The concepts of placebos and placebo effects refer to extremely diverse phenomena. I recommend dissolving the concepts of placebos and placebo effects into loosely related groups of specific mechanisms, including (potentially among others) expectation-fulfillment, classical conditioning, and attentional-somatic feedback loops. If this approach is on the right track, it has three main implications for the ethics of informed consent. First, because of the expectation-fulfillment mechanism, the process of informing cannot be considered independently from the potential effects of treatment. Obtaining informed (...) consent influences the effects of treatment. This provides support for the authorized concealment and authorized deception paradigms, and perhaps even for outright deceptive placebo use. Second, doctors may easily fail to consider the potential benefits of conditioning, leading them to misjudge the trade-off between beneficence and autonomy. Third, how attentional-somatic feedback loops play out depends not only on the content of the informing process but also on its framing. This suggests a role for libertarian paternalism in clinical practice. (shrink)

Clinical use of placebos is controversial among bioethicists. While placebos have been shown to provide benefit for patients with some conditions, offering placebos to patients without disclosing that they are placebos raises ethical concerns, including the concern that this lack of transparency about the nature of placebos amounts to deceiving patients. Some have proposed open-label placebos as an ethically preferable alternative: patients are offered placebos and told that the treatment being offered is a placebo. To contribute to the ongoing discussion (...) about the ethics and feasibility of clinical use of placebos, we conducted focus groups to explore physician attitudes about clinical use of placebos, including non-disclosed and OLPs, and physician attitudes about the underlying ethical issues. We found that while the non-transparency and deceptiveness of offering non-disclosed placebos was a concern for some physicians, their primary focus when considering both non-disclosed and OLPs was identifying and weighing potential harms and benefits to patients. Some participants also felt further research and training in prescribing OLPs would be needed before they would be willing to use them in their practice. Data are available upon request. (shrink)

In this article I offer a defence of the use of deceptive placebos—inert treatments like sugar pills or saline injections—in clinical practice. In particular, I will defend what I call the ideal placebo case—where a doctor or nurse has good reason to believe that a deceptive placebo offers a patient’s best, or only, chance of some therapeutic benefit. Taking a Kantian approach to the question of clinical placebo use, I examine the Kantian prohibition on deception as interference with the will (...) of a rational agent, and argue that deception to promote the placebo effect can be carried out in a way that does not interfere with the patient’s will in the way prohibited by Kant. The deception involved in a placebo treatment is not carried out to interfere with or obstruct the function of the will, but merely to make possible a means to the patient’s ends that that would otherwise be unavailable. I will therefore argue that deception carried out in order to promote a therapeutic placebo effect can be done in a way that is consistent with respect for a patient’s autonomy, and may be a rare case of deception that is compatible with a Kantian ethical approach. (shrink)

Informed consent, as Alfano (2015) recognizes, has been routinely idealized within philosophical debate: Philosophers typically present a psychologically sanitized formulation of the temporal seque...

Beneficent clinical usage of placebos has been a problem for the application of Kant’s deontology in medical ethics, which, in its strictest form, rejects deception universally. Some defenders of deontology have countered this by arguing placebos can be used by a physician without necessarily being deceptive. In this paper we argue that such a manipulation of Kant’s absolutism is not credible, and therefore, that we should look beyond deontology in our consideration of placebo usage in clinical practice. We conclude that (...) Kant’s deontology cannot be made compatible with placebo use in clinical practice due to the primacy it affords to the principle of autonomy. (shrink)

In a recent article in this Journal, Shlomo Cohen and Haim Shapiro introduce the concept of “comparable placebo treatments” —placebo treatments with biological effects similar to the drugs they replace—and argue that doctors are not being deceptive when they prescribe or administer CPTs without revealing that they are placebos. We critique two of Cohen and Shapiro’s primary arguments. First, Cohen and Shapiro argue that offering undisclosed placebos is not lying to the patient, but rather is making a self-fulfilling prophecy—telling a (...) “lie” that, ideally, will become true. We argue that offering undisclosed placebos is not a “lie” but is a straightforward case of deceptively misleading the patient. Second, Cohen and Shapiro argue that offering undisclosed CPTs is not equivocation. We argue that it typically is equivocation or deception of another sort. If justifiable, undisclosed placebo use will have to be justified as a practice that is deceptive in most instances. (shrink)

The conceptual and ethical challenges regarding clinical placebo are interwoven with each other, so that one's definition of clinical placebo influences the moral reasoning with regard to its use i...