The use of placebo in diagnosing psychogenic seizures: who is being deceived?

Induction procedures have been employed by some neurologists as a method of attempting to determine whether paroxysmal events experienced by the patient are psychogenic in origin. Although various techniques are used, those involving injection of intravenous saline and placebo patches are the focus of this article because they involve deception of the patient and raise the greatest ethical concerns. Issues of potential harm to the patient are examined in light of the typical psychological profile of patients who have psychogenic seizures. In addition, reliability of the procedure, possible benefit to the patient, and alternatives to using the procedure are considered. Finally, the question of whether there is ethical justification to consider induction procedures as an acceptable exception to informed consent is discussed. The authors argue that there is little if any justification for using induction procedures involving placebos, and that when the procedure is considered justifiable it should be done only if examination by a mental health professional discloses no psychological contraindications to proceeding and if a debriefing of the patient explaining the process and purpose of the induction is to take place following the procedure.