The placebo phenomenon and medical ethics: Rethinking the relationship between informed consent and risk–benefit assessment
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It has been presumed within bioethics that the benefits and risks of treatments can be assessed independently of information disclosure to patients as part of the informed consent process. Research on placebo and nocebo effects indicates that this is not true for symptomatic treatments. The benefits and risks that patients experience from symptomatic treatments can be shaped powerfully by information about these treatments provided by clinicians. In this paper we discuss the implications of placebo and nocebo research for risk–benefit assessment and informed consent.
KeywordsPlacebo response Nocebo effect Informed consent Risk–benefit assessment
We thank Annette Rid, Reidar Lie, and Alan Wertheimer for helpful comments on previous drafts of this paper. This research was supported by the Intramural Research Program of the Clinical Center, NIH and the National Center for Complementary and Alternative Medicine.
- 3.Miller, F.G., L. Colloca, and T.J. Kaptchuk. 2009. The placebo effect: Illness and interpersonal healing. Perspectives in Biology and Medicine 52(4): 518–539.Google Scholar
- 5.Brody, H. 1982. The lie that heals: The ethics of giving placebos. Annals of Internal Medicine 97(1): 112–118.Google Scholar
- 6.Foddy, B. 2009. A duty to deceive: Placebos in clinical practice. American Journal of Bioethics 9(12): 4–12.Google Scholar
- 11.Luparello, T.J., N. Leist, C.H. Lourie, and P. Sweet. 1970. The interaction of psychologic stimuli and pharmacologic agents on airway reactivity in asthmatic subjects. Psychosomatic Medicine 32(5): 509–513.Google Scholar
- 17.Miller, F.G., Kallmes, D.F., and R. Buchbinder. In press. Vertebroplasty and the placebo response. Radiology.Google Scholar
- 22.Searle, J.R. 2004. Mind: A brief introduction. New York: Oxford University Press.Google Scholar
- 25.Faden, R.R., and T.L. Beauchamp. 1986. A history and theory of informed consent. New York: Oxford University Press.Google Scholar
- 26.Reiser, S.J. 1980. Words as scalpels: Transmitting evidence in the clinical dialogue. Annals of Internal Medicine 92(6): 837–842.Google Scholar
- 27.Thaler, R.H., and C.R. Sunstein. 2008. Nudge. New Haven: Yale University Press.Google Scholar