How Placebo Deception Can Infringe Autonomy

Ethical Issues in Using Deception to Facilitate Rehabilitation for a Patient With Severe Traumatic Brain Injury

“…Furthermore, discussions of biomedical ethics have allowed for the idea of "benevolent deception," which may be justified in rare circumstances. [5][6][7] While not specific to clinical interventions, standard 8.07 of the APA ethics code (deception in research) addresses circumstances under which deception may be acceptable within research projects. This standard notes that deceptive techniques can be justified at times by the study's applied value, if "effective nondeceptive alternative procedures are not feasible."…”

Response to Open Peer Commentaries on “A Duty to Deceive: Placebos in Clinical Practice”

“…Several commentators accuse me here of taking a paternalistic position, in which the patient's right to refuse is outweighed by the fact that that taking placebo is in her best interests (Duffy 2009;Kolber 2009;Berger 2009;Shah 2009). This was not my intent.…”

“…Since deceptive prescription of treatment prevents a patient from knowingly refusing it, deceptive therapy can be coercive, as several commentators in these pages have pointed out (Kolber 2009;Hester and Talisse 2009;Shah 2009;Powell, 2009). I do not wish to suggest that placebo deception is never coercive.…”

“…Shah (2009) predicts that placebo deception would cause the destruction of doctorpatient trust, while Kanaan (2009) suggests that it would lead to drastically low rates of adherence to real treatments. Others fear that placebo prescriptions may sometimes inhibit treatment by other doctors or diagnosis of new ailments in the placebo-treated patient (Kolber 2009;Schenker et al 2009). …”

“…Finally, Kolber (2009) asks whether there is in fact a duty to deceive patients with placebos. Doctors have a duty to do the best they can to relieve a patient's symptoms.…”