Lay attitudes toward deception in medicine: Theoretical considerations and empirical evidence

Abstract

Background: There is a lack of empirical data on lay attitudes toward different sorts of deception in medicine. However, lay attitudes toward deception should be taken into account when we consider whether deception is ever permissible in a medical context. The objective of this study was to examine lay attitudes of U.S. citizens toward different sorts of deception across different medical contexts. Methods: A one-time online survey was administered to U.S. users of the Amazon "Mechanical Turk" website. Participants were asked to answer questions regarding a series of vignettes depicting different sorts of deception in medical care, as well as a question regarding their general attitudes toward truth-telling. Results: Of the 200 respondents, the majority found the use of placebos in different contexts to be acceptable following partial disclosure but found it to be unacceptable if it involved outright lying. Also, 55.5% of respondents supported the use of sham surgery in clinical research, although 55% claimed that it would be unacceptable to deceive patients in this research, even if this would improve the quality of the data from the study. Respondents supported fully informing patients about distressing medical information in different contexts, especially when the patient is suffering from a chronic condition. In addition, 42.5% of respondents believed that it is worse to deceive someone by providing the person with false information than it is to do so by giving the person true information that is likely to lead them to form a false belief, without telling them other important information that shows it to be false. However, 41.5% believed that the two methods of deception were morally equivalent. Conclusions: Respondents believed that some forms of deception were acceptable in some circumstances. While the majority of our respondents opposed outright lying in medical contexts, they were prepared to support partial disclosure and the use of placebos when it is in the patient's interests or when it is what the person would want. These results support the position that physicians should be allowed a greater degree of authority to make a professional judgment about whether deception might be morally warranted by the circumstances, provided that it doesn't involve outright lying.

<p>Lay People’s Ethical Attitudes To Placebo Treatment: A Q-Methodology Study</p>

“…Description as inactive drug, and giving no description or description as pharmacologically active drug with delayed disclosure were less acceptable (apparently because of reduced benefit), whereas description as pharmacologically active drug and giving no description were the least acceptable actions. The data are consistent with previous results32 and indicate that, for our respondents, the act itself is also important (although less important than its consequences), deception that creates false belief is worse than deception that negates or blocks true belief, and outright lying is different and worse than non-lying deception.…”

“…“Acceptable if benefit to patient large”, “Acceptable if no harm to patient”, “Acceptable with moderate benefit to patient”, and “Acceptable with large benefit to other patients” were among the five most agreeable statements. This is consistent with the results of previous studies that, using different methodology and studying Western populations, showed acceptability of placebo treatment to patients and the general public,21,32,34,35 the philosophical approach used by some defenders of placebo treatment,24 the notion of good being more basic than the notion of right, and the precedence of “care/harm” as a psychological foundation of morality over other foundations 46…”

“…Although not mentioned in the Hippocratic Oath, fundamental to most medical associations’ ethics is that a physician should not deceive their patients 9. There are few studies that explored patients and lay people attitudes to placebo treatment 21,32–34. Placebo treatment was acceptable, especially with deception rather than outright lying and when there is a serious or persistent condition,21,32 with the intent to benefit the patient and when there is no alternative treatment,34 and with benefit certainty and transparency 33.…”

“…There are few studies that explored patients and lay people attitudes to placebo treatment 21,32–34. Placebo treatment was acceptable, especially with deception rather than outright lying and when there is a serious or persistent condition,21,32 with the intent to benefit the patient and when there is no alternative treatment,34 and with benefit certainty and transparency 33. Further, contrary to theoretical analysis, patients appear to accept a paternalistic approach more than physicians,21,35 who also believe that it is ethically permissible to prescribe placebos 6,8.…”

Explaining placebo effects in an online survey study: Does ‘Pavlov’ ring a bell?

“…In one study, 50–84% of the participants indicated that if they were informed about the potential benefit of placebo effects in treatment, they deemed placebo treatment acceptable [ 15 ]. However, data from other studies reported more nuances in attitudes, where participants reported this to be strongly dependent on factors such as the type of a condition [ 11 , 17 ]. Another recurrent topic from these patient studies was the need for transparency and shared decision-making [ 11 , 14 , 15 ].…”