Author(s): Imran Uddin
Is it permissible for a doctor or nurse to knowingly administer placebo in a clinical setting? Placebo is any medication or procedure that produces an effect in patients resulting from its implicit or explicit intent and not from its specific physical or chemical properties. Or a placebo is a substance or intervention believed to be inactive, but is administered by the healthcare professional as if it was an active medication.
Is it permissible for a doctor or nurse to knowingly administer placebo in a clinical setting? Placebo is any medication or procedure that produces an effect in patients resulting from its implicit or explicit intent and not from its specific physical or chemical properties. Or a placebo is a substance or intervention believed to be inactive, but is administered by the healthcare professional as if it was an active medication. The clinical use of placebo has become so common that it is used in many countries of the world. Surveys in various countries reveal that 17 to 80% of doctors have prescribed ‘placebos’ in routine clinical practice [1]. Some health care practitioners are in favour of using placebo and others are against; therefore, it has become a controversial issue among the health care practitioners. I, as a health care professional suggest that, Placebo treatment should not be used in medicine because it is unethical and sometimes has harmful effects on patient’s health.
Firstly, the clinical use of placebo should not be allowed because it is unethical. It involves deception because patient is unaware that the treatment she/he is receiving is placebo or the actual medicine which is ethically not good. Furthermore, as stated by, “Withholding information has a tremendous effects on the clinical practice regarding truth telling and informed consent” (p.186). It means that if the patient later on knows by any means that the treatment which was given to him/her was a placebo. It will definitely affect the doctor and patient future relationship. Moreover, current practice in medicine encourages shared decision making and mutual understanding between patients and health care professionals [2].Thus, based on the above arguments Placebo use in medicine should not be allowed because it is against the codes of ethics and current practice of shared decision making
Secondly, Placebo should not be used in clinical practice because sometimes it deteriorates the health condition of patients and also has harmful effects on patients’ health. The use of placebo declines the health condition of patient in such a way when the doctor misunderstands the patient’s complains. It means that if the patient is actually having pain, but the doctor assumes that this patient has become demander. The doctor on the base of this preconception that there is no complain of pain and administers placebo to that patient in order to calm him/her. This misunderstanding of healthcare professional may lead to worsening the health condition of patient. Moreover, the placebo also has some adverse effects on patient’s health for example it causes respiratory depression and reduces heart rate [3]. According to Placebo-activated opioid systems not only act on pain mechanism, but they also act on the respiratory center and produce respiratory depression [3]. So, the use of placebo in some circumstances may risk the patient’s health so it should be banned in medical practice.
On the other hand, some health care professionals argue that “placebo is preferable in some cases, if it makes the patient comfortable and the deception can be forgiven when intended to help a patient” [2].This argument is not relevant because if the standard treatment is available then why should we deceive patients. In addition, it is against the code of ethics as, “The American medical association’s code of ethics prohibits physicians from giving substances they believe are placebos to their patients unless the patients is informed of and agrees to the use of substance” [4]. So, treatment with deception is not moral because it can diminish the trust between patient and doctor. It diminishes the trust especially in those cases when the placebo does not work, and the patient later on discerned that it was a placebo not the actual medicine.
In addition, some opponents believe that “the patient’s prior general consent to the goals of treatment (blanket consent) effectively authorizes the clinical use of placebo” [2]. Prior or blanket consent is a type of consent form which is filled and signed by the patient at the time of admission at hospital. The opponents believe that this consent which is taken from patient or relative at the time of admission is enough to give any treatment or conduct any procedure without further approval. In response to opponents’ view “prior consent (blanket consent) may not be justified in case for clinical use of placebo” [2].Although Blanket consent may be justified in some clinical situations, including emergency situations or care of a patient who explicitly requests not to be fully informed about (for example) doing CPR. However, this is not the case for the clinical use of placebo. Placebo is not an emergency situation that should be performed without patient informed consent. So, it is irrelevant to administer placebo to patient on the basis of prior consent.
In conclusion, the use of placebo in clinical practice violates the right of autonomy and also creates some adverse effects on patient’s health; therefore it should not be used in medicine. It is unethical because it involves deception which is against the American Medical Association’s code of ethics. Furthermore, placebo also produces some adverse effects like respiratory depression and reduction in heart rate along with its therapeutic effects. Although some health care professionals are in favour of using placebo but their arguments are irrelevant. Lastly, I will suggest that trust between health care professionals and patients plays an important role in psychological support and treatment of the patient. The use of placebo breaches that trust, so proper consideration should be given to its clinical use [5,6].
