Ethical Considerations in Ibogaine Therapy

Sandra Karpetas

Iboga Therapy House

Global Ibogaine Therapy Alliance (GITA)

2nd International Ibogaine Therapy Provider Conference

Barcelona, Spain 2010

Why do we need ethical

standards?

Ethical insensitivity can contribute to: – Health and safety problems

– Dissatisfied clients/patients

– Public relations problems

– Financial problems

– Legal problems

– Organizational challenges

How can ethics in therapy

be helpful?Ethical Standards:

– Increase the quality of care and services

provided

– Increase transparency and accountability

– Help to protect clients and therapists from

undue harm

– Foster greater recognition from the public

domain

– Create conditions for maximizing therapeutic

potential

Ethical GuidelinesInternationally Recognized Ethics in Therapy and

Research:– Beneficence: Promotion of well-being

– Non-malfeasance: Avoid potential harms

– Dignity: Respect for the person

– Informed Consent: The person's right to information, to

ask questions and to weigh the risks/benefits before

making a decision

– Transparency: Open communication about

policies/procedures, disclosure of key information for

client decision making

– Confidentiality: Respect for privacy

– Feedback: The right to provide feedback, whether

positive and/or negative and to file a grievance or

incident report

Beneficence: Promotion of

well-beingIbogaine therapists should promote health in all aspects of

their programming, procedures and policies.

This includes key concepts such as health promotion, harm

reduction

and physical, psychological, emotional, spiritual and social

well-being

– Foster knowledge, skills, attitudinal changes and

supports needed to help people engage in safer and

healthier lifestyles

– Avoid deficit thinking, build on strengths and support

positive perspectives

Non-malfeasance: avoid

potential harms– There is an urgent ethical responsibility to decide

whether the risk is too great for some participants,

and thus to act to reduce or eliminate the risk even

if that means stopping or modifying the therapy.

– Therapists also have a responsibility to

continuously educate themselves and remain up to

date on ibogaine safety related information.

Neglect of this responsibility can be considered

negligence and/or misconduct and may contribute

to adverse events and/or death.

Dignity: Respect for the

person– Respect autonomy and support informed decision-

making

– Accept and work with individual differences in client

characteristics in both preventing and responding

to potential challenges. These include unique risks

associated with gender, age, sexual orientation,

cultural/religious identity, etc...

– Recognize that the realities of poverty, class,

racism, social isolation, past trauma,

discrimination, labels, stigma and other social

inequalities affect both people's vulnerability to

and capacity for effectively dealing with self care.

Informed ConsentThe client has a right to information, to ask questions

and to weigh the risks and benefits before making a

decision to undergo therapy

Minimal Risk

If potential subjects can reasonably be expected to regard

the probability and magnitude of possible harms implied

by participation in the research to be no greater than

those encountered by the subject in those aspects of

his/her everyday life that relate to the research, then

the research can be regarded as within the range of

minimal risk.

-Tri Council Policy Statement 1998

What does an ethical consent

form consist of?A proper consent form should include:

– Introduction/Background Information about

ibogaine

– Ibogaine's Legal Status in the country where

therapy takes place

– Therapeutic and Other Procedures from start to

finish - in detail (include search, source of ibogaine,

dosing, monitoring protocols,

complementary/additional therapies, etc...)

– Ibogaine's Potential Effects, Side Effects and Risks

– Emergency Protocols (including specifics of what

you would do in case of an adverse event, injury or

death)

What does an ethical consent

form consist of?– Potential Benefits (including a disclosure regarding

no guarantee that it will help)

– Quitting or Withdrawing from Participation in the

Therapy - including your procedures and risks

should someone decide to leave the site of therapy

whilst under your care

– Data Collection, Publication and Communication of

Results - disclose any plans to share information

with others/public

– Confidentiality - handling and storage of personal

info, files, medical info etc... plus staff/team

confidentiality agreements

What does an ethical consent

form consist of?– Alternative Sources of Therapy – ibogaine therapy

is not the only option and not necessarily the

easiest/safest

– Incentives– disclose any vested interests including

financial

– Client Rights and Responsibilities - include DWF Bill

of Rights, outline client responsibilities, the right to

file incident or grievance reports and how to do so

– Who to contact for more information – include

contact info

– The actual Informed Consent statement page to be

signed

Elements of a consent form:– Each page should be numbered and have a space

at the bottom for initials acknowledging the

following statement:

I have read the contents of this page. I have had the

opportunity to ask questions about it, and I

understand what it says. Initials____

– The form should be written in an easy to

understand manner (8th grade reading level).

Complicated terms should be defined in an easy to

understand way

– The actual informed consent statement page –

include a statement regarding minimal risk

– Space for date, signature of client and witness

signature/date

Note: A copy should be available for client without

extra charge

Confidentiality– Respect for privacy before, during and after care

– Handling and storage of sensitive information:

- keep all files/personal/medical info secure and

locked

- consider using a secure server w/ SSL certificate

- do not use publicly-accessible computers

• Ask client how they prefer to be contacted and when

– Omit personally identifying info in

publications/reports/discussions

– Each staff member should sign a confidentiality

agreement

Feedback

Every client (regardless of whether they paid for the

services or not) has the right to provide feedback,

whether positive and/or negative and to file a

grievance or incident report if they deem necessary.

It is the responsibility of the therapy provider to

provide information on how to do so.

Ibogaine Incident or Grievance Report Form:

http://www.doraweiner.org/incident.html

A few other considerations:Compassion, empathy, strong interpersonal, listening,

counseling and facilitation skills are of utmost

importance. Individuals on the staff/team should

possess the following:

– Recognition of and respect for diversity

– Awareness of one’s own learning process

– Ability to be attentive/good listening skills

– Trust in one’s way of working

– Ability to work with authority

– Willingness to do one’s own inner work

Also: Have a fair and just conflict resolution policy in

place

Sandra Karpetas

sandra_k@ibogatherapyhouse.net

+ 1 604 785 0924

www.ibogatherapyhouse.net

Global Ibogaine Therapy Alliance

www..ibogainefederation.org