Back in July of 2002 the New England Journal of Medicine published a study on arthroscopic surgery. This study featured the usual division between the control group and the experimental group. The experimental group received real surgeries and the control group went through placebo surgeries. Somewhat surprisingly, patients who received the placebo surgery reported both feeling better and performed better at walking and stair climbing than patients who had received the real surgery. After reading this study, I wrote “Lies…the Best Medicine?” and it appeared in my What Don’t You Know? While working through my massive backlog of magazines, I came across a 2018 update on placebo surgeries in Scientific America in which Claudia Wallis argued in favor of fake operations. Reminded of my ancient essay, I decided to revisit my thoughts on the ethics of using placebo surgeries.
As in my old essay, I think that there is a decent argument against using such surgeries. The basic idea is that treating a patient with a placebo requires deceiving the patient. If the effect requires that the patient believe that they have received a real surgery, then the patient must be convinced of an untruth: that they received real surgery. If the medical personnel are honest and tell the patient that the surgery was fake, then they would not benefit. If it is generally wrong to lie, then this deceit would be wrong. What would make it even worse is that medical personnel, as medical professionals, should be honest with patients. Thus, even if placebo surgery is effective or even more effective than real surgery, then it should not be used.
One interesting counter to this argument is to note that even when patients know they are receiving a placebo, it can still be effective. As such, medical personnel could be honest with patients about their receiving a placebo surgery and still maintain the effectiveness of the non-treatment. This would allow the use of placebo surgery while avoiding the moral problem of deceit. However, this does not solve the problem in cases in which patients must be kept in the dark about whether they are receiving the real surgery or not. To be specific, placebo surgery is often used to test the effectiveness of surgeries in a rigorous manner. If the real surgery is no better (or even worse) than a placebo, then there would be no medical reason to use the surgery over a placebo or no surgery at all.
It can be argued that deception in such situations is acceptable. One approach is to point out examples of acceptable, beneficial deception. Obvious examples include the benign deceits about Santa Claus, the Easter Bunny and the Tooth Fairy. As another illustration, there are the lies people tell so to avoid causing others suffering or to spare their feelings. If this sort of benign deceit is acceptable, then so is the use of deceit to produce the placebo effect or to conduct a study for the greater good.
A second approach is to focus on the purpose of the medical profession. While philosophers and scientists are supposed to seek the truth, the end of medicine is to relieve pain and prevent or cure ills. If deception, in the form of a placebo, can achieve the end of medicine, then it is just one more tool—like a scalpel or drug. In fact, it could be argued that effective placebos are even better than drugs or surgery. Surgery always involves some risk and even mild drugs have side effects. Placebos would, presumably, involve little or no risk. That said, it is worth considering that there could also be mental side-effects with placebos.
Since placebo treatment is usually not free, it could be objected that it is still wrong: patients are charged, and nothing has been done for them. If medical personnel were using placebos to cover up illnesses and injuries while pocketing profits from fake treatment, then that would be a problem. However, if the treatment is honest and works then it should be as legitimate as any other form of treatment. So, if a patient needs to see a doctor to get the placebo effect working properly and it works as well or better than the “real” treatment, then it is as reasonable to bill for the placebo treatment as the “real” treatment—although the price should be adjusted accordingly. If the placebo effect could be created without involving medical personnel, then charging patients for it would be morally problematic.
In the case of studies in which the subjects are not paying, then there would be no special moral concern for the use of the placebo—that would, in fact, be required for conducting a proper study. This does raise the usual moral concerns about conducting studies, but that is a subject worthy of consideration on its own.
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