Summary: The Ethics Of Placebos

The Ethics of Placebos

Placebos, whether we know it or not, are being used and prescribed to us throughout our lives. However, there are some questions that are tied to the use and suggestion to use placebos. The major question is, is it ethical to be prescribed a placebo while still maintaining our autonomy as a patient? This topic has been a subject of debate for over a century, however, little scientific data has been found to prefer the use of placebos over nonuse. The author will attempt to come to a conclusion of this debate, one that respects and acknowledges the ethics of the health care field and the patient. Before doing so, the author will provide information on what a placebo is, scientific comparisons to real drugs, pay consideration

to the patient’s autonomy, consider the health care provider’s role, and argue both for and against the use of placebos.
What is a Placebo?
“A placebo is a substance provided to a patient that the physician believes has no specific pharmacological effect upon the condition being treated” (Barnhill 2012, p.

30). These inactive substances are administered by a health care professional as if it were any other active medication. The purpose of a placebo fluctuates depending on the situation given. However, for the most part, placebos are given in order to achieve a desired treatment in which a pharmacological agent could have reached the same outcome. This is done, usually, without the patient knowing that the ‘medication’ has no actual pharmacological properties. Asai and Kadooka (2012), further break down the definition of a placebo into two categories. There is a pure placebo and an impure placebo. A pure placebo is made of substances with no known clinical use. An impure placebo is composed of substances that are not made to treat that patient’s condition, but another condition. Barnhill (2012), adds one more type of placebo to the list. Joining sugar pills and active drugs that are effective for a different disease, are active drugs that are administered at too low of a dose to be effective. All of these can be considered placebos and are occasionally given without the patient’s

knowledge.
Placebo Results in Comparison to Real Drugs
Being given a medication that has no actual purpose would make anybody question its widespread use.

However, as research goes on, there seems to be instances of placebos resulting in desired outcomes. “About one-third of patients have experiences some degree of improvement in conditions such as pain, angina pectoris, cough, anxiety, depression, hypertension, headeache, seasickness, and the common cold with placebos” (Asai & Kadooka 2012, p. 188). Rawlins (2015), discusses another instance in which patients who knew they were taking placebos had relief of irritable bowel syndrome symptoms. Not only are these placebos reaching a desired result, they are doing so without the risks of medication side effects and interactions. Cohen and Shapiro (2013) even consider placebo use as the gold standard of treatment. “The placebo effect, is this defines as an improvement in a patient’s condition resulting from the symbolic aspects of the encounter with a healer o a healing setting, rather than the pharmacologic or physiologic actions of the intervention” (Asai & Kadooka 2012, p.

187).
Right to Autonomy
If there is one thing that a health care professional must honor and respect in a patient, it is their right to autonomy. Patients have the right to steer their treatment in whichever direction they desire, as long as they are provided with the necessary information to do so. Being prescribed a placebo is thought to take away from that right. Patient’s rely on their health care providers to do what they think is best for them and this establishes a trust. When a physician prescribes a placebo, it is thought to break that trust between them. For example, if a patient develops a trusting relationship with their provider and they discover that they have been given a placebo as treatment, they may feel angry or betrayed. The trust that they had with their physician (and possibly all physicians) is gone and instead they may develop worse or even new symptoms due to stress. However, many do not see it this way. “…most considered placebo use acceptable under certain conditions, such as prior positive results, informing patients of placebo use, or if research evidence indicated that the placebo was effective” (Asai & Kadooka 2012, p. 187). While placebo use seems controversial in that it deceives the patient, it is the bigger picture that matters most. Cohen and Shapiro (2013), give an example to better help relate placebos to an everyday topic. They compare the lie associated with giving a placebo to that which you would lie to a spouse about throwing them a surprise party. “The moral affirmation is in the spouse’s loving gratitude when the lie unravels” (Cohen & Shapiro 2013, p. 701). Beneficence versus autonomy is discussed by Asai and Kadooka (2012). The lie that comes along with giving a placebo may be overlooked when the intent was to help the patient’s condition improve.