Lying, deception, equivocation and the ethics of prescribing placebos in clinical practice

Marco Annoni

Marco Annoni

Keywords: Placebo effects, Medical Ethics, Lying, Deception, Truth-telling

Abstract

In this paper I explore different ways in which doctors can be dishonest in clinical communications. As a case in point, I object to the idea that doctors can prescribe placebos in ways that are not transparent and yet not paternalistic. First, I briefly present evidence demonstrating that placebo effects may modulate a host of clinical outcomes. Second, I argue that doctor’s duty of truth-telling in clinical contexts entails two complementary obligations: the one not to lie and deceive (i.e, the duty of truthfulness), and the one to inform patients in order to respect their autonomy (i.e, the duty to inform). Third, I distinguish different ways in which doctors may violate their duty of veracity. Specifically, I identify two ways in which doctors may fail to uphold the duty of truthfulness (by lying and deceiving), and two ways in which they can instead infringe on the duty to inform (by keeping patients in the dark and by telling half-truths). Based on these distinctions, I conclude that doctors cannot have the placebo cake and eat it too: either they prescribe placebos in a fully transparent manner, or they need to morally justify a paternalistic exception to their duty of veracity

References

American Medical Association (AMA) (2006), «Code of Ethics Opinion 8.083. Placebo Use in Clinical Practice», from http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion8083.shtml

Annoni, Marco (2013), «Highlights from the 2013 Science of Placebo thematic workshop», in Ecancer, 7, 346, from http://ecancer.org/journal/7/346-highlights-from-the-2013-science-of-placebo-thematic-workshop.php

Annoni, Marco, and Miller, Franklin G. (2014), «Placebo in clinical practice: an ethical overview», in Douleur et Analgésie, n. 27, pp. 215-220.

Annoni, Marco (2015), «Exceptional lies: The ethics of deceptive placebos in clinical settings», in Biblioteca della libertà, n. 213, pp. 1-17.

Annoni, Marco, and Miller, Franklin G. (2016), «Placebo Effects and the Ethics of Therapeutic Communication: A Pragmatic Perspective», in Kennedy Institute of Ethics Journal, n. 26, pp. 79-103.

Beauchamp, Thomas L., and Childress, James F. (2009), Principles of Biomedical Ethics, Oxford University Press, New York and Oxford.

Beauchamp, Thomas L. (2010), Autonomy and Consent, in Miller F. G. and Wertheimer A. (eds.), The Ethics of Consent, Oxford University Press, New York.

Benedetti, Fabrizio (2009), Placebo effects: Understanding the mechanisms in health an disease, Oxford University Press, New York 20152.

Benedetti, Fabrizio (2011), The Patient’s Brain: the neuroscience behind the doctor-patient relationship, Oxford University Press, New York.

Bok, Sissela (1974), «The Ethics of Giving Placebos», in Scientific American, n. 231 (5), pp. 17-23.

Bok, Sissela (1978), Lying: Moral Choices in Public and Private Life, Vintage Books, New York 1999.

Brody, Howard (1992), The Healer’s Power, Yale University Press, New Haven.

Brody, Howard (1995), «Placebo», in Encyclopedia of Bioethics, edited by W.T. Reich, pp. 1951-1953, Simon & Schuster Macmillan, New York.

Cabot, Richard C. (1903), «The Use of Truth and Falsehood in Medicine: an Experimental Study», in American Medicine, n. 5, pp. 3444-3449.

Carson, Thomas L. (2010), Lying and Deception. Theory and Practice, Oxford University Press, Oxford.

Chisholm, Roderick M., and Feehan, Thomas D. (1977), «The intent to deceive», in Journal of Philosophy, n. 74, pp. 143-159.

Cohen, Shlomo, and Shapiro, Haim (2013), «“Comparable Placebo Treatment” and the Ethics of Deception» in Journal of Medicine and Philosophy, n. 38, pp. 696-709.

Faden, Ruth R., and Beauchamp, Thomas L. (1986), A History and Theory of Informed Consent, Oxford University Press, New York.

Gold, Azgad, and Lichtenberg, Pesach (2014), «The moral case for the clinical placebo», in Journal of Medical Ethics, n. 40, pp. 219-224.

Jackson, Jennifer (2001), Truth, Trust and Medicine, Routledge, London and New York.

Kaptchuk, Ted J. (1998), «Intentional Ignorance: a history of blind assessment and placebo controls in medicine», in Bulletin of the History of Medicine, n. 72, pp. 389-433.

Kaptchuk, Ted J., Kelley John M., et al. (2008), «Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome», in British Medical Journal, n. 336, pp. 7651.

Kaptchuk, Ted J., Miller, Franklin G. (2015), «Placebo Effects in Medicine», in New England Journal of Medicine, n. 373, pp. 8-9.

Kolber, Adam J. (2007), «A Limited Defense of Clinical Placebo Deception», in Yale Policy Review, n. 26, pp. 75-134.

Miller, Franklin G., and Kaptchuk, Ted J. (2008), «The power of context: Reconceptualizing the placebo effect», in Journal of the Royal Society of Medicine, n. 101, pp. 222-225.

Ross, William D. (1930), The Right and the Good, Claredon, Oxford.

Ross, William D. (1939), The Right and the Good, Claredon, Oxford.

Shapiro, Arthur K., and Shapiro, Elaine (1997), The Powerful Placebo: From Ancient Priests to Modern Physician, The John Hopkins University Press, Baltimore.