ECT - voluntary or involuntary - is it a real choice?

Every Wednesday morning Ray Sandford, 54 has been forced to get out to go to receive his ECT treatment. You can read the whole story on this post, an Action Alert, Susan has published today.

"Of course, MindFreedom International has documented proven cases of electroshock against the expressed wishes of the subject all over the world, including in the USA. MindFreedom succeeded in having the United Nations World Health Organization call in writing for a global ban on all involuntary electroshock."
"Ms. Wilhelm said, “We are following the letter of the law.” She said the State of Minnesota had secured a variety of court orders that require Ray to have forced electroshock against his expressed wishes. Ms. Wilehlm says it’s all legal and she can’t do anything about it."

By the end of Susan's post she had put a link where Philip Dawdy published her letter about her experience with electroshock:

“Mr. and Mrs. S” went my doctor – “We’ve tried everything on your daughter but she is extremely depressed and still suicidal. We’ve tried several different drug therapies and nothing is working, and we are left with two things. She has ten days left on her insurance and if she is still like the way she is now, we will be forced to put her in a state hospital. Or we can try ECT”.

ECT was then explained to my parents, and they saw a video. And with the State’s leading expert on ECT who told them he would be personally administering it, papers were signed, I was convinced by mom and dad “ do this to make your mother happy”, and the next day woken up at 5 am to be driven to the local teaching hospital for my first round.

Please, read the whole letter.
Two months ago I met a mother who was on a Brazilian mental institution where her daughter was for one week being treated with ECT because "-They have tried everything and the last resource was ECT, the psychiatrists told me."

I'm very confused. It seems to me that whether being voluntary or involuntary ECT is being used in a very strange way. If ECT is presented as the last resource is it a real choice the family is doing?