The principle of parity: the 'placebo effect' and physician communication
The principle of parity: the 'placebo effect' and physician communication
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DOI：
10.1136/medethics-2011-100177
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发表时间：
2012-04-01
影响因子：
4.1
通讯作者：
Blease, Charlotte
中科院分区：
文献类型：
--
作者：
Blease, Charlotte
在临床实践中使用“安慰剂”是医生和医学伦理学家持续争论的一个来源。很少有关于什么是“安慰剂”以及它们如何工作的广泛讨论。在本文中，借鉴Louhiala和Puustinen的工作，作者建议在临床上用“积极护理效应”取代“安慰剂效应”。医疗总是发生在一个“护理的背景下”，它涵盖了与医疗干预相关的所有现象：它包括特定的治疗方法，医务人员和患者之间的人际关系以及其他因素，包括医生和患者对治疗力量的信念。总之，这些现象可以对患者产生全方位的治疗效果-从无效果到小效果，再到大效果。在对患者有显著治疗益处的情况下，可以说是“积极的护理效果”。由于一般医学理事会和美国医学会的道德守则要求透明的病人治疗和坚持完全开放的“安慰剂”的使用，作者认为，作为一个问题的概念的严谨性和一致性，如果“安慰剂效应”一词被替换为“积极的护理效果”，这些道德守则似乎坚持透明的所有这些有益的成分的治疗。鉴于这似乎是一个违反直觉的义务，作者总结了这一概念修订的临床后果的一些意见，包括如何这一重要的辩论可能会发展的简要讨论。
The use of 'placebos' in clinical practice is a source of continued controversy for physicians and medical ethicists. There is rarely any extensive discussion on what 'placebos' are and how they work. In this paper, drawing on Louhiala and Puustinen's work, the author proposes that the term 'placebo effect' be replaced in clinical contexts with the term 'positive care effect'. Medical treatment always takes place in a 'context of care' that encompasses all the phenomena associated with medical intervention: it includes the particular method of treatment, the interpersonal relationships between medical staff and the patient and other factors, including physicians' and patients' beliefs in the power of the treatment. Together, these phenomena can result in a full spectrum of therapeutic effects to the patient-from no effects, to small effects, to large effects. In cases where there are significant therapeutic benefits to the patient, 'positive care effects' may be spoken of. Since the ethical codes of the General Medical Council and the American Medical Association demand transparency with respect to patient treatment and insist on complete openness in 'placebo' usage, the author argues that, as a matter of conceptual rigour and consistency, if the term 'placebo effect' is replaced by 'positive care effect', these ethical codes appear to insist on transparency about all such beneficial components of treatment. Given that this appears to be a counterintuitive obligation, the author concludes the paper with some comments on the clinical consequences of this conceptual revision, including a brief discussion of how this important debate might develop.