Objective - To discuss the ethical and legal basis of ECT use in Italy, one year after the regulation set up by the Minister of Health. Methods - Literature review and presentation of authors' personal opinions. Results - Despite being the oldest somatic therapy still practised in psychiatry, ECT effectiveness has been systematically evaluated only during the last 20 years, and its clinical indications have become progressively restricted. Yet there are wide variations between countries and within each individual country about the extension, the modalities and the indications for its use. ECT seems to be practised mainly in large scale public psychiatric hospitals and in private clinics, but its use in systems following a community approach is very limited. Wide variations exist also with reference to the severity of regulations imposed by governments or suggested by professional associations. The extent of education and auditing by university centres varies considerably, but is generally considered unsatisfactory. There are still some reports about possible political and repressive use of ECT in some countries, especially developing ones. Conclusion - The authors consider that every national system of care should have a clear policy and clear regulations about ECT. The provisions set up by the Italian Minister of Health seem to be consistent with Italian health policies and psychiatric community care.