THE USE OF PLACEBO IN DIAGNOSING PSYCHOGENIC SEIZURES - WHO IS BEING DECEIVED

Induction procedures have been employed by some neurologists as a meth od of attempting to determine whether paroxysmal events experienced by the patient are psychogenic in origin. Although various techniques ar e used, those involving injection of intravenous saline and placebo pa tches are the focus of this article because they involve deception of the patient and raise the greatest ethical concerns. Issues of potenti al harm to the patient are examined in light of the typical psychologi cal profile of patients who have psychogenic seizures. In addition, re liability of the procedure, possible benefit to the patient, and alter natives to using the procedure are considered. Finally, the question o f whether there is ethical justification to consider induction procedu res as an acceptable exception to informed consent is discussed. The a uthors argue that there is little if any justification for using induc tion procedures involving placebos, and that when the procedure is con sidered justifiable it should be done only if examination by a mental health professional discloses no psychological contraindications to pr oceeding and if a debriefing of the patient explaining the process and purpose of the induction is to take place following the procedure.