Lecturer in Philosophy, Tel-Aviv University
Dates of visit: January - February 2011
Project description: Recent scientific and medical rech, especially with functional brain imaging, demonstrates that in certain cases the final common pathway of action of placebo drugs is indistinguishable from that of the real drugs they are supposed to replace. So, for example, giving placebo for pain might activate the opiate-responsive neural pathways in the brainóa mechanism seemingly identical to what is seen when the patient receives an opiatic drug. Now the ethical problem with placebo treatment is that it is a kind of deception, where supposedly you make the patient believe you give him a drug that actually works on the tissue level but in fact what you give him works just psychologically. The scientific findings, however, bring to a new level the seeming deconstruction of the distinction between "placebo" and "real" drug. It would be reasonable to view instances of placebo treatment that fulfill this criterion as a category unto itselfócall it "comparable placebo treatment"óhitherto unrecognized as such. The phenomenon of comparable placebo treatment raises interesting philosophical questions, among which are the following. What sense is left to "deception" when the placebo works precisely (according to objective parameters of the mechanism of action) as the "real" drug? Given that the success of the placebo depends on the patient's belief that he is getting a real drug, and therefore involves a manipulation of sorts, but given also that the placebo nonetheless indeed functions precisely as the patient expects the real drug to function, we need to investigate the conditions under which manipulation amounts to deception. (Only select kinds of human interaction are expected to be entirely devoid of any manipulation.) It is interesting to ask what the implications of all this are with respect to the ethics of placebo treatment and what light it can shed more generally on the ethics of truthfulness.