a report every 3 months to the local mental health director, who must then send a copy of the report to the Director of Health Care Services.62 The report must include the number of persons who received ECT in each of these categories: (1) involuntary patients who gave informed consent; (2) involuntary patients who a court said could not give informed consent and who received Convulsive Treatment against their will; (3) voluntary patients who gave informed consent; and (4) voluntary patients who a court said could not give informed consent. The State Department of State Hospitals must also submit these reports to the Director of Health Care Services every 3 months.63

21. What can someone do if they believe a doctor violated their rights?

Regional Center Clients

If a regional center client or their representative believes that the client’s rights are being violated, they can file an initial complaint with the Clients’ Rights Advocate responsible for the facility in which the person lives or is a client of.64 The Clients’ Rights Advocate will investigate the complaint and send a written proposed resolution to the complainant within 10 working days.

If they don’t know the Clients’ Rights Advocate, they can find out at DRC's Office of Clients' Rights Staff Links or by contacting:

Disability Rights California
Office of Client Rights
1831 K Street
Sacramento, California 95811-4114

Northern California 1-800-390-7032 (TTY 877-669-6023)

Southern California 1-866-833-6712 (TTY 877-669-6023)

Non-Regional Center Clients

If someone who is not a regional center client believes that a doctor or facility violated their rights, they can report the violation to:

Disability Rights California
Office of Patients’ Rights
1831 K Street
Sacramento, California 95811-4114
Telephone: (916) 504-5810
http://www.disabilityrightsca.org/
Email: COPRINFOREQUEST@disabilityrightsca.org

or

Department of Health Care Services
Office of the Ombudsman
Telephone: (888) 452-8609
Email: MMCDOmbudsmanOffice@dhcs.ca.gov

The local director of mental health or a designee (another person they assign), and in some circumstances the Director of Health Care Services or their designee (another person they assign in their place), must investigate the report.65 If the person is a patient in the Department of State Hospitals when their rights are violated, then the Director of the Department of State Hospitals or their designee must also conduct an investigation.

If the local director of mental health, the Director of Health Care Services, or the Director of the Department of State Hospitals determines that a patient’s rights were violated, they can then take a variety of actions including:

1. requiring the violation to stop within a certain period of time;
2. referring the matter to the Medical Board of California or other professional licensing agency to investigate and punish the doctor, if necessary;
3. taking away a facility’s authority to treat patients involuntarily; or
4. referring the matter to the local district attorney or the Attorney General for prosecution.66

If the Attorney General decides to prosecute the case and a doctor is found to have intentionally violated a person’s rights regarding Convulsive Treatment, the doctor can be fined five thousand dollars ($5,000) for each violation and can have their medical license taken away.67

Prison

If someone in prison believes their rights were or are being violated, they can file a health care grievance using a CDCR 602 HC form.68 They must file the grievance within 30 calendar days of the action or decision being grieved.69 Generally, CDCR health care staff must process the grievance within 45 business days.70

County Jails and Juvenile Facilities

Each county jail and juvenile facility must develop written policies and procedures to process grievances.71 In county jails, people have a right to an initial response to their grievance within no more than 15 calendar days.72 Youth have a right to an initial response within 3 business days.73

22. Can someone file a lawsuit if they believe their rights involving Convulsive Treatment were violated?

If someone is interested in filing a legal claim related to their experience with Convulsive Treatment, they should be aware that there may be statutes of limitations (legal limits on the amount of time that can pass before they can file a complaint). In order to know the deadlines, they should contact an attorney immediately. The California Courts Self-Help program also publishes information about some common statutes of limitations, to learn more click here. If they miss any deadline, they may not be able to move forward with their matter.

