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Placebo Effects and Informed Consent.
Am J Bioeth 2015; 15(10):3-12AJ

Abstract

The concepts of placebos and placebo effects refer to extremely diverse phenomena. I recommend dissolving the concepts of placebos and placebo effects into loosely related groups of specific mechanisms, including (potentially among others) expectation-fulfillment, classical conditioning, and attentional-somatic feedback loops. If this approach is on the right track, it has three main implications for the ethics of informed consent. First, because of the expectation-fulfillment mechanism, the process of informing cannot be considered independently from the potential effects of treatment. Obtaining informed consent influences the effects of treatment. This provides support for the authorized concealment and authorized deception paradigms, and perhaps even for outright deceptive placebo use. Second, doctors may easily fail to consider the potential benefits of conditioning, leading them to misjudge the trade-off between beneficence and autonomy. Third, how attentional-somatic feedback loops play out depends not only on the content of the informing process but also on its framing. This suggests a role for libertarian paternalism in clinical practice.

Authors+Show Affiliations

a Delft University of Technology.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26479091

Citation

Alfano, Mark. "Placebo Effects and Informed Consent." The American Journal of Bioethics : AJOB, vol. 15, no. 10, 2015, pp. 3-12.
Alfano M. Placebo Effects and Informed Consent. Am J Bioeth. 2015;15(10):3-12.
Alfano, M. (2015). Placebo Effects and Informed Consent. The American Journal of Bioethics : AJOB, 15(10), pp. 3-12. doi:10.1080/15265161.2015.1074302.
Alfano M. Placebo Effects and Informed Consent. Am J Bioeth. 2015;15(10):3-12. PubMed PMID: 26479091.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Placebo Effects and Informed Consent. A1 - Alfano,Mark, PY - 2015/10/20/entrez PY - 2015/10/21/pubmed PY - 2016/5/3/medline KW - placebo, nocebo, informed consent, authorized concealment, authorized deception SP - 3 EP - 12 JF - The American journal of bioethics : AJOB JO - Am J Bioeth VL - 15 IS - 10 N2 - The concepts of placebos and placebo effects refer to extremely diverse phenomena. I recommend dissolving the concepts of placebos and placebo effects into loosely related groups of specific mechanisms, including (potentially among others) expectation-fulfillment, classical conditioning, and attentional-somatic feedback loops. If this approach is on the right track, it has three main implications for the ethics of informed consent. First, because of the expectation-fulfillment mechanism, the process of informing cannot be considered independently from the potential effects of treatment. Obtaining informed consent influences the effects of treatment. This provides support for the authorized concealment and authorized deception paradigms, and perhaps even for outright deceptive placebo use. Second, doctors may easily fail to consider the potential benefits of conditioning, leading them to misjudge the trade-off between beneficence and autonomy. Third, how attentional-somatic feedback loops play out depends not only on the content of the informing process but also on its framing. This suggests a role for libertarian paternalism in clinical practice. SN - 1536-0075 UR - https://www.unboundmedicine.com/medline/citation/26479091/Placebo_Effects_and_Informed_Consent_ L2 - http://www.tandfonline.com/doi/full/10.1080/15265161.2015.1074302 DB - PRIME DP - Unbound Medicine ER -