ReviewEthical dilemmas in pediatric and adolescent psychogenic nonepileptic seizures

- Unique ethical dilemmas arise throughout the disease course for young patients with PNES.
- Contextual factors and practical obstacles can exacerbate these ethical dilemmas.
- Physicians are obligated to counsel patients and parents on conflicting values.
- Management strategies must reflect careful prioritization of underlying values.
- Further ethics-based discussions are needed to promote best care practices.

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.