Anne Barnhill focuses her article in this issue on the American Medical Association's ethics policy governing clinical use of placebos, but the implications of her analysis are deeper, touching on how physicians should make judgments about which interventions to offer patients in the process of shared decision-making.To address the more immediate concerns about AMA policy first, Barnhill suggests that "The purpose of AMA policy on clinical use of placebos is to safeguard patient trust (and thereby prevent medical harm to patients) and respect patient autonomy, while allowing medical benefit to patients." That's accurate so far as it goes (she extrapolates a bit, but that's okay). However, reading the report of the Council on Ethical and Judicial Affairs and the corresponding opinion through a narrowly consequentialist lens misses what may be the more important thrust of the council's analysis and resulting policy. (CEJA reports set out the background reasoning that informs the council's recommendations, which subsequently become opinions in the Code of Medical Ethics.) CEJA does not ground its entire ethical reasoning in the notion that lying to patients might lead to harm. Rather, it also recognizes a fundamental obligation not to deceive patients, which applies in the particular context of using placebos in clinical practice.
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