If someone wants to file a lawsuit against the manufacturers of an ECT device based on a manufacturer’s failure to warn them of the risks of ECT, they will need to show that the maker of the ECT device should have provided stronger warnings about the device’s side effects to the prescribing doctor.74

Appendix A: Potential Side Effects of Electroconvulsive Therapy (ECT)

The most common side effects of ECT include disorientation, confusion, and memory loss.75 Some studies show that at least “some forms of ECT have persistent long-term effects” on the ability to think clearly.”76 In the largest study of ECT recipients, 84.5% of respondents spontaneously reported memory loss, 70.3% said they had trouble retaining new information (anterograde amnesia), and 80.4% said they had loss of memory of life events. "For 65% of those experiencing anterograde amnesia, and 81% of those with retrograde amnesia, the deficit lasted 3 years or more.” “There was no evidence that memory loss had reduced in recent years, as often suggested.”

Some studies indicate that ECT may have “no long-term benefits compared with [a] placebo.”77 Makers of ECT devices admit that, “[i]n rare cases, patients may experience permanent memory loss or permanent brain damage.”78

Critics of ECT point out that because the FDA does not require a patient registry to track outcomes, and one manufacturer admitted in federal court deposition that they never investigated any negative ECT effects reported to the FDA in more than 30 years, it is difficult to know exactly how common it is for a patient to experience permanent memory loss or permanent brain damage.79

Physical risks of ECT may also include a range of injuries, including but not limited to:80

• cardiovascular complications, including arrhythmia, heart attack, acute hypertension, hypotension, and stroke;
• pulmonary complications (e.g., aspiration/inhalation of foreign material, pneumonia, hypoxia, respiratory obstruction, pulmonary embolism, prolonged apnea);
• prolonged or delayed onset seizures;
• onset/exacerbation of psychiatric symptoms;
• neurological symptoms (e.g., paresthesia, dyskinesias, motor dysfunction);
• pain/somatic discomfort (including headache, muscle soreness, and nausea);
• skin burns;
• physical trauma (including fractures, contusions, injury from falls, dental and oral injury); and
• death.

While there is no ban on administering ECT to a pregnant person, one scientific study that looked at multiple other studies found that 29% of the time there was an adverse event such as fetal heart rate reduction, uterine contractions, and premature labor.81 That study also found that the child mortality rate for ECT performed under the modern protocol was 9.4%.82

As noted above, given the potential short- and long-term side effects of ECT, it is crucial that a patient speak with a health care provider to discuss the benefits, risks, and side effects of ECT as it relates to their individual care and treatment. A recent study found that 59% of ECT recipients reported that they hadn’t been given “adequate information”, including the risks and potential side effects, before receiving ECT.83

In another recent publication reporting responses of more than 1,100 ECT experiences, 62% of patients reported ECT reduced quality of life, of which 27% said quality of life after ECT was 'very much worse.'84

The UN Special Rapporteur on torture and other cruel, inhuman and degrading treatment or punishment has “called on countries to impose a total ban on all forced and non-consensual medical interventions, including the involuntary administration of … electroconvulsive therapy….”85

Recently, there have been lawsuits filed by individuals who claim they were harmed by ECT devices.86 An expert in one lawsuit testified that an ECT device gives 16 times more current than an average taser.87

Appendix B: Treatment, Alternatives, Risks Questions

Doctors are required to inform patients about the risks, reasons, and mixed opinions of Convulsive Treatment, including ECT, but a patient may want to ask additional questions to inform themself. When talking to a doctor, a patient can think about the acronym “TAR” (Treatment, Alternatives, Risks) and ask some of the following questions:

• Treatment:
  • Why are you recommending ECT for me?
  • What will be involved in receiving ECT?
  • How many times will I need the treatment?
  • How long will each treatment last?
  • How likely is it that ECT will improve my condition?
  • Will this be temporary or permanent?
  • How likely is it that my condition will improve without ECT?
• Alternatives
  • What other treatment options are available to treat my conditions?
  • What is involved in those alternative treatments?
  • How likely are those alternative treatments to improve my conditions on a temporary or permanent basis?
  • Why do you think that ECT may be better for me than those other treatments?
• Risks
  • What are the possible side effects and risks of ECT?
  • How serious are these side effects likely to be?
  • Would they be temporary or permanent?
  • How likely is it that I will experience these side effects?
  • What steps are you going to take to minimize the risk of any side effects to me?

