Ethical dilemmas in pediatric and adolescent psychogenic nonepileptic seizures

Cristie M Cole; Tatiana Falcone; Rochelle Caplan; Jane Timmons-Mitchell; Kristine Jares; Paul J Ford

doi:10.1016/j.yebeh.2014.06.019

Ethical dilemmas in pediatric and adolescent psychogenic nonepileptic seizures

Epilepsy Behav. 2014 Aug:37:145-50. doi: 10.1016/j.yebeh.2014.06.019. Epub 2014 Jul 10.

Authors

Cristie M Cole¹, Tatiana Falcone², Rochelle Caplan³, Jane Timmons-Mitchell⁴, Kristine Jares⁵, Paul J Ford⁶

Affiliations

¹ Department of Bioethics, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: colec@ccf.org.
² Neurological Institute, Department of Psychology and Psychiatry, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: falcont1@ccf.org.
³ Department of Psychiatry and Behavioral Services, David Geffen School of Medicine at UCLA, 150 UCLA Medical Plaza, Los Angeles, CA 90095, USA; Department of Child and Adolescent Psychiatry, Brain Research Institute, UCLA, Box 951761, Los Angeles, CA, USA. Electronic address: rcaplan@ucla.edu.
⁴ Begun Center for Violence Prevention Research and Education, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 11402 Bellflower Road, Cleveland, OH 44106, USA. Electronic address: jct2@case.edu.
⁵ Department of Social Work, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
⁶ Department of Bioethics, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; NeuroEthics Program, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: fordp@ccf.org.

Abstract

To date, only a very narrow window of ethical dilemmas in psychogenic nonepileptic seizures (PNES) has been explored. Numerous distinct ethical dilemmas arise in diagnosing and treating pediatric and adolescent patients with PNESs. Important ethical values at stake include trust, transparency, confidentiality, professionalism, autonomy of all stakeholders, and justice. In order to further elucidate the ethical challenges in caring for this population, an ethical analysis of the special challenges faced in four specific domains is undertaken: (1) conducting and communicating a diagnosis of PNESs, (2) advising patients about full transparency and disclosure to community including patients' peers, (3) responding to requests to continue antiepileptic drugs, and (4) managing challenges arising from school policy and procedure. An analysis of these ethical issues is essential for the advancement of best care practices that promote the overall well-being of patients and their families.

Keywords: Antiepileptic drugs; Communication; Diagnosis; Disclosure; Doctor shopping; Psychogenic nonepileptic seizures; School.

Publication types

Research Support, N.I.H., Extramural
Review

MeSH terms

Adolescent
Anticonvulsants / therapeutic use
Child
Child, Preschool
Communication
Ethics, Medical*
Humans
Seizures / psychology*
Seizures / therapy*

Substances

Anticonvulsants

Abstract

Publication types

MeSH terms

Substances

Grants and funding