[Partial disclosure of information in the presence of presumable nocebo effects: an ethical analysis].Rev Med Chil 2018; 146(4):518-522RM
When prescribing a treatment, the physician should give truthful information about the likely benefits and the potential adverse effects, allowing the patient to make an autonomous decision about whether to take the treatment. However, the mere expectation of adverse effects may precipitate the corresponding symptoms. This is called "nocebo effect", which in contrast to the placebo effect, can lead to harm to the patient due to psychological factors. Nocebo effects are common and clinically significant, although often unnoticed. This situation generates conflicts in medical ethics guiding principles, namely the moral obligation to disclose all possible effects of the prescribed drug as opposed to the duty of avoiding the harm of side effects that are likely to occur in a case. In other words, the physician faces a dilemma between the due respect for autonomy and the duty of non-maleficence. This article reflects about this conflict, by exploring the limits of the principle of autonomy and how to balance it with the principle of non-maleficence. We suggest an interpretation of the principle of autonomy from a patient-centered perspective, suggesting that it is ethically sound to give a prudential, partial disclosure of information to the patient, for the sake of avoiding potential nocebo effects. The article concludes with some cautionary considerations to be considered about this decision.