• 1. Cal. Code Regs. tit. 9, § 836.
• 2. 21 C.F.R. § 882.5940(a).
• 3. Cal. Code Regs. tit. 15, § 3999.348(a).
• 4. 21 C.F.R 882.5940(b)(1)(viii)(I).
• 5. 21 C.F.R 882.5940(b)(1)(viii)(J).
• 6. Cal. Code Regs. tit. 9, § 835.
• 7. Cal. Welf. & Inst. Code § 5326.75; Cal. Welf. & Inst. Code § 5326.7(d); see also Cal. Code Regs. tit. 9, § 839; Cal. Welf. & Inst. Code § 5326.5; see also Cal. Welf. & Inst. Code § 5326.2; see generallyCanterbury v. Spence, 464 F.2d 772, 780, cert. denied, 409 U.S. 1064 (1972) (“The root premise” of informed consent “is the concept, fundamental in American jurisprudence, that ‘[e]very human being of adult years and sound mind has a right to determine what shall be done with his own body’ ”) (quoting Schloendorff v. Society of New York Hospital, 105 N.E. 92, 93 (1914) (Cardozo, J.)); see also Washington v. Harper, 494 U.S. 210, 241 (1990) (STEVENS, J., dissenting) (“There is no doubt ... that a competent individual's right to refuse [psychotropic] medication is a fundamental liberty interest deserving the highest order of protection”).
• 8. Cal. Welf. & Inst. Code § 5326.6(b); see also World Health Organization (“WHO”) and the Office of the High Commissioner on Human Rights (“OHCHR”), Mental health, human rights and legislation: guidance and practice 58 (2023), https://iris.who.int/bitstream/handle/10665/373126/9789240080737-eng.pdf?sequence=1(stating that “ECT without consent … may constitute torture and ill-treatment.”) [hereinafter World Health Organization].
• 9. Cal. Welf. & Inst. Code § 5325.1.
• 10. Cal. Welf. & Inst. Code § 5326.5(a).
• 11. Cal. Welf. & Inst. Code § 5326.4.
• 12. Cal. Welf. & Inst. Code § 5326.2.
• 13. Cal. Welf. & Inst. Code § 5326.5; see also Department of Health Care Services 1800 (06/2013), available at https://www.dhcs.ca.gov/hm/formsandpubs/forms/Forms/Mental_Health/DHCS_1800.pdf (last accessed on October 17, 2025).
• 14. Cal. Welf. & Inst. Code § 5326.4.
• 15. Cal. Welf. & Inst. Code § 5326.7(d).
• 16. Cal. Code Regs. tit. 9, § 849(a); Note that some studies have found that anything more than 10 treatments can increase the risk of developing other conditions, such as Amyotrophic Lateral Sclerosis (“ALS”), although additional studies are needed to disprove or prove this association (see, e.g., Gabor Mezei et al., Receipt of Electroconvulsive Therapy and Subsequent Development of Amyotrophic Lateral Sclerosis: A Cohort Study, 43 Bioelectromagnetics 81 (2022)).
• 17. Cal. Code Regs. tit. 9, § 849(b).
• 18. Cal. Welf. & Inst. Code § 5326.2(g).
• 19. Cal. Welf. & Inst. Code § 5326.6(d).
• 20. Cal. Welf. & Inst. Code § 5326.7(d).
• 21. Cal. Welf. & Inst. Code §§ 5325(f), 5326.2(g), 5326.85; Cal. Code Regs. tit. 9, § 841.
• 22. Cal. Welf. & Inst. Code § 4503(f).
• 23. Cal. Welf. & Inst. Code § 5326.85; Cal. Code Regs. tit. 9, § 841.
