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Introduction
It is widely supposed that the prescription of placebo treatments to patients for therapeutic purposes (rather than in the context of placebo-controlled trials) is ethically problematic on the grounds that the patient cannot give informed consent to the treatment. i This claim, I argue, rests on two confusions; once these are dispelled, it can be maintained only by taking an implausible view of the physician's duties, qua physician, to the patient.
The first confusion primarily affects theorising about the meaning of 'informed consent', and has to do with the relation between information and informedness. The second affects both the patient purportedly 'deceived' by receiving a placebo treatment and those of us who speculate about his or her decision-making, and it concerns the relation of body and mind. Taken together, they lead naturally to the conclusion that the prescription of placebos to unwitting patients is unethical; however, as I shall show, they are both false.
There are some similarities between my approach and that recently advanced by Gold and Lichtenberg in these pages; 4 however, there are also significant differences. While both views target 'Cartesian' accounts of the mind-body relation, mine is concerned specifically with an underlying Cartesian intuition, rather than with any particular theoretical position. And whereas Gold and Lichtenberg distinguish between lying and deceiving a patient in order to defend a virtues-based paternalism against concerns about patient autonomy, my approach denies that any such deception, or violation of autonomy, takes place.
I begin by briefly sketching the main ethical case against placebo treatments, to which my argument responds. Following this sketch, I discuss in turn the two confusions which the case involves before examining the remaining duties towards her patient which a physician could reasonably be thought to break by the provision of placebo treatments.
For purposes of argument, I assume here that at least some placebo treatments are efficacious in at least some circumstances. This is not uncontroversial. Likewise, while the conceptual soundness of the term 'placebo' has been forcefully challenged, 2 3 5 6 I do not address those concerns in the present paper; my analysis here focuses on the concepts of information and informed consent as they pertain to placebo treatments, rather than on the placebo concept itself.
The case...