Background:
This article discusses three separate cases in which a placebo was administered in clinical settings. I am going to focus on Case 1. In this case we have a 45 year old man suffering from diabetes and hypertension who has just undergone a second leg amputation. Following the surgery, the man was facing severe pain and after being treated with multiple injections his pain still hadn’t subsided so the staff decided to administer him intramuscular saline, a placebo, which ultimately helped with the pain but was the patient deceived?
Dilemma:
The ethics of the placebo have typically been dealt with in a research setting, however here we are questioning the use of the placebo in clinical practices. In research studies, the use of the placebo is a very common method of evaluating a control group versus an experimental group. However when patients go to their physicians, they are seeking out a cure or treatment for whatever illness they are facing, they are looking for a prescription and generally they trust their physician’s opinion and ultimate method of treatment. So the issue here is was it right for the physician in Case 1 to administer his patient a placebo, while having his patient believe he was being treated with a legitimate pain killer
Discussion:
Placebos have been proven to be an effective method, so that is not where the ethical problem is. Rather, the ethical problem is whether or not administration of a placebo is deceiving the patient. If it is indeed deception, then the placebo treatment would always be unethical and a violation of the patient’s right to be fully informed at all times.
However, in this particular case, the patient was told that the injection he was going to be given would ease his pain. Not only was he told this but his physicians had full belief that the saline would indeed work as they had anticipated. And ultimately that is exactly what it did, the treatment, although it was a placebo, did in fact significantly reduce the patient’s pain. So where is the dishonesty in communication between doctor and patient? It doesn’t seem like there is any.
Yes, the patient has a right to know what he or she is being administered and any other medical information that they want. However, if they do not ask their physician for this information then the physician is not obligated to tell them. This is very different from a physician withholding potential negative side effects of a treatment or medication; we cannot confuse the two situations as they are entirely different and in the latter case I believe the physician does have an obligation to tell their patient any potential consequence of a treatment or prescription. But in this case there are no negative side effects that the physician is withholding, and if the patient were to ask for the name of the pill or how it works then yes, in any situation, he or she should morally be given that information in complete truth. But the patient did not ask the physician those questions, therefore that information is not required to be given.
For these reasons, I do not believe that the administration of the placebo in Case 1 was unethical or a violation of the patient’s rights in any way, shape or form. I believe that the physician was looking out for the best interest of his or her patient and since the patient did not ask for specific information about the pill he was being administered, it was unnecessary for the physician to say anything.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1733989/pdf/v030p00551.pdf
I agree with you Mikaila that providing the patient with the placebo in Case 1 was not unethical or a disregard to the patient’s rights. The physician should do what he feels is best for his or her patient. If the physician thinks the placebo may help with the patient’s pain, then I consider administering the placebo is the correct decision. Furthermore, I strongly maintain that if a medical problem can be improved without the use of treatment or medication, then that should be the method utilized. In our society, we are constantly relying on the use of medication to deal with any pain we face. However, don’t we all often exaggerate the pain we are in just because of the situation? Yes, the man in Case 1 just suffered a second leg amputation, but if the physician administered him with a placebo for the pain, the physician must have some reason for doing so. I feel that if the physician thinks the placebo will help with the patient’s uneasiness, then his opinion should be trusted.
I like when you express that it is not deceitful because “the patient was told that the injection he was going to be given would ease his pain.” Additionally, I think it was a strong point to make that “not only was he told this but his physicians had full belief that the saline would indeed work as they had anticipated.” Therefore, the physicians did what their job entails, which is to help alleviate patients’ pain, and that is exactly what they told the patient they would do.
My one argument that I am going to make is that as much as I think placebos really do psychology and often physically make a difference, I think that in order to insure that there is no deception, the physician must inform the patient of a possibility that he will be receiving sham treatment. Even if it’s just written in the consent form as an option, I think the patient has the obligatory right to know that this is one of his potential treatment options down the road.