While the placebo effect can be harnessed beneficially when prescribing non-placebo therapies, there will always be some cases in which no pharmacologically active medication can be given to a patient, either because an appropriate medication does not exist, or because no positive diagnosis can be made. In these cases, there is still an opportunity to benefit the patient using the placebo effect alone, by prescribing placebo medications. Yet there are a number of conventional objections to the use of placebo treatments in the clinic, which have combined to motivate formal and informal prohibitions against clinical placebo use, not least of which is the recent ruling by the American Medical Association on the matter. Chief among these objections is the claim that placebo use is deceptive, and that it is always unethical to deceive patients about the nature of their treatment.
In this paper, I challenge the view that the deceptive nature of placebo treatments creates an insurmountable ethical barrier to their use. I agree that placebo treatments are deceptive, but explain that the usual objections against deceiving patients do not apply in this special case, since placebo deception can be unlike other forms of clinical deception. I explain that clinical deception should only be considered paternalistic or coercive when it fails to serve the stated interests of the patient. I show how the remaining ethical objections pose significant, but not insurmountable moral barriers to the clinical use of placebo. By using placebos within a set of coherent ethical constraints, it is possible to prescribe them in a way that maximizes patient benefit while preserving their autonomy and preventing them from being abused or coerced. Finally, I explain how doctors should deal with a patient’s discovery of the nature of their placebo treatment. If doctors are aware of the various constraints on their use, placebo medications can form a useful treatment option for the occasional circumstances in which they can be beneficially and ethically administered.
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