|
 Provocations
Michael
LaBossiere
Number
Three: Lies - the best medicine?
In
July 2002 a study was published by the New England Journal of Medicine
on the subject of arthroscopic surgery. In addition to addressing
medical issues, the study also raises an ethical issue in regards
to the use of placebos.
In
brief, the study focused on arthroscopic knee surgery and involved
two main groups of patients: one received real surgery and the other
underwent "fake" surgery which simulated the actual surgery.
The patients who underwent the "fake" surgery claimed
they felt better after the process and, interestingly enough, were
able to walk and climb stairs faster than those who had underwent
the real surgery. The benefits of the "surgery" were,
of course, purely psychological: the patients believed they were
better, so they felt better.
While
the placebo effect does seem to benefit patients, there is still
the issue of whether or not it is ethical for doctors to use it
in the treatment of patients.
On
one side of the issue is the view that such treatment is unethical.
The case for this is as follows. By definition, the use of placebos
in treatment involves deceiving the patient - the effect arises
because the patient believes in the efficacy of the alleged treatment.
If the doctor was honest and convinced the patient that the treatment
was a mere deception, the treatment would, of course, not be effective.
Given that it is, in general, wrong to deceive people, it would
then follow that such deception in medicine would be wrong. If the
fact that the doctor is a professional who is expected to be honest
in her dealings with patients is taken into account, such deception
seems all the more onerous. Thus, such deceptive treatments should
not be used.
On
the other side of the issue is the view that while lying is generally
not good, a deception in such situations is acceptable. The case
for this is as follows. First, there are cases in which beneficial
deception is acceptable. For example, children are told about Santa
Claus, the Easter Bunny and the Tooth Fairy because it brings extra
happiness into their lives. As another example, people are sometimes
told lies to avoid causing them suffering or to spare their feelings.
If such lying is justified (which it seems to be), then the use
of the placebo effect to ease patient's pain and aid their recovery
seems perfectly acceptable and perhaps even commendable.
Second,
while philosophers and scientists are under a professional moral
obligation to be truthful, medical doctors are not under this same
obligation. The proper goal of philosophy and science is truth and
thus those who enter these professions are obligated to the truth.
The proper goal of medicine is not truth. The proper goal of medicine
is the relieving of pain and the curing of ills. It seems reasonable
that doctors should be allowed to use various means to achieve this
proper end of their discipline. If deception, in the form of placebos,
can help achieve this goal, then their use is no more unethical
than the use of surgery or medication. Thus, since placebos are
just one more means of treatment, their use is morally acceptable.
Finally,
the placebo effect works without the use of surgery or actual medications.
Given the potentially dangerous side-effects of even fairly innocuous
drugs and the hazards of even minor surgery, it would seem that
the use of effective placebos is morally acceptable. After all,
such treatment brings about the desired effect with less risk.
It
might be objected that even though the patients might feel better,
nothing has really been done for them. On one hand, this is a reasonable
concern. It would be unforgivable for doctors to simply cover up
illnesses and injuries with placebos instead of actually treating
them for real. On the other hand, there are many cases in which
the main problem is pain. While being injured or ill is an objective
matter (a person is or is not hurt or ill regardless of what she
thinks about her condition) pain is subjective. Being in pain is
simply feeling pain. So, if a person does not feel the pain, they
are not in pain. In such cases the placebo effect would seem to
be a reasonable and morally acceptable treatment.
Provocations
will next be updated early November 2002
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