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The moral case for the clinical placebo
  1. Azgad Gold1,
  2. Pesach Lichtenberg1,2
  1. 1Department of Psychiatry, Herzog Hospital, Jerusalem, Israel
  2. 2Department of Psychiatry, School of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
  1. Correspondence to Dr Pesach Lichtenberg, Department of Psychiatry, Herzog Hospital, POB 3900, Jerusalem 91035, Israel; licht{at}cc.huji.ac.il

Abstract

Placebos are arguably the most commonly prescribed drug, across cultures and throughout history. Nevertheless, today many would consider their use in the clinic unethical, since placebo treatment involves deception and the violation of patients’ autonomy. We examine the placebo's definition and its clinical efficacy from a biopsychosocial perspective, and argue that the intentional use of the placebo and placebo effect, in certain circumstances and under several conditions, may be morally acceptable. We highlight the role of a virtue-based ethical orientation and its implications for the beneficent use of the placebo. In addition, the definitions of lying and deception are discussed, clarified and applied to the clinical placebo dilemma. Lastly, we suggest that concerns about patient autonomy, when invoked as a further argument against administering placebos, are extended beyond their reasonable and coherent application.

  • Clinical Ethics
  • Informed Consent
  • Autonomy
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