So, you're a doctor, and you've just come to a 100% certain conclusion about the diagnosis of this patient.
Unfortunately, this patient has a deadly disease. There is no cure, not even any treatment available, besides just treating the symptoms, which won't really help.
Being a responsible doctor, you've already told the patient about the diagnosis of the disease, but haven't told of the prognosis yet. The patient doesn't know that he'll surely die within a week.
Now, you have a few options:
A- Tell the patient that this prescription will probably cure them, and write them a prescription for a harmless pill, say a mild pain-reliever, and hope that the placebo effect will actually help the patient, perhaps even cure him.
B- Tell the patient the truth, allowing him to set his affairs in order and say his goodbyes.
Now, B is the more honest way to go, but A has a chance of extending, or even saving, his life.
Which is morally the best thing to do? The lie that might save him, or the truth?
A tough one, for sure.
When I first became a paramedic, we picked up a guy in a gas station parking lot. He had collapsed, and wasn't breathing. This guy was in his mid 50's, weighed about 400 pounds, and was an alcoholic. We tubed him and gave CPR and a cocktail of drugs, but couldn't get him to breathe on his own. About half way to the hospital, he developed a pulse and woke up. He looked right at me and asked me if he was going to die. I already knew the answer, which was "yes", and I am so glad that we are legally not allowed to answer such questions. I was mortified at being asked. So I can't imagine how a doctor deals with having such information in their hands.
Legally, at least in the States, I think doctors are obligated to tell the truth about such a prognosis. They still use the placebo, though, telling the patient it is an experimental drug or whatnot. I've seen that happen many times.
But yes, this has to be enormously difficult. And of course the ethical is "B", but from a humane, healing, point of view, and making the patient as comfortable as you can in their last hours or weeks, option "A" may sometimes be the better of the two.
Depends on the disease I suppose. You're not going to cure Huntington's with a placebo.
Picked B. If I were a doctor, I think it would be the most correct thing to do in most situations.
There's arguably a bigger picture as well. If you lie and the placebo takes its assumed positive role, cool (I still don't know if this is "right"). If you lie and the patient dies: 1) You have some explaining to do on behalf of your career, 2) You have some explaining to do to the family left behind, and 3) You live with the idea of lying to an individual who probably didn't put any closure to their life, which I think most people would prefer to do.
I've been thinking about this today: What if the doctor is not completely sure about his findings? He knows the patient is in a bad way cancer wise, and "has a feeling" he may die anything from one month to 3 years?
If I were the doctor I would encourage the patient to get a second opinion, or if that is not possible, i.e. the patient does not look up to it, or may not be able to afford it, redo the tests, and then work on the positive side i.e. saying it is cancer and these are your options for a cure?
What would you do in a scenario like this?
I don't think I'd be able to handle making such a decision.
Placebo effects aren't that powerful, are they? I mean if this disease is too the point where it's going to kill the guy in less than a week -- that would really take a full-fledged miracle. And if you're hoping for a miracle (and since we're on the religion board), why not tell the guy and have him and all his family and friends pray for him.
I think it would be wrong to lie to this person. Besides if his family were to find out the only reason they didn't get a chance to say goodbye to him is that you were lying to him on the minuscule chance of a placebo effect miracle -- they would be really really really pissed.
I think it is very difficult to anticipate in advance how to act. There are obviously very clear ethical and common sense guidelines in place, as well as plenty of experiences that doctors can share with one another, but obviously in the end of the day he has to make the final decision of what to say, or what not to say, and how to say it. And of course it is quite human that what he has to say will not make his patient very happy, and different patients will be reacting differently.
Placebos can be surprisingly effective. Many modern drugs outperform the placebos only by a tiny margin. (One of the drug companies' many open secrets.)
I sometimes wonder with those who are obviously that sick, for the prognosis to be that bad, that they would sense it themselves as well. In fact, if it is something like cancer, they may even wish for it to end as they would have to be very sick at that point.
The placebo effect certainly does have some weight, but it isn't a cure-all. A placebo won't just kill a virus (I wish it did - then it would help cure AIDS) or stop the rapid uncontrolled division of cells (cancer), but it will certainly help with pain and some medical problems...
