One of a physician’s prime objectives is to do no harm to their patients. So, based on that requirement and the principle of beneficence a physician administering a placebo treatment is not morally compromising. In administering placebo the physician limits and often times eliminates suffering with no major side effects to the patient (551 Lichtenberg et al). Looking only at the placebo being a substance that does not have active ingredients is missing its true purpose. As Lichtenberg et al imply, one must look beyond the biomedical perspective of healing in order to understand the placebo’s place in medicine. With the ethical guidelines Lichtenberg et al laid out for using placebo in mind, a placebo treatment is morally sound. That stated, I wanted to address the particular case where the physician did not administer a placebo as the more moral action to take.
In the second vignette from the Lichtenberg et al article it tells of a house call made to a 40 year old man diagnosed with gastroenteritis. The patient’s wife insisted her husband be given a shot of penicillin for his ailments despite the apprehension of the physician. Ultimately, the physician is able to leave without administering the antibiotics with a promise to come back if the patient wasn’t relieved in 24 hours. In this case it would have been highly unethical for the physician to use a placebo treatment because of the possible negative effects.
Gastroenteritis, otherwise known as the stomach flu involves your stomach and intestines being inflamed and irritated. The stomach flu has nothing to do with influenza (flu) and the cause of infection can either be viral or bacterial. If the cause is bacterial then it is caused by microbes, which are infectious microscopic single-celled organisms. Theses organisms can go undetected on foods and surfaces until they begin to cause infections in one’s body. Whereas, viral infections are also cause by microbes but these have an outer protein coat, which incases a DNA core that requires other cells to replicate. To treat a bacterial infection, most physicians prescribe antibiotics because they can kill bacteria and/or stop them from reproducing. However treating with antibiotics for viral infections has no effect on the actual virus and can cause antibiotic resistance. Antibiotics flush your system of bacteria both good and bad, but the full prescription must be taken in order to do this. If a patient does not take the full regimen of antibiotics the body can build a tolerance to antibiotics with the bacteria that remains. In the case of treating viruses, since there are no infectious bacteria to clear out the chances of your body building immunity to the antibiotics is much higher. As a result, an even stronger dose of antibiotics will be required for the next time an infection occurs or worst-case antibiotics become ineffective. Thus, future infections will be harder to treat and cause longer suffering for the patient.
Given the above information, if that physician were to administer penicillin, an antibiotic, in this instance to the patient he would have been enacting harm. Being antibiotic resistant is a problem for the medical field and detrimental to patients. In this case, the penicillin’s sole purpose would have been to mollify the patient, which Lichtenberg et al point out as unethical use of placebo. So some might argue that the physician had a dilemma of whether to acquiesce to the spouses request or not. However, with the potential of all that could go wrong with irresponsible use of antibiotics his choice is clear. Therefore, the physician – and any for that matter – would be violating his moral obligations in using antibiotics as placebo.
Works Cited
“Bacterial vs. Viral Infections: Causes and Treatments.” WebMD. WebMD. Web. 13 Feb.
2015. <http://www.webmd.com/a-to-z-guides/bacterial-and-viral infections?page=2>.
“Gastroenteritis (Stomach Flu): Symptoms, Causes, Treatments.” WebMD. WebMD.
Web. 13 Feb. 2015. <http://www.webmd.com/digestivedisorders/gastroenteritis>.
Lichtenberg, P., U. Heresco-Levy, and U. Nitzan. “The Ethics Of The Placebo In Clinical
Practice.” Journal of Medical Ethics 30.6: 551-54. JSTOR. Web. 13 Feb. 2015.
U.S National Library of Medicine. U.S. National Library of Medicine, 25 Aug. 2014.
Web. 14 Feb. 2015. <http://www.nlm.nih.gov/medlineplus/antibiotics.html>.
Ugochi,
I definitely agree with you that the doctor made the right decision to not give the patient with gastroenteritis an unnecessary shot of penicillin. Both you and Lichtenberg et all mention that a dose of penicillin would only compromise the patient’s immune system, but I liked how you took it even further by saying that “[…]future infections will be harder to treat and cause longer suffering for the patient.” In Aristotelian ethics, phronesis, the ability to think about long range consequences and possibilities, is literally translated to mean practical thought, and the doctor in this case definitely used practical thinking and chose the right decision to make.
On a side note, I’m curious as to how the wife and her husband were EVER given a dose of penicillin in the past and how they know that it will supposedly work to treat the husband’s gastroenteritis? Did some other incompetent doctor give it to the man or does the woman’s scope of knowledge only expand so far and she THINKS that penicillin will help her husband? These are rhetorical questions of course, but just food for thought.
Gabby,
I’ll venture to answer your rhetorical question and my answer very much ties into placebos. I agree with your conjecture in that I think a previous physician might have very well felt the infection the 40 year old patient was suffering from was bacterial and administered a penicillin shot. Consequently, the placebo effect might have taken effect in that instance and the patient felt false relief even though his infection was viral and the antibiotics were not actually treating his infection. So, the wife must have taken that to mean the penicillin was in fact an effective means of treatment. However, this physician clearly had reason to believe that the infection did not need penicillin and it would be gone in a few days as stated. People do not fully understand the repercussions of anti-biotic resistance so they want antibiotics for everything because they feel they want to just be treated with something. So, I’m glad the physician did not give in to the patients wife.