When Subtle Deception Turns into an Outright Lie

摘要

In “A Duty to Deceive: Placebos in Clinical Practice” Bennett Foddy (2009) argues that the deceptive use of placebos should be a regular part of medical practice. This would cast the clinical encounter as a kind of magic show. During the performance, the patient would know that not everything is what it appears to be—the patient may receive a deceptively kind word or a deceptive prescription. And yet, like the illusionist’s audience, the patient would know that all will turn out well in the end. Foddy worries less about such a relationship—with deception built in—than others might because, as he argues, it would not undermine patients’ autonomy, would not coerce patients, and would not damage the foundational trust of the physician–patient relationship. Support for this position is found in a number of dubious absences—the absence of research on the effectiveness of placebos, the absence of the possibility for clinical research on placebos, the absence of known effective therapies for some medical conditions, and the absence of a pharmacological harm caused by placebos. These absences, however, raise questions as much as they support Foddy’s position. What functions as the ’placebo’ in a trial to test placebo effectiveness? Why claim that there is a “categorical ban on deception in scientific research” (4) when research in psychology regularly involves deceiving subjects? Should nontraditional medicine’s effectiveness be considered as well? That is, who is consulted to determine ’known effective’ treatments? And when should non-pharmacological harms be considered?