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The Ethical Debate of Placebos
In health care there is a fine line between what is ethical and what is not. As time goes on this line becomes thinner and thinner. In the article The Moral Case For The Clinical Placebo, Azgad Gold and Pesach Lichtenberg are two researchers that argue that there are exceptions to this fine line when talking about placebos. They specifically argue, “The intentional use of the placebo, in certain circumstances and under several conditions, can be justified.”1 The placebo is rapidly becoming a problem because it is now a commonly prescribed drug and many people have different ethical views on the topic.
Gold and Lichtenberg believe that the placebo is effective and should be used in certain cases and under specific circumstances. They say that the placebo may be more effective in a clinical setting rather then in a research setting.1 It has also been proven that if a patient knows about the placebo they are less likely to show improvement in their health. This is why full disclosure is not always possible. This also means that the patient has to form some type of trust in the physician and believe that the physician is there to help them get better. Trust between the patient and the physician is what makes the placebo effect possible. Both of these researchers believe that it is ethically acceptable to use the placebo because in most cases it can be morally justified; meaning that the placebos can be used because, in the end, it is for the benefit of the patient and not the physician.
Many argue against Gold and Lichtenberg’s beliefs. Others believe that giving the patient a placebo is denying them of a “real” treatment and that it “is unethical, if not illegal.”1 Many people also believe tha...
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...ebo can be morally justified in many circumstances. There is now a rough guideline that physicians must follow that help balance out all the conflicts that arise when discussing the placebo. The prescription of the placebo must help improve the patient’s health in the end otherwise the patient must not take it. The placebo also cannot be presented in a false manner to the patient. There does not have to be full disclosure under certain circumstances. Paternalism is also allowed under certain conditions. Both Gold and Lichtenberg argue with evidence and research reasons why the placebo is morally justified in certain situations.
NOTES
1.) Gold A. and Lichtenberg P. The Moral Case for the Clinical Placebo, 219-224.
BIBLIOGRAPHY
Azgad Gold and Pesach Lichenberg, “The Moral Case for the Clinical Placebo,” J Med Ethics 40 (2014): 219-224.
In Marcia Angell’s article, “The Ethics of Clinical Research in the Third World,” she strongly argues the use of clinical placebo-controlled trials done in developing countries are unethical if an effective treatment already exists. Angell believes studies that compare potential new treatment with a placebo controlled group is ineffective and unnecessary. All research studies should offer the best standard of care and give participants the most beneficial outcome and treatment possible. The main priority of a study is not the goals of the research itself, but the well-being of the participants. Angell uses many sources to defend her argument, such as WHO.
An ethical dilemma that is currently happening in the medical field regards pain management. Doctors and other medical professionals are faced with this ethical decision on whether to prescribe strong pain medication to patients who claim to be experiencing pain, or to not in skepticism that the patient is lying to get opioids and other strong medications. “Opioids are drugs that act on the nervous system to relieve pain. Continued use and abuse can lead to physical dependence and withdrawal symptoms,” (Drug Free World Online). Opioids are often prescribed to patients experiencing excruciating pain, but doctors are faced with prescribing these drugs as an ethical issue because only a patient can measure the pain they are in, it is simply impossible
Denise Dudzinski, PhD, MTS, Helene Starks, PhD, MPH, Nicole White, MD, MA (2009) ETHICS IN MEDICINE. Retrieved from: http://depts.washington.edu/bioethx/topics/pad.html
A divergent set of issues and opinions involving medical care for the very seriously ill patient have dogged the bioethics community for decades. While sophisticated medical technology has allowed people to live longer, it has also caused protracted death, most often to the severe detriment of individuals and their families. Ira Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center, believes too many Americans are “dying badly.” In discussing this issue, he stated, “Families cannot imagine there could be anything worse than their loved one dying, but in fact, there are things worse.” “It’s having someone you love…suffering, dying connected to machines” (CBS News, 2014). In the not distant past, the knowledge, skills, and technology were simply not available to cure, much less prolong the deaths of gravely ill people. In addition to the ethical and moral dilemmas this presents, the costs of intensive treatment often do not realize appreciable benefits. However, cost alone should not determine when care becomes “futile” as this veers medicine into an even more dangerous ethical quagmire. While preserving life with the best possible care is always good medicine, the suffering and protracted deaths caused from the continued use of futile measures benefits no one. For this reason, the determination of futility should be a joint decision between the physician, the patient, and his or her surrogate.
Physician-assisted suicide refers to the physician acting indirectly in the death of the patient -- providing the means for death. The ethics of PAS is a continually debated topic. The range of arguments in support and opposition of PAS are vast. Justice, compassion, the moral irrelevance of the difference between killing and letting die, individual liberty are many arguments for PAS. The distinction between killing and letting die, sanctity of life, "do no harm" principle of medicine, and the potential for abuse are some of the arguments in favor of making PAS illegal. However, self-determination, and ultimately respect for autonomy are relied on heavily as principle arguments in the PAS issue.
These patients are desperate and are vulnerable, often consenting to research studies without fully understanding the potential outcome. Therefore, it is imperative to educate the patients, public, and regulatory agencies regarding the pros and cons of these therapies.
In the United States, the basis for ethical protection for human research subjects in clinical research trials are outlined by the Belmont Report developed in the late 1970’s. This document, published by the Nation Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, highlights three important basic principles that are to be considered when any clinical trial will involve human research subjects. They are; respect for persons, beneficence, and justice. (Chadwick & Gunn, 2004)
In conclusion, all three of these practices offer the opportunity for great medical advancement but struggle with ethical issues and possible risks as well as questions of their viablity as legitimate treatments to benefit medical problems.
"ETHICAL DEBATE: On the horns of a dilemma." Chemist & Druggist. 03 Dec. 2005: 30. eLibrary. Web. 20 Jan. 2014.
Steinbock, Bonnie, Alex J. London, and John D. Arras. "The Principles Approach." Ethical Issues in Modern Medicine. Contemporary Readings in Bioethics. 8th ed. New York: McGraw-Hill, 2013. 36-37. Print.
The point to pay close attention to is, that these patients went through what is called integrative medicine. Hart definition of it is, integrative medicine can be defined as an approach to practice of medicine that makes use of the best- available evidence, taking into account the whole person (body, mind, and sprit), including all aspects of lifestyle.(as cited in Kligler et al., 2004) . Attitudes of medical students towards CAM seem to be slightly more enthusiastic, at Georgetown University School of Medicine, in Washington D.C. Ninety-one percent believed that CAM should be includes ideas and methods from which allopathic medicine can benefit from. Seventy-five per...
Freedman B. Equipoise and the ethics of clinical research. N Engl J Med. 1987; 317(3): 141-145
McGee, Glenn and Arthur L. Caplan. "Medical Ethics." Microsoft® Encarta® 98 Encyclopedia. © 1993-1997: Microsoft Corporation. CD-ROM.
...ebo means that anything seems to be real but actually it is not real then, doctors create something fake such as pills, shots or drugs on people’s brains in order to heal a disease. For example, a pill is given to a person who has insomnia and said positive things about treatment. After that emotional effect and pill, person feels better and s/he can sleep well afterwards. In another specimen, people can