The Placebo Phenomenon: Implications for the Ethics of Shared Decision-Making
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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.
KeywordsBack Pain Irritable Bowel Syndrome Placebo Effect Irritable Bowel Syndrome Patient Placebo Response
We are grateful to several anonymous reviewers for their detailed and helpful comments. The opinions expressed are those of the authors and do not necessarily reflect the position or policy of the National Institutes of Health, the Public Health Service, or the Department of Health and Human Services.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 2.Harrington A. The cure within: a history of mind-body medicine. New York: Norton; 2008.Google Scholar
- 4.Benedetti F. Placebo effects: understanding the mechanisms in health and disease. New York: Oxford University Press; 2009.Google Scholar
- 5.Hahn RA. The nocebo phenomenon: scope and foundations. In: Harrington A, ed. The placebo effect: an interdisciplinary exploration. Cambridge, MA: Harvard University Press; 1997:56–76.Google Scholar
- 6.Guess HA, Kleinman A, Kusek JW, Engel LW. The science of the placebo: toward an interdisciplinary research agenda. London: BMJ Books; 2002.Google Scholar
- 8.Tilburt JC, Emanuel EJ, Kaptchuk TJ, et al. Prescribing ‘placebo treatments’: results of national survey of US internists and rheumatologists. BMJ. 2008; 337:a1938.Google Scholar
- 10.Patient Protection and Affordable Care Act, Title III, Subtitle F. Sec. 3506. Program to facilitate shared decisionmaking. http://en.wikisource.org/wiki/Patient_Protection_and_Affordable_Care_Act/Title_III/Subtitle_F#SEC._936._PROGRAM_TO_FACILITATE_SHARED_DECISIONMAKING. (accessed December 19, 2011).
- 16.Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Making health care decisions. Part 1: Report. Washington, DC: US Government Printing Office, 1982:31.Google Scholar
- 17.Faden RR, Beauchamp TL. A history and theory of informed consent. New York: Oxford University Press; 1986.Google Scholar
- 18.Katz J. The silent world of doctor and patient. New York: Free Press; 1984.Google Scholar
- 29.Miller FG, Colloca L. The placebo phenomenon and medical ethics: rethinking the relationship between informed consent and risk-benefit assessment. Theor Med Bioeth. 2011; doi: 10.1007/s11017-011-9179-8