title: Ethical dilemmas in pediatric and adolescent psychogenic nonepileptic seizures.
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.
authors.affiliation: Department of Bioethics, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: colec@ccf.org.
authors.forename: Cristie M
authors.initials: CM
authors.lastname: Cole
authors.affiliation: 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.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Falcone
authors.affiliation: 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.
authors.forename: Rochelle
authors.initials: R
authors.lastname: Caplan
authors.affiliation: 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.
authors.forename: Jane
authors.initials: J
authors.lastname: Timmons-Mitchell
authors.affiliation: Department of Social Work, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Kristine
authors.initials: K
authors.lastname: Jares
authors.affiliation: 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.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Ford
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003142:Communication; D004992:Ethics, Medical; D006801:Humans; D012640:Seizures / Q000523:psychology* / Q000628:therapy*
chemical_list: D000927:Anticonvulsants
keywords: Antiepileptic drugs; Communication; Diagnosis; Disclosure; Doctor shopping; Psychogenic nonepileptic seizures; School