The Ethical Concerns Surrounding the Placebo Effect
There are several ethical implications concerning the use of placebos whether in clinical trials or as a treatment option for patients. One article by Marshall Kapp examines several ethical issues surrounding the use of placebos when treating patients and some of the main points from the article are summarized below.
The use of placebos involves deception
One of the biggest and most talked about ethical issues surrounding placebos is the idea of deceit – that physicians must lie to their patients about the medication they are providing to them because if they knew it was a placebo, it may not have the same or no effect. The physician may deceive the patient by blatantly lying or by not saying anything at all.
The use of placebos decreases a patient's autonomy
A second ethical issue goes hand in hand with deception and involves the autonomy of the patient. Some believe that when a placebo is used and a large amount of deceit is involved, the physician takes on a paternalistic role and as a result limits the patient's participation in his/her own care.
The use of placebos can result in malfeasance
A very important ethical issue surrounding prescribing placebos is the concept of malfeasance – which means misconduct or wrongdoing. One of the largest concerns with prescribing a placebo is that you never know what the outcome is going to be. It could be beneficial, have no effect at all, or have a negative or “nocebo” effect. Treating a patient using placebos can also lead to misdiagnosis or lack of monitoring by the physician. For example, if a patient is given a placebo for a condition and shows improvement, the doctor may just attribute this to some kind of neurosis and may not further investigate the patient further. It has also been noted that some patients can develop a dependency to placebos.
The use of placebo limits justice
This ethical issue involves the idea that patients in similar medical situations should be cared for and treated equally. It would be morally wrong to give a "difficult" patient a placebo treatment to merely silence him or her compared to a more tolerable patient.
There are several ethical implications concerning the use of placebos whether in clinical trials or as a treatment option for patients. One article by Marshall Kapp examines several ethical issues surrounding the use of placebos when treating patients and some of the main points from the article are summarized below.
The use of placebos involves deception
One of the biggest and most talked about ethical issues surrounding placebos is the idea of deceit – that physicians must lie to their patients about the medication they are providing to them because if they knew it was a placebo, it may not have the same or no effect. The physician may deceive the patient by blatantly lying or by not saying anything at all.
The use of placebos decreases a patient's autonomy
A second ethical issue goes hand in hand with deception and involves the autonomy of the patient. Some believe that when a placebo is used and a large amount of deceit is involved, the physician takes on a paternalistic role and as a result limits the patient's participation in his/her own care.
The use of placebos can result in malfeasance
A very important ethical issue surrounding prescribing placebos is the concept of malfeasance – which means misconduct or wrongdoing. One of the largest concerns with prescribing a placebo is that you never know what the outcome is going to be. It could be beneficial, have no effect at all, or have a negative or “nocebo” effect. Treating a patient using placebos can also lead to misdiagnosis or lack of monitoring by the physician. For example, if a patient is given a placebo for a condition and shows improvement, the doctor may just attribute this to some kind of neurosis and may not further investigate the patient further. It has also been noted that some patients can develop a dependency to placebos.
The use of placebo limits justice
This ethical issue involves the idea that patients in similar medical situations should be cared for and treated equally. It would be morally wrong to give a "difficult" patient a placebo treatment to merely silence him or her compared to a more tolerable patient.
Ethical Guidelines for Placebo Use
Because there are a number of ethical issues surrounding placebo use should their practice be abandoned altogether? A clinical ethics article by Lichtenberg et al mentions 6 guidelines to follow if choosing to use placebos in patients. They are summarized below:
As healthcare practitioners, using placebos in the treatment of patients is something that requires much thought and research and should not be done blindly as there can be significant negative consequences from the use of these seemingly harmless treatments. Benefit however has been seen in some patients so the use of placebos should not be completely eliminated from practice or research.
Because there are a number of ethical issues surrounding placebo use should their practice be abandoned altogether? A clinical ethics article by Lichtenberg et al mentions 6 guidelines to follow if choosing to use placebos in patients. They are summarized below:
- The physician must have good intentions for treating the patient and keep the best interest of the patient in mind
- Placebo must be provided in an attempt to relieve the patient’s complaint ONLY
- If the placebo is not working, it needs to be stopped
- A placebo should not be given if it is suspected another treatment would be more beneficial for the patient
- The physician should always be honest with the patient when asked about the patient can expect when taking the placebo
- If the patient is showing a positive response to placebo, stopping the treatment would be considered unethical
As healthcare practitioners, using placebos in the treatment of patients is something that requires much thought and research and should not be done blindly as there can be significant negative consequences from the use of these seemingly harmless treatments. Benefit however has been seen in some patients so the use of placebos should not be completely eliminated from practice or research.
References
1. Kapp MB. Placebo therapy and the law: prescribe with care. Am J Law Med. 1983;8(4):371-405.
2. Posner GP, Prager KM, Kirsch M, Legins KE. Is prescribing placebos ethical? American Council on Science and Health. http://www.acsh.org/opinion/is-prescribing-placebos-ethical/. Published October 1, 1998. Accessed May 29, 2013.
3. Lichtenberg P, Heresco-Levy U, Nitzan U. The ethics of the placebo in clinical practice. J Med Ethics. 2004;30: 551-554.
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