• 24. Cal. Code Regs. tit. 9, § 840; see Conservatorship of Pamela J., 133 Cal. App. 4th 807, 824, 35 Cal. Rptr. 3d 228, 239 (Cal. Ct. App. 4th 2005); see generally Riese v. St. Mary's Hosp. & Med. Ctr., 209 Cal. App. 3d 1303, 1323, 271 Cal. Rptr. 199, 211 (Cal. Ct. App. 1st 1987).
• 25. Cal. Prob. Code §§ 4617, 4652.
• 26. Cal. Code Regs. tit. 9, § 840(b); Cal Wel & Inst Code § 4503(f).
• 27. Cal. Welf. & Inst. Code § 5326.7(f).
• 28. Id.
• 29. Cal. Welf. & Inst. Code § 5326.7(g).
• 30. Id.
• 31. Cal. Welf. & Inst. Code § 5326.7(h).
• 32. Cal. Welf. & Inst. Code § 5326.8; Note that due to the controversial nature of ECT, there have been calls for ECT to be banned altogether (see e.g., World Health Organization, supra note viii at 58; see also John Read et al., Should we stop using electroconvulsive therapy? BMJ 364 (2019); Peter R. Breggin, Electroshock: scientific, ethical, and political issues, 11 Int’l. J. Risk Saf Med. 5 (1998), available at http://www.ectresources.org/ECTscience/Breggin_1998_ECT__Overview.pdf).
• 33. Cal. Welf. & Inst. Code § 5326.8(a).
• 34. Cal. Welf. & Inst. Code § 5326.8(b).
• 35. Cal. Welf. & Inst. Code § 5326.8(c).
• 36. Cal. Welf. & Inst. Code § 5326.8(d).
• 37. Cal. Code Regs. tit. 9, § 845(d).
• 38. Cal. Code Regs. tit. 9, § 845(c).
• 39. Id.
• 40. Cal. Code Regs. tit. 17, § 50830.
• 41. Cal. Code Regs. tit. 17, § 50833(a)(2).
• 42. Cal. Code Regs. tit. 17, § 50833(a)(3).
• 43. Cal. Code Regs. tit. 17, § 50831(a)(2).
• 44. Cal. Code Regs. tit. 17, § 50833(a)(3).
• 45. Cal. Code Regs. tit. 17, § 50833(a)(4).
• 46. Id.
• 47. Cal. Code Regs. tit. 15, § 3999.348(a).
• 48. Cal. Code Regs. tit. 15, § 3999.348(c).
• 49. Cal. Code Regs. tit. 15, § 3999.348(c)(2).
• 50. Cal. Code Regs. tit. 15, §§ 3999.348(a)(2).
• 51. Cal. Code Regs. tit. 15, § 3999.348(a)(1).
• 52. Id.
• 53. Cal. Code Regs. tit. 15, § 3999.348(g)(1).
• 54. In re Terrazas, 288 Cal.Rptr.3d 801, 805 (Cal. Ct. App. 4th 2022).
• 55. Cal. Code Regs. tit. 15, § 3999.348(e)(1).
• 56. See Cal. Code Regs. tit. 15, § 1214.
• 57. See Cal. Code Regs. tit. 15, § 1434.
• 58. See Cal. Code Regs. tit. 15, § 1214.
• 59. Cal. Wel. & Inst. Code § 5326.91; Cal. Code Regs. tit. 9 CCR § 847(a).
• 60. Cal. Wel. & Inst. Code § 5326.91.
• 61. Id.
• 62. Cal. Welf. & Inst. Code § 5326.15(a). A copy of the quarterly DHCS 1011 form can be found at QUARTERLY REPORT FOR CONVULSIVE TREATMENTS AND PSYCHOSURGERY ADMINISTERED (DHCS 1011).
• 63. Cal. Welf. & Inst. Code § 5326.15(b).
• 64. Cal. Code Regs. tit. 17, § 50540(b).
• 65. Cal. Welf. & Inst. Code § 5326.9(a).
• 66. Cal. Welf. & Inst. Code § 5326.9(b)-(c).
• 67. Cal. Welf. & Inst. Code § 5326.9(d).
• 68. Cal. Code Regs. tit. 15, §§ 3999.226, 3999.227(a).
• 69. Cal. Code Regs. tit. 15, § 3999.227(b).
• 70. Cal. Code Regs. tit. 15, § 3999.228(i).
• 71. Cal. Code Regs. tit. 15, §§ 1073(a), 1361.
• 72. Cal. Code Regs. tit. 15, §§ 1073(a)(7).
• 73. Cal. Code Regs. tit. 15, § 1361(d).
• 74. Himes v. Somatics, LLC, 549 P.3d 916, 933 (Cal. 2024).
