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A Kantian defence of placebo deception

Abstract

In this article I offer a defence of the use of deceptive placebos—inert treatments like sugar pills or saline injections—in clinical practice. In particular, I will defend what I call the ideal placebo case—where a doctor or nurse has good reason to believe that a deceptive placebo offers a patient’s best, or only, chance of some therapeutic benefit. Taking a Kantian approach to the question of clinical placebo use, I examine the Kantian prohibition on deception as interference with the will of a rational agent, and argue that deception to promote the placebo effect can be carried out in a way that does not interfere with the patient’s will in the way prohibited by Kant. The deception involved in a placebo treatment is not carried out to interfere with or obstruct the function of the will, but merely to make possible a means to the patient’s ends that that would otherwise be unavailable. I will therefore argue that deception carried out in order to promote a therapeutic placebo effect can be done in a way that is consistent with respect for a patient’s autonomy, and may be a rare case of deception that is compatible with a Kantian ethical approach.

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Notes

  1. For example, the first assumption is challenged in Hróbjartsson and Gøtzsche (2001), whereas the second is contested in Kaptchuk et al. (2010).

  2. Presuming there was some way to take a stranger’s house and sell it, one could imagine that the money could be used to save many lives—but this doesn’t make it ok to take a stranger’s house! But while Herman is firm on this point, I’d argue that it becomes less certain if it is the murderer’s own property that we must take to prevent him from killing someone.

  3. Gold and Lichtenberg adopt Carson’s (2010) distinction between lying and deception. Lying is the act of giving someone false information, which one believes to be false, with the intention of causing them to have a false belief. Deception is the act of intentionally causing someone to form a false belief—whether or not this is done by giving them false information.

References

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Correspondence to Anton Allen.

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Allen, A. A Kantian defence of placebo deception. Monash Bioeth. Rev. 37, 81–93 (2019). https://doi.org/10.1007/s40592-019-00102-z

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Keywords

  • Placebos
  • Deception
  • Ethics
  • Kant
  • Autonomy