Actually, its very interesting that placebos can sometimes do those things.
*does some research*
*needs to find a medical drug study on a very physical disease that has three groups: real drug users, placebo users, control group with no medication. That would allow me to see the exact effect of the placebo by comparing it to the control group.*
^^Those results do not impress me. I said that a placebo does hold some weight, but that it isn't a cure-all. Taking care of an allergic reaction, curing a headache, or making pain cease is one thing that a placebo does have a huge effect over. But as I said, a placebo will not (or I at least have not seen any good studies supporting - and I doubt they exist) fix a mutation like cancer or kill a virus (like the HIV virus).
That's the best I can find...
All the promising links want me to pay for membership before I can read the results of the studies.
^^Well cryptosporidiosis is just a short term infection. It isn't a virus. I believe that it's caused by a parasite found in water. Also, how do you know that the placebo is actually treating the infection and not just treating the symptoms (diarrhea)?
^True: not very good proof.
Nearly all the hard data is inaccessible to me though. I have a very hard time finding any study results that give actual numbers, and don't try to make me pay for it.
^^If you ever do come across any information, I would be interested in seeing it. I just don't think you'll come across too much because I don't think placebos are that powerful. I don't think that they'll kill a virus. Believe me, I wish they did. Then doctors could just lie and say that they've found a cure for AIDS and millions of people would be saved. I think that placebos can be powerful for minor instances like a headache. I also think that placebos probably, more than not, just take care of the symptoms. So a placebo will stop the pain of a headache or stop the diarrhea from cryptosporidiosis. But if you do see any instances where a placebo does something more than stop a symptom, let me know.
i have to point out a flaw in the formulation of the problem that fuggers up the solution. You say:
Then you offer a choice of options, where option A is:
There are three options with what we have here:
So! All clear, right? We can't be totally clueless about the prognosis, and we can't be 100% sure. So now we know what we're dealing with.
Now the prognosis is 100% certain?!?
In other words, this problem is irrational. It is internally inconsistent. At the same time it hinges on the idea that the prognosis is both 100% certain and not 100% certain, which is impossible. Which means, you can't ponder it rationally and come up with a rational answer. You can't reason it through, because if you try you will realize that reason doesn't really run through it... which means that ultimately any answer you give will be a "gut feeling".
That being said, it has two contradictory components, but we can consider each component by itself... thus removing the contradiction.
So first, let's assume the prognosis really is 100% certain. In that case, option A is meaningless. It won't work. So to hell with it, just be honest with the patient, and let him or her clear up their affairs.
Alright, now let's assume the prognosis is not really 100% certain... you're pretty sure that they're going to die, but there is a chance that a placebo might help, or possibly cure them.
One of the fundamental components of a doctor's method is primum nil nocere, or "above all, do no harm". What this means in practise is that sometimes it is better to do nothing, rather than taking action and making things worse. It is relevant in this case, because the doctor has a choice to do nothing (simply inform the patient that they're ******), or to try something that is a long shot and will more likely than not cause more grief for the patient and their family in the long-run.
When placebos are "free" - in the sense of total cost, not just money cost - then they are a brilliant idea. If you have a patient that is in pain, and you can do nothing, then you might prescribe a placebo. The difference is in that case is that if the placebo works, brilliant! But if it fails, oh well, life goes on as it was before you tried the placebo. In other words, there is no risk - no cost - to trying the placebo. You're doing no harm.
But in this case, there is a huge cost. If the placebo works, brilliant! But if it fails... then this patient will die ignorant of what is going on, never having got the chance to make peace with their fate, make preparations for their family (and even possibly seek out treatments that you may know nothing about, or alternate medical opinions that may change everything!). That is big-time harm.
Thus, any doctor would be ethically bound to not go with option A. They would have to inform the patient.
(And by the way, when using a placebo, a doctor does not lie about diagnoses or prognoses. They tell the straight truth... except that they'll say the placebo drug has had some success alleviating the symptoms or some such trap. What this example would call for is for the doctor to lie about the prognosis, and possibly the diagnosis, while gambling on the placebo. That makes option A even more ethically untenable.)