Question Suppose that I'm working on a medical treatment for a project with no known cure or even treatment. My subjects report that they feel much better after receiving the treatment, but subsequent study shows that the treatment is, in fact, ineffective and all that I'm seeing is the placebo effect. Can I ethically tell them the truth and thereby make them feel worse subjectively? Would that violate the "do no harm" principle of medical ethics?

Accepted:
October 7, 2005

Comments

The injunction “Do no harm” is hard to follow unless one knows whatcounts as harm, and there is no clear consensus about this issue. Itdoes seem that by making a person feel worse, I am harming her. Feelingbad is in itself a bad thing, and it might also lead to other badthings. If I feel bad, then I may not be able to do other things that Iwould otherwise enjoy, things that I might believe have value inthemselves. At the same time, it seems that I could be harmed if I amprevented from learning the truth about my situation. If I have falsebeliefs, I might make choices that I would otherwise not make, choicesthat lead me to feeling worse than I would otherwise have felt. Could Ibe harmed by being led to believe something false about myself even ifthis false belief never leads to any decrease of good feelings or anyincrease in feelings of pain, dissatisfaction, or discontent? Let’simagine that I believe about myself that I am widely admired and deeplyloved by my friends and family and that this belief gives me deepfeelings of contentment and satisfaction. But let’s imagine also that Iam completely deluded: I am ridiculed behind my back and privatelydespised by my friends and family who are hoping to achieve a biginheritance from me. Let’s suppose further that their secret is safe,unless you tell me the truth. Would I be made better off by learningthe truth about myself?

But returning to your particularcase. Even if one has figured out what counts as genuine harm, it'soften a tricky matter in any particular situation to figure out whichcourse of action will cause the least harm. For example, whether agiven patient would be most benefitted were he to learn that his deathis imminent (so that he could make wise decisions about what to do withthe rest of his life), or whether he would be most benefitted by being"blissfully ignorant", will depend on the nature of the person and whatchoices he has. But in any case, most of us value knowing the truthabout our situation, and even if we know that we tend to screw up ourown lives and even if we believe that others could make betterdecisions forus, we still prefer to make informed decisions for ourselves. For allof thesereasons, it has seemed to many that physicians should always discloseto their patients information about their medical condition (including,it would seem, what effect a given drug is having on the patient'shealth).