- Case 1 1 If Dr Patel Goes Forward With The Test Explain Which Principle Might Justify His Actions And Why 2 If Dr P 1 (35.97 KiB) Viewed 13 times
ETHICS CASE 3.3 The ethics of beneficial deceptions Ms. Lamonica was admitted for a neurological evaluation after experiencing 2 severe seizures. At 38, Ms. Lamonica was overweight, but otherwise in good health. All studies including electroencephalograms (EEG) were normal. Because her description of her seizures seemed to exclude epilepsy she remained fully conscious during the events, for example, and experienced no confusion afterward-her team of neurologists led by Dr. Patel began to suspect that her episodes were nonepileptic seizures (NES). The physicians contemplated using a provocative test to confirm the diagnosis. The test was controversial because it entailed deceiving the patient. Ms. Lamonica would have EEG electrodes attached to her scalp and an intravenous catheter inserted. Dr. Patel would then tell her he was administering a solution designed to provoke a seizure. In reality, the solution would be simple saline. If Ms. Lamonica had a seizure, Dr. Patel would stop the infusion, tell her the drug was leaving her system, and watch for a concomitant end to the seizure. If no abnormal electrical activity was seen during the seizure, the diagnosis of NES would be confirmed. An estimated 10 to 20 percent of patients who are hospitalized for seizures or treated at epilepsy clinics are suspected to have NES; some have epilepsy and NES. Nonepileptic seizures are treated with psychiatric rather than neurological interventions. While epilepsy can often be managed with medications, pharmacologic treatment for NES tends to be ineffective. Anticonvulsant medication would be inappropriate. Psychotherapy is useful for some NES patients, though many remain unimproved long after diagnosis. The key to distinguishing NES from epilepsy is whether EEG evidence of a true seizure is recorded by EEG during a typical spell. To avoid keeping the patient attached to the EEG machine for hours or days in hopes of witnessing an episode, some physicians choose to employ the so-called provocative saline infusion the sham test described above to expedite the diagnosis. Provocative saline infusion is thus a nocebo, a drug the patient perceives as harmful, which in Ms. Lamonica's case would mean seizure-inducing. To see if she would even be willing to undergo testing, Dr. Patel offers the possibility of the provocative test to Ms. Lamonica, as well as the alternative of no test. He explains how the test will be performed and truthfully tells her the benefit of the test is that it will help him determine the type of seizure she's experiencing. However, given the necessary deception associated with the test, he deceives Ms. Lamonica by telling her that the solution will be seizure-inducing and explaining the risks associated with inducing a seizure. reality, the physical risks associated with a saline infusion are much more minimal than the risks told to Ms. Lamonica. Ms. Lamonica indicates that she would be willing to consent to the test. Dr. Patel is conflicted. He regrets the necessity of deceiving her and feels that she deserves to know the truth, especially for an invasive procedure, but he also knows that the test won't work if she's told the truth in advance. By performing the test, he would be able to determine whether anticonvulsive medication would be appropriate for her, and he would have a better idea of how to care for her going forward. Dr. Patel must now decide whether to administer the provocative saline infusion to Ms. Lamonica.