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One of the most pertinent questions in medical ethics is balancing physician autonomy with patient trust. Giving physicians full authority over all action at the expense of the patient’s autonomy and trust is a unsettling notion for most patients. The use of placebo as a treatment may act to break this trust.
Using placebos is an absolutely essential part of the medical research process, as controlling patient test groups under varying conditions is a requirement set forth by the Food and Drug Administration (Clinical Trials and Human Subject Protection). In this circumstance, a placebo treatment is legally required for determining the efficacy of a drug or procedure. However, placebos may offer their own therapeutic benefits in some circumstances (Daniel E Moerman, 472). Because placebos can result in real symptom improvement, prescribing a patient a placebo is now considered by some to be a viable option.
However, when the placebo becomes a possible treatment option remains uncertain. There are a few requirements that govern the discretionary usage of a placebo as treatment. First, the physician must be acting in the best interest of the patient. In cases of moderate pain treatment, placebo may be seen as a good medical decision, especially if the pain is not indicative of more severe physical problems. In fact, using placebo over opioid pain relievers offers reduced side effects, albeit at the expense of euphoria and sedation. Second, the patient must be consistently monitored so that standard treatment can be administered if there is no improvement. Third, the physician must be honest if the patient decides to inquire about the specifics of treatment. While those in favor of placebo usage argue that physicians do not have to initially disclosure it, they concede that physicians must guarantee a basic level of trust in the patient relationship.
The article’s second case presents a dilemma that extrapolates on the third point made above: Is the physician’s initial deception of the patient unethical? While certain benefits — or lack of problems — make placebo a viable option, choosing this treatment runs the risk of diminishing trust in the patient-physician relationship. In cases that do not absolutely require negative-control patient groups, I see the use of undisclosed placebo as a violation of trust by the physician. Patients seek out medical professionals to receive the best advice and treatment. Therefore, it is my opinion that medical professionals should not use placebo treatments, as doing so undermines the trust between the two parties.
While placebo should not be rejected as an outright useless treatment, the patient’s trust in their physician relies on knowing that the doctor is acting honestly, transparently, and in their best interest. Knowing this allows patients to put more confidence in the actions of their doctor, thereby strengthening the relationship and improving health outcomes (Lynda A Anderson). Despite this, there is little room for arguing against use placebos in clinical trials, especially phases II and III. Unless a patient is being studied and compared to groups with different variables — like authentic treatment or placebo — physicians should not consider using placebos and must value honesty with their patients.
Citations
Clinical Trials and Human Subject Protection, accessed 3 Feb 2017, http://www.fda.gov/ScienceResearch/SpecialTopics/RunningClinicalTrials/
Daniel E Moerman, Wayne B Jonas. “Deconstructing the Placebo Effect and Finding the Meaning of Response,” Annals of Internal Medicine 136 (2002): 471-476.
Lynda A Anderson, Robert F Dedrick. “Development of Trust in Physician Scale: A Measure to Assess Interpersonal Trust in Patient-Physician Relationships,” Sage Journal 67 (1990).
Very cool post, I take it that your view is that while placebos are an integral part of medical research, it is on the other hand a problematic issue when it comes to physician-patient relations because any use of placebos under the latter circumstance would seem to be one of deception, and therefore would undermine the trust between practictioner and patient. Perhaps to push you just a little, there are instances when patients demand for placebos, or even in others where patients refuse to believe that the placebo actually isn’t a placebo. A question that comes to mind thus is: to what extent physician-patient trust relations outweigh the apparent ‘effectivity’ that placebos have on patients? Are these two issues mutually exclusive?
Initially, I believed in the therapeutic use of placebos and its benefits. After all, the clinicians, who have a background in medical knowledge, believe that most placebos are pharmacologically inactive and biomedically inert to the body.
After reading your post, I start to realize the important of the patient- physician relationship. In the long run, I believe it may be beneficial to both the patient and physician. If the patient finds out about the placebo, the relationship is impaired. The patient will be hesitant to further treatments, making the physician unable to provide health care in an effective manner. If there are little to no primary treatments available, then I believe a placebo treatment may be introduced as an alternative.
Overall, I believe there is still much to learn about the placebo process and how it affects the brain. I do not believe it is moral or safe to practice placebo treatments until all the effects are fully understood. In her medical journal, Harrington brings up the idea that we hear mostly about the positive effects of a placebo treatments. There is still room to research the harmful effects. It is yet to be determined whether the body and mind are “in a full agreement” of feeling symptoms, pain, etc. In other words, what counts as a “meaningful” healing? In the future, perhaps, when there is more research and evidence complete on this topic, it can be considered useful.
Harrington, Anne. The Placebo Effect: An Interdisciplinary Exploration. Cambridge, MA: Harvard UP, 1997. N. pag. Print.