• 75. See 21 C.F.R. § 882.5940(b)(1)(ix)(H); see, e.g., Glenda MacQueen et al.,The long-term impact of treatment with electroconvulsive therapy on discrete memory systems in patients with bipolar disorder, 32 J. Psychiatry Neurosci. 241 (2007), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1911194/pdf/20070700s00003p241.pdf .
• 76. See, e.g., Harold A. Sackeim et al., The Cognitive Effects of Electroconvulsive Therapy in Community Settings, 32 Neuropsychopharmacol 244 (2007), https://doi.org/10.1038/sj.npp.1301180; see also Read, supranote xxxii at 1 (raising concerns that electroconvulsive therapy “has no long term benefits compared with placebo and often causes brain damage”).
• 77. See, e.g., Read, supra note xxxii at 1; Breggin, supra note xxxii at 5 (“Electroconvulsive treatment (ECT) is increasingly used in North America and there are attempts to promote its further use world-wide. However, most controlled studies of efficacy in depression indicate that the treatment is no better than placebo with no positive effect on the rate of suicide.”).
• 78. See Somatics LLC, Regulatory update to Thymatron System IV instruction manual 10 (2021) (http://www.thymatron.com/ downloads/System_IV_Regulatory_Update.pdf, accessed May 29, 2024). Archieved https://web.archive.org/web/20200718120228/http://www.thymatron.com/downloads/System_IV_Regulatory_Update.pdf
• 79. Neurological Devices; Reclassification of Electroconvulsive Therapy Devices; Effective Date of Requirement for Premarket Approval for Electroconvulsive Therapy Devices for Certain Specified Intended Uses § 3(D), Comments on Regulatory Process of the Proposed Order, 83 Fed. Reg. 66116 (Dec. 26, 2018).
• 80. See 21 C.F.R. § 882.5940(b)(1)(ix)(H)(3); see also Somatics LLC, User Manual - Thymatron System IV 9 (2021) (listing adverse events that have occurred as a result of ECT devices).
• 81. Kari Ann Leiknes et al., Electronconvulsive therapy during pregnancy: a systematic review of case studies, 18 Archives of Women’s Mental Health 1 (2015).
• 82. Id. at 6.
• 83. John Read et al., A large exploratory survey of electroconvulsive therapy recipients, family members and friends: what information do they recall being given?, J. of Med. Ethics, Aug. 14, 2025, https://jme.bmj.com/content/early/2025/08/25/jme-2024-110629.
• 84. John Read et al., A Survey of 1144 ECT Recipients, Family Members and Friends: Does ECT Work?, Int’l J. of Mental Health Nursing, Aug. 10, 2025, https://onlinelibrary.wiley.com/doi/10.1111/inm.70109.
• 85. World Health Organization, supra note viii at 15; see Juan E. Méndez, Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, United Nations General Assembly Human Rights Council (Feb. 1, 2013) at 23 (https://docs.un.org/en/A/HRC/22/53).
• 86. See, e.g., Himes v. Somatics, LLC, 549 P.3d 916 (Cal. 2024); Thelen v. Somatics, LLC, 672 F.Supp.3d 1216 (M.D. Fl. 2023).
• 87. See Thelen v. Somatics, LLC., Testimony of Kenneth Castleman, at 39:25-40:5 (June 5, 2023), available at https://www.wisnerbaum.com/wp-content/uploads/Day-4-REDACTED-Thelen-Jury-Trial.pdf.