Should Doctors Prescribe Placebos?
A doctor could prescribe a sugar pill for a patient who isn’t really sick but needs to feel that something is being done.
This is a Q1 violation if you believe that doctors should never be deceptive, even if it is for a greater good. It is also a Q1 violation if you don’t think that placebos can ever be the best treatment.
This is a Q2 violation if you would be upset to discover that you have been receiving faux medication because your doctor thinks your medical condition is largely or entirely mental, even if the treatment had seemed effective.
The conflict here is between the desire for a physician to be honest and the desire for a physician to do what, in the physician’s opinion, is best for the patient. There are circumstances in which a physician thinks that a patient’s symptoms are related to a need to feel like they are being taken care of as opposed being a sign of some non-mental illness. The physician must either tell the patient of this diagnosis or prescribe a treatment that delivers the feeling of being cared for without having any biological effect.* It is not possible to do both because placebos do not work for patients who know they are taking placebos.
If the use of placebos is morally allowable, is it allowable under all circumstances in which it might be effective or only under certain specific conditions? Should all other reasonable causes for the patient’s symptoms be ruled out first? Is it still allowable if the patient has indicated a desire to know the truth, no matter what it is? Is it allowable if the patient has a limited income but the placebos would cost money?
In which of these situations would a physician be morally correct?
- Prescribing antibiotics for a patient who has a virus just to make the patient feel like the doctor has done something.
- Prescribing a brand-name medication that the patient requested even though a less expensive generic version would be just as effective.
- Prescribing muscle relaxants for a patient who has a back problem, but telling him it’s scoliosis medicine because the patient insists he’s coming down with scoliosis.
- Not telling a woman what the possible side effects of birth-control pills might be because knowing about the symptoms might psychosomatically cause the symptoms.
- Assuming that a woman who complains of severe cramps every month just has a low tolerance for normal pain.
- Assuming that someone who comes into the office convinced he has a disease because he researched his symptoms on the Internet has a psychosomatic illness.
- Telling a man who wears a tin-foil hat to reflect CIA mind-control rays that a piece of foil in his wallet would be just as effective.
- Telling a squirmy child who is about to receive a painful shot, "This isn’t going to hurt."
- Telling a squirmy child that he’ll get a painful shot on the count of three, then administering it on the count of two.
- Referring a patient for tests that the patient requested but are unnecessary and expensive.
- Asking a friend who is not a doctor to give a worried patient a "second opinion."
- Lying to a patient for his own good but telling his spouse the truth.
- Lying to a young patient for his own good but telling his mother the truth.
- Telling a woman who is going to die very soon that she’ll be fine.
*This could include not only placebo medications but also harmless unnecessary tests, a change in diet, a change in habit, or a procedure that the doctor knows has no medical effect (depending on the doctor’s medical philosophy, this might include acupuncture, aura adjustment, etc.)
You are encouraged to leave your answers to the questions posed in this post in the comments section. This post is based on an excerpt from Ask Yourself to be Moral, by D. Cancilla, available at LuLu.com and Amazon.com. See the 2Q system page for details of the philosophical system mentioned in this post.