Original Research

Journal of General Internal Medicine

, Volume 27, Issue 6, pp 739-742

First online:

The Placebo Phenomenon: Implications for the Ethics of Shared Decision-Making

  • Howard BrodyAffiliated withInstitute for the Medical Humanities and Department of Family Medicine, University of Texas Medical Branch Email author 
  • , Luana CollocaAffiliated withNational Center for Complementary and Alternative Medicine, National Institutes of Health
  • , Franklin G. MillerAffiliated withDepartment of Bioethics, Clinical Center, National Institutes of Health

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Recent research into the placebo effect has implications for the ethics of shared decision-making (SDM). The older biomedical model views SDM as affecting which therapy is chosen, but not the nature or likelihood of any health outcomes produced by the therapy. Research indicates, however, that both the content and manner in which information is shared with the patient, and the patient’s experience of being involved in the decision, can directly alter therapeutic outcomes via placebo responses. An ethical tension is thereby created between SDM aimed strictly and solely at conveying accurate information, and “outcome engineering” in which SDM is adapted toward therapeutic goals. Several practical strategies mitigate this tension and promote respect for autonomous decision-making while still utilizing the therapeutic potential of SDM.