Allen Anton
Monash University, Melbourne, Australia.
The University of Melbourne, Melbourne, Australia.
Monash Bioeth Rev. 2019 Dec;37(3-4):81-93. doi: 10.1007/s40592-019-00102-z.
In this article I offer a defence of the use of deceptive placebos-inert treatments like sugar pills or saline injections-in clinical practice. In particular, I will defend what I call the ideal placebo case-where a doctor or nurse has good reason to believe that a deceptive placebo offers a patient's best, or only, chance of some therapeutic benefit. Taking a Kantian approach to the question of clinical placebo use, I examine the Kantian prohibition on deception as interference with the will of a rational agent, and argue that deception to promote the placebo effect can be carried out in a way that does not interfere with the patient's will in the way prohibited by Kant. The deception involved in a placebo treatment is not carried out to interfere with or obstruct the function of the will, but merely to make possible a means to the patient's ends that that would otherwise be unavailable. I will therefore argue that deception carried out in order to promote a therapeutic placebo effect can be done in a way that is consistent with respect for a patient's autonomy, and may be a rare case of deception that is compatible with a Kantian ethical approach.
在本文中,我为在临床实践中使用欺骗性安慰剂(如糖丸或生理盐水注射等惰性治疗手段)进行辩护。具体而言,我将为我所称的理想安慰剂案例进行辩护,即医生或护士有充分理由相信,欺骗性安慰剂能为患者提供获得某种治疗益处的最佳或唯一机会。我采用康德主义的方法来探讨临床使用安慰剂的问题,审视康德主义对欺骗作为干扰理性主体意志的禁令,并论证促进安慰剂效应的欺骗行为可以以一种不按照康德所禁止的方式干扰患者意志的方式来实施。安慰剂治疗中所涉及的欺骗行为并非为了干扰或阻碍意志的功能,而仅仅是为了使实现患者目的的一种手段成为可能,否则这种手段将无法实现。因此,我将论证,为促进治疗性安慰剂效应而实施的欺骗行为可以以一种尊重患者自主性的方式进行,并且可能是与康德主义伦理方法相容的一种罕见的欺骗情形。