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 Post Posted: Sun Apr 21, 2013 2:56 pm 
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Would it be unethical for a health care professional to use Granny Weatherwax's headology on patients in real life? Like when Granny Weatherwax tells villagers that water goblins are attracted to the smell of poo, so that they'll dig their wells far away from the outhouse, because otherwise they'd never believe that tiny invisible animals in the water will make them sick.

What if a doctor in real life encounters a patient who will not believe a medical diagnosis? For example, there's a family with two asthmatic children, but the parents absolutely refuse to believe the diagnosis of asthma. They've already seen and rejected the advice of two doctors. The third doctor prescribes them asthma medication, but tells the parents that it's flu medication. Would this be wrong?

Or a dermatologist encounters a patient who believes she has Morgellons Disease, an imaginary ailment where people believe that worms are living in their skin. The patient refuses to accept a psychiatric diagnosis and thinks that doctors who dismiss her self-diagnosis are part of some government conspiracy. Would it be acceptable for a doctor to say "OK, you have worms, but they'll die if you take a low-dose anti-psychotic medication. The dose is so low it won't affect your mind, but the stuff kills worms really effectively."

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 Post Posted: Sun Apr 21, 2013 5:55 pm 
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In the case of the family? I'd call social services. Asthma can kill if it gets bad enough, and if the parents are refusing treatment... Wouldn't want to do it, but it may well be necessary.

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 Post Posted: Sun Apr 21, 2013 7:06 pm 
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Yes, it's unethical.

But sometimes unethical things work.

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 Post Posted: Mon Apr 22, 2013 3:38 am 
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Does that justify it? What's the alternative? Letting the parents stomp off with two untreated asthmatic kids? Even if it's not life-threatening asthma, it still sucks for them. And the person who thinks she has worms? It is better to tell her "there is no such thing as Morgellons" and let her go off to be miserable and itchy and paranoid, and to possibly dose herself with horse dewormers and bleach? Low-dose anti-psychotics are the only clinically proven treatment for this syndrome, but it's also the one treatment that sufferers are most likely to reject.

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 Post Posted: Mon Apr 22, 2013 8:32 pm 
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It is unethical but I think the bigger problem is that it is promoting fallacies which, I feel, doesn't help anyone in the long run. I don't however have an alternative solution to your hypotheticals.

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 Post Posted: Mon Apr 22, 2013 11:34 pm 
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Straight Jackets?

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 Post Posted: Tue Apr 23, 2013 12:13 am 
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How about if the medical professional doesn't use deception per se?

I read an article a while ago about a doctor in the US who saw a Japanese college student who complained about excessive body odor. The student thought his body odor was offensive to others. The only problem was that the kid didn't actually smell bad. The doctor could not detect any noticeable odor, and nor did his staff. On further questioning, the doctor found out that the kid was socially isolated and had difficulty making American friends. So he thought that maybe the kid's problem was psychological, suggested he might be depressed, and recommended counselling. The kid rejected the idea completely, not least because the stigma against mental illness is very strong in Japan.

It turns out that the fear that your B.O. is offending others is a form of social anxiety common to Japan, but also found elsewhere.

Would it then be ethical for the doctor to suggest that sensitivity to smells is rather culturally specific, and that perhaps he was noticing a change in his own smell due to dietary changes since he moved to the US, but that the smell was unlikely to bother Americans? And then to advise him to try changing his diet to see if that helps, and if it doesn't, to come back?

All of the above is technically true, but does nothing to address the issue of social anxiety.

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 Post Posted: Tue Apr 23, 2013 12:26 am 
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Not all of the above is technically true. It is false that the patient has a sensitivity to smells. It would also be false to claim that this none existent sensitivity is picking up changes in his odour based on dietary changes. This could lead to the spreading of misinformation and while the perceived effects aren't as bad as something like anti-vaccination, still not something I would consider beneficial.

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 Post Posted: Tue Apr 23, 2013 4:03 am 
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Well, it's intended to provide validation for the patient's perceptions. It's possible for your personal smell to be affected by diet, and it's also possible that a scent that is disturbing to one person may be completely unnoticeable to another. What's the harm in reassuring a patient that you've tried to rule out physical causes before going the "You are probably delusional" route?

Considering there are other patients whose legitimate medical complaints may be dismissed by doctors as 'all in the mind' (people suffering from inexplicable chronic pain come to mind), is it that bad to initially err on the side of believing a patient? At least when they come back, they may be more willing to explore alternative causes.

