Sweet little lies: the ethics of placebo use in clinical practice

This thesis intends to establish whether it is permissible for a doctor or nurse to administer a deceptive placebo to a patient if it is believed that this treatment presents that patient's best or only chance at some therapeutic benefit. To do this I first establish that there is good reason to believe that placebo treatments can have a real therapeutic effect, and that deceptive placebos are currently being used widely in clinical practice around the world. I take a Kantian approach to answer the question of whether a deceptive placebo can be consistent with respect for patient autonomy. I argue that 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. It is therefore possible for a deceptive placebo to administered in a way that is consistent with a Kantian respect for rational agency. Moreover, this analysis highlights the features that separate morally permissible cases of placebo deception from morally impermissible cases, and from morally impermissible cases of paternalistic deception more generally. I examine different standards of informed consent and argue that, as by most workable standards a patient can give valid informed consent to a treatment without knowing its exact nature or mechanism of action, that a deceptive placebo treatment can meet these standards in at least some cases. Lastly I examine the argument that the deception involved in a placebo treatment constitutes a betrayal of the trust between practitioner and patient. To do this I investigate the connection between honesty and trustworthiness, deception and betrayal. I argue that, while outright lies are indeed detrimental to the trust relationship between practitioner and patient, the withholding of that information necessary to facilitate placebo treatment need not be. I therefore conclude that, where a placebo treatment is believed to present a patient's best or only chance at some therapeutic benefit, it is permissible for a doctor or nurse to withhold information on that treatment's nature in order to facilitate the placebo effect.