Background:
This particular case study describes two clinical scenarios, which show a placebo being administered. Case 2 describes a 40-year-old man who is diagnosed with gastroenteritis. The patient reports that he is suffering from diarrhea and abdominal cramps. As the doctor explains to the patient that the symptoms will subside, the wife of the patient demands that the patient be given an injection of penicillin. As the doctor refuses, he insures the wife that he will make another house visit if the symptoms do not subside within 24 hours of him leaving.
Dilemma:
The ethical problem with the placebo is that as it is usually used only for control groups in research studies. When used in clinical settings the question of whether the patient is being misled if given a placebo or if any harm can come from such usage becomes a concern. As we know the problem is not that the patient is receiving ineffective medicine but it can be useless or produce less desire side effects. Raising the issue that the doctor is deceiving the patient is a violation of the patient’s rights to be honestly and fully informed about the treatment. So the issue here is if it is right for the physician in Case 2 to administer his patient a placebo, if that is what the wife is demanding.
Discussion:
Research has proven that in some cases placebos have resulted in effective therapies, but as discussed previously the problem is the deception and harm the doctor can become responsible for. However, in this particular case, the patient has been advised that the symptoms that he is experiencing will subside with due time. As the doctor has fully assessed him and concluded that prescribing pain medications or an antibiotic is not a necessity in this matter it only would be right for him to do what’s in the patients best interest. But there is a possibility that the suggestion to give an injection may cause the symptoms the patient is experiencing to subside. Now we need to assess if the possibility of this “cure” is worth the doctor trying the placebo. Penicillin is an antibiotic, which is commonly to treat a bacterial infection. However treating with antibiotics for viral infections has no effect on the actual virus and can cause antibiotic resistance. Which is probably why in this situation the doctor chooses not to give an antibiotic.
For these reasons, I do not believe that the administration of the placebo in Case 2 was unethical or a violation of the patient’s rights. From a professional viewpoint I believe the physicians duty is always to keep the patient out of harms way. So his decision not to administer the penicillin reflects that the physician knew that it was unnecessary. To elaborate the doctor knew that the administration of the unnecessary drug could cause antibiotic resistance for the patient, which can impede on the patient ability to relieve proper care if he is to have a viral infection in the future. As we look at the bigger picture its important to always remember that doctors are always to make sound decisions based on what is best the patients health.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1733989/pdf/v030p00551.pdf
I agree with you that the administration of the placebo in Case 2 was ethical and did not violate the patient’s rights. Although I do recognize that penicillin would not have effectively treated a viral infection and could have led to antibiotic resistance, I think it’s interesting to consider the morality of the decision were the patient to have had a bacterial, rather than a viral, infection. If, say, penicillin could have helped this man, would our opinions have changed? Personally, I believe that when conducting research studies, the most effective treatment at the time should be administered to the control group. Depriving individuals of treatment especially if it can significantly improve their quality of life and instead providing them with a sugar pill is unethical as it violates the principle of maleficence, knowingly causing the patient more harm or putting them at a higher risk than individuals who otherwise would have had access to standard care. Outside of the lab, I would argue that this too should hold true.