Additionally, does it matter whether the problem is physical or mental? For example, if a shrink sees a client who believes that her house is being haunted by her recently deceased husband's ghost, and that she needs to move away and change her children's names in order to escape him, would it be wrong to say, "I know a great realtor, and I'll help you print the name change forms out from the internet", instead of "I think you need grief counselling"?

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 Post Posted: Tue Apr 23, 2013 10:29 am 
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If you act on the belief that you know other peoples interests better, then they themselfs, you are always on thin ice. There are cases where you are right with this (especially if you have some medical profession or similiar) but if you get used to think like that, there are plenty of traps for you.

Psychotherapeuts often have supervision by other psychotherapeuts (propably thats even mandatory), which is a good place to discuss such thin ice situations.

I guess often you can get away without making too definite statements. "We will have to try a couple of different treatments and check which works. Here is the prescription for the first one. Come again in a month and we will look how it has worked" "I want to rule out a psychological problem, before prescribing medication. Please consult a psychiatrist and come back with their diagnosis."

Regarding examples like the haunting by a ghost, AFAIK modern psychotherapy does not always have the goal to "completly cure" the clients. An example i have heard, is that convincing a client, who believes to be watched by foreign agents, that the best way to counter the foreign agencies plans is, to behave like they don't exist, is at least a good intermediate step in a therapy. So propably it is a good step for the haunted house client to move, regardless if the ghosts really exist. It could also be, that if they move, that just means that some other symptoms pop up, so it would be wasted effort. To come up with an answer, which is more likely true, is part of a therapists job.

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 Post Posted: Tue Apr 23, 2013 9:45 pm 
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Presenting optional diagnoses seems to be the way to go.

It is possible that the change in your diet has effected your odour and due to the sudden change you are particularly sensitive to it. We cannot notice an odour so it is also possible that the change in your life has caused you to be more aware of your body odour. This will reduce as you adjust to the new social situation. We can look at addressing either or both of these. The choice is up to you.

While the perceived manifestation of a Spector is most likely caused by grief, one way to deal with this is to remove yourself from the negative situation. Please understand that this may be expensive and a disruption to your and your children's life. I can suggest a cheeper option of grief therapy which has been shown to help. Whether this is because the perceived Spector no longer has any negative energy to be drawn to or for more mundane reasons, the results do not say.

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 Post Posted: Mon Apr 29, 2013 10:04 am 
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As with any ethical question, it's easy to create scenarios where the dishonest path is clearly the best option. But I think the reason we require informed consent to treatments is a protection against the fact that medical professionals are human beings who can be wrong or misguided. The idea is that an adult has a right to made their own judgments about health options. There have been plenty of historical cases of uniformed treatments gone wrong in the past --secret sterilizations, forced lobotomies, intentional injections of syphilis --and that's just all in the United States alone.

However, this whole scenario presents an interesting contrast with the idea of "medicine kisses" for kids, which I broached here a while back, to a great deal of resistance. A number of people thought it was wrong to tell a kid that a kiss would make a "boo-boo" feel better. However, in my opinion, the kiss itself actually is the treatment, and it does make the child feel better, even though the effect is presumably psychological.

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 Post Posted: Tue Apr 30, 2013 12:32 pm 
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My kids seem to do all right when I carefully inspect it and declare, 'It does feel bad now, but it will feel better soon.'

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 Post Posted: Tue Apr 30, 2013 10:16 pm 
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kitoba wrote:
However, this whole scenario presents an interesting contrast with the idea of "medicine kisses" for kids, which I broached here a while back, to a great deal of resistance. A number of people thought it was wrong to tell a kid that a kiss would make a "boo-boo" feel better.

Really? Really? People thought that was wrong? Odd.

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 Post Posted: Mon May 13, 2013 1:29 am 
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I would think the only way "medicine kisses" would be a problem would be if you allowed the child to continue to think it in high school. Kind of like telling your kid that Santa is bringing them presents. It's a deception, but it's one we tell to allow a child to enjoy the benefits of their naivete that we as adults can't have. But that means we can't use that on people who are legally responsible for themselves to try to coerce them into the care they should have.

I could come up with scenarios where you could possibly justify it: Someone is messed up in the head because they're off their meds, and and you use deception to get them to take them, for example. But you're again dealing with competency for self-determination.

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