I've decided, in an effort to stretch my ability to answer ethical questions, to take a look at a few ethical dilemmas. Since I'll most certainly face a number of ethical questions in my future profession (as a physician), I figure this is as good of a time as any to delve into these questions.
A note, though: most of these dilemmas will be medically related. They will in some ways deal with society as a whole (in that they'll have patients and non-medical professionals affected by whatever decision is made), and I will try to spit out a few on non-medically related issues.
So, without further ado, my first topic: Should placebo pills be given to sick patients?
Now, the theory behind a placebo pill is that the patient believes he or she is taking something that will help him or her, even though there is no actual medicine involved. They thus get better by the power of their own mind. Clinical studies always test medicines against the placebo to ensure it's effectiveness against whatever it's attempting to treat.
I have read about two instances of placebo pills being given to people. First, internists prescribing placebo pills to patients. According to a recent study, almost one-half of internists (those would be the general adult doctor, for those of you not in the know) in the Chicago area have prescribed placebo pills to patients in their clinical practice. Here's a brief summary of the other results:
Of the respondents who reported using placebos in clinical practice, 34 percent introduced the placebos to the patient as "a substance that may help and will not hurt." Nineteen percent said, "it is medication," and nine percent said, "it is medicine with no specific effect." Only four percent of the physicians explicitly said, "it is a placebo." In addition, 33 percent of the physicians reported they gave other information to patients, including, "this may help you but I am not sure how it works." Only 12 percent of respondents said that placebo use should be categorically prohibited.
The second instance is parents giving their children an over-the-counter placebo pill. In this case, a company has put placebo pills on the market, and claimed that parents can know when these pills are necessary.
There are a variety of issues with giving a patient, any patient, a placebo pill. First of all, there's the obvious: in most cases, someone is lying, whether it be the parent, or the physician. It also may encourage the belief that there is, in fact, a cure for everything, especially if children are given a pill for every ache and pain they have (the alternative being a good old fashioned 'kiss and make it better'). Furthermore, it may encourage the belief in the physician/parent that theses aches and pains are all in the patient's head, which could potentially cause serious harm to the patient.
However, there is much to be said in favor of placebo pills as well. First of all, we have an overmedication problem, particularly with antibiotics, in this country. An increase in placebo pills over antibiotics that will do little good might be better to do. Second, in some cases, they do work. A hypochondriac will certainly be swayed by a placebo pill, and a child who merely yearns for comfort will be helped by an attentive mother or father giving the pill.
So, what's my opinion? Well, I'm uncomfortable with the idea of lying to a patient. My goal as a future physician is to be as honest as I can and as helpful as I can. Giving a placebo with the intent of decieving a patient doesn't match that goal.
I also to avoid medication when possible. I'd rather tell someone to drink some green tea or something of the like rather than give them a pill that contains the chemicals found in green tea. I hate medications, and so I want to limit my use of them as much as possible in my practice. So, giving a prescription for a pill, when I could encourage some meditation or something of the like seems contrary as well.
I also don't like the idea that I may be doing more harm than good in prescribing such a pill, since the person might actually have something wrong with them. But if they don't, and I prescribe medication, that might do more damage as well.
In the end, I can't say that I'd be completely again prescribing a placebo pill. There may be some instances where it is more helpful than anything else I can offer. But, I do think it will be a last resort for me. I don't like the idea of deception, even if it is for the benefit of the patient.
What is your opinion?
In my opinion, the truth can be a bitter pill to swallow. But ultimately, a doctor should never lie to a patient. I would be outraged if I ever discovered my doctor lied to me, even if it was "for my own good." Firstly, I can determine quite well myself what is and isn't good for me. You may be my doctor, but you cannot under any circumstance make that decision for me.
Secondly, I remember reading about one doctor's experience with honesty in the hospital. In his situation, he wasn't sure if it would be appropriate to tell a patient whether or not they're dying. Patient number 1: a robust, happy man. The doctor does not tell him he is dying, and the patient is devastated when he eventually finds out, because he did not complete any of the things he wanted to. Patient number 2: a quiet but successful artist. The doctor tells her she is dying; she goes home, miserably shuts herself in, and refuses to paint for the remainder of her life.
The point is, some patients will want the truth, some will not. I think it's better to simply tell all of them exactly what is going on with their own bodies. To do otherwise is unethical. It is the patient's body, and the doctor has no right to "fool around" with it, prescribing placebo pills in an attempt to deceive the patient.
I think you have quite a few good points. Giving out placebo pills encourages the belief that there is a cure for everything and you should seek pills for every ailment. Given to people just to let them believe they've obtained their unneeded antibiotics--I can just see them getting better and "knowing" it was because the "antibiotic" worked, so the next time they're sick they manage to get a real antibiotic. And I'm also not really comfortable with the idea of doctors, basically, lying to their clients.
In a research trial, it's fine. It's needed. As a last resort (perhaps someone who, for some reason, cannot have medication for pain management), I don't see a problem with giving someone a placebo and saying "here is something that will help."
I guess the intention behind the placebo is a big factor. If the intention is that you don't want to give a medication, then I don't think it's appropriate. If the intention is to give something to a client that is going to help them, then it can be viewed as ethical.
Read my Blogs!
This is Why I'm Hot
And My Other Blogs
I think there's something wrong with companies marketing placebo pills to parents to give their kids. Parents need to teach their children how to really take care of their bodies, and handing kids fake medicine every time they're hurt or sick will just undermine any effort to teach them to really take care of themselves. If a kid needs the comfort of a quick fix, kisses, telling them to "rub it better," ice, bandaids, or distracting activities usually work, so why teach them to rely on "medicine" which may not always be available?
When it comes to doctors prescribing placebos it's a tough call. I think there maybe times that really is the best thing they can do, but I think they need to be very careful about how they use placebos, and only use them in conjunction with a care plan that will address the root of the issue. I also think it is less deceptive and more ethical for doctors to suggest natural foods or drinks that "may help" then to prescribe placebo pills.
"Excellence is the result of caring more than others think is wise, risking more than others think is safe, dreaming more than others think is practical, and expecting more than others think is possible."
Rest in peace
yourfuneralguy
http://www.lowercostfuneral.com/rbrianblog
everyone a placebo. Docs are taught they are better than the rest of us and that is the worse placebo of all.
My daughter had a terrible rash.
We went to doctor after doctor, took pills until one doctor got out nail polish and removed the varnish on her hand. Yhis doc treats you as an equal with no placebo.