Ethical and forensic medical implications in the use of placebos.

Abstract

The Authors, on the basis of clinical cases on pharmacological experimentation from a Brescia (Italy) Ethics Committee offer some considerations on the ethical and forensic aspects of the use of placebos.

Firstly they should analyse the meaning of the word placebo and also from a historical point of view, describe the use of these substances: the examples of pharmacological experimentation are numerous to understand the use of placebos.

The ethical problems are very important: first of all the principles of autonomy, beneficence, non-maleficence and justice. Opinions on this are conflicting: some people in fact think that it is not correct either ethically or methodologically to give placebos to some patients while others promote placebo’s use when they do not know another alternative efficacious therapy. Moreover, a relevant problem is the communication to the patient of his therapy, practically the comunication of the truth to the patient, to garantee his autonomy. However it seems that to ensure the required effect of the placebo, the patients must not be awere that it is a placebo and must believe in the treatment.

The Deontological Code emphasises the principle of benefit to the patient and gives some directives for the use of placebos. Informed consent is, also in this environment, a fundamental element renforced by the Constitution and by the Criminal Code.