offering placebos to terminally ill patients

Great Debates
1

I’m currently reading a book debunking most “alternative medicine,” and one thing the author keeps harping on is the placebo effect–how powerful it can be under certain circumstances.

Would it be wrong (ignoring legality for the moment) for a doctor to give a “new experimental drug that’s been shown to work really well!” (e.g. sugar pill or vitamin C) to someone for whom there are no or few treatment options left?

Can the ends (comfort for the patient) justify the means (lying to the patient)?

Note: I’m not saying this does or doesn’t happen. I just wonder what I would think if I heard of such a case.

Julie

2

To do such a thing would violate the principle of “informed consent” and would also negatively impact the physician/patient relationship.

QtM, MD

3

In addition to what QtM said, I believe it would be morally questionable (at best) to offer false hope to someone.

Imagine being led to believe you could be cured or at least your life extended. You would start to hope to be able to be present at major events in the lives of the people you care about, i.e. anniversaries, graduations, etc.

Now imagine that after a short while you inevitably begin to get worse and realize you will never see those things happen.

I can’t think of a more cruel thing to do to someone than to give them false hope for the future only to have it unavoidably dashed.

4

In addition to what QtM said, I believe it would be morally questionable (at best) to offer false hope to someone.

Imagine being led to believe you could be cured or at least your life extended. You would start to hope to be able to be present at major events in the lives of the people you care about, i.e. anniversaries, graduations, etc.

Now imagine that after a short while you inevitably begin to get worse and realize you will never see those things happen.

I can’t think of a more cruel thing to do to someone than to give them false hope for the future only to have it unavoidably dashed.

5

Would it be cruel to say, “This won’t cure you, but it will/might make you feel better”?

To be honest, I don’t really worry about negatively impacting the physician/patient relationship when the patient is going to be dead soon.

Julie

6

OOPS!

Sorry about the double post!

7

I do. I should suddenly act unethically at the end of the relationship?

Besides, placebos don’t offer cures. They may make a small yet significant proportion of the patients feel better in terminal situations, that’s all. We’ve got medications that work a lot better than a placebo to relieve pain and suffering.

8

If it would help the dying patient feel better, is it acting unethically? You’re assuming the answer is “yes.”

As for the placebo offering a cure, where in the world did I suggest the placebos would cure anyone? My point is exactly what you just said.

There may be medications that work better, and I am not suggesting such medications not be used.

Julie

9

Are you trying to imply that by giving the false hope there might be a chance at “faith healing” ? When of course nothing else would save the patient…

It might sound crazy… but it might be a crazy and valid last resort. Thou I think faith healing has more chances in a religious context or maybe at the beggining of an illness… not when its almost done killing the patient.

As for the patient doctor relationship… maybe family consent ?

10

Not healing, no. I’ve never heard of a placebo effect being so dramatic.

But for some people, it might work to lessen some symptoms. Placebos have to be controlled for so rigorously in drug trials precisely because the effect can be so powerful and pervasive.

Again, I am not suggesting someone be told they will be cured, or their lives extended. Just “This has helped some people feel a lot better.”

Julie

11

Hmmm… would it be unethical to tell a white lie in a hopeless situation to make someone feel better? Absolutists will tell you that any lie, no matter how small, diminishes the teller. Others might say that withholding a comfort from someone who is in pain when said comfort has no foreseeable detrimental effects would be worse. I am not a doctor, and perhaps years worth of experience, training, and malpractice insurance premiums would change my mind, but I would rather err on the side of mercy and risk the tarnishing effects of the untruth. I definitely would give the placebo a shot. YMMV

12

Ptahlis - what would you hope to accomplish with the placebo?

13

We’re debating in two different contexts here. What you might do in some remote village faraway from civilization for a dying relative, is different from what a doctor is supposed to do at a hospital for a patient he has legal responsibilities for.

Lying to a patient is a one-way ticket to a billion dollar malpractice lawsuit.

14

Well, I am operating under the assumption that the placebo was offered for the relief of pain, although that was not explicitly stated in the OP. If a sugar pill might ease someone’s pain when other meds were no longer helping, I’d take that shot-- as a purely ethical consideration of course. Malpractice suits and other practical considerations like losing my medical license or somne such might prove too overwhelming in reality, but the post merely asked us to make an ethical judgement, not a practical one. In my book, and in this particular instance, easing suffering by telling a lie is ethically preferable to watching someone die in unnecessary pain.