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Consent and Hypnosis

23rd May 2020

The process of gathering consent for procedures is well described in a variety of documents. My concerns have been very eloquently sumarised by Dr Allan Cyna here, and I suggest you stop reading this and read his article instead.

Self-Hypnosis

All hypnosis is self-hypnosis... so the person is doing it to themselves... so we don’t need consent. Right? Or Wrong?

You need to get permission to do something to someone else... except when it is so ingrained in normal practice, we don’t think of it as being a thing. Is negative suggestion hypnosis? Probably. Do we consent for it? Never! So why do we have to consent for the alternative? Can you imagine?

“I’m just going to choose my words really carefully, to make sure this cannula goes in nice and smoothly. Is that OK?

“No.”

“OK. That’s not OK. Sharp scratch as this cannula goes in”

“Owww Owww Oww”

So, do we consent for “hypnosis” or “good communication”

This example is a little simple. Consent for more formal hypnosis is of course essential. Much of it is implied as the patient has already entered a therapeutic relationship. But much needs to be explained - what hypnosis is, the purpose of the therapy etc.

But not all hypnosis is planned. Do you ask a patient nearly dead if you can recount the words of the Kansas experiment to them, knowing that this will lessen their chance of dying, and reduce their in-hospital length of stay? Asides from the fact the patient probably couldn’t give you valid consent... no. Is this because you haven’t formally inducted a trance?

Documentation

Some people get written and signed consent before hypnotising their clients. Does this make consent any better, or any more valid, or any less nocebo inducing?

Risks

Much has been written about the risks of anaesthesia, and how frequently a risk needs to occur before you consent for it. The RcoA has a wonderful infographic about these risks - something for patients and practitioners to enjoy.  The GMC has some clear guidelines on consent and what we should consent for - they believe that if something has a 1-2% risk of happening, that’s significant enough we should warn the patient about it.

So, what risks should we share with our patient about hypnosis? Failure of treatment? How often does that happen... and does it just introduce nocebo? Making things worse? A long time ago, a BSCAH newsletter asked for case reports of when it didn’t work, to try and get an idea of how often hypnosis doesn’t work or make things worse. As we have no case reports...can we assume failure and worsening of symptoms is not a risk? Does abreaction happen commonly enough to “consent” for it?

So, should we consent? I consent for a “formal trance”, other times... ... I just “seek permission”.

Dr Charlotte Davies (A&E Consultant)



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