A placebo for the pain: a medico-legal case analysis.
OBJECTIVE
The objectives of this medico-legal case report are to consider the current status of the use of placebos in pain medicine from clinical, ethical, and legal perspectives. The focus of the analysis is a particular case in which the deceptive use of placebo pain therapy on an adolescent gave rise to professional grievances filed by the patient's mother against the physician who ordered and several nurses who administered the placebo. The medical board declined to take disciplinary action against the physician, and disciplinary action by the board of registered nursing against the nurses was successfully challenged by two of the charged nurses in an administrative review. While there is a growing literature that challenges the need for or justification of the deceptive use of placebos, the practice continues and, as the case under consideration indicates, retains some influential supporters.


METHODS
This is a case report from a community hospital. The patient, referred to here as KC, was an adolescent with migraine headaches. The substitution of a placebo (saline solution) for an opioid analgesic (morphine) was made during KC's treatment.


RESULTS
The patient's pain subsided sufficiently following the administration of a placebo to permit his discharge from the hospital. The subsequent discovery by the patient's mother of the deceptive use of a placebo prompted her to file charges of professional misconduct against the treating physician and three nurses with their respective professional licensing boards. The medical board declined to take disciplinary action against the physician, and the disciplinary action by the board of registered nursing was successfully challenged in a ruling by an administrative law judge following a hearing in which expert witnesses took conflicting positions on the acceptability of the deceptive use of a placebo.


CONCLUSIONS
While there is a developing literature that challenges the ethical legitimacy of the deceptive use of placebos in pain medicine, that literature has yet to be recognized as unqualifiedly setting the standard of care or of professionalism in medicine and nursing.
Rich
Ben A
BA
University of California, Davis School of Medicine, Sacramento, California 95817, USA. barich@ucdavis.edu
D000293:Adolescent; D000700:Analgesics / Q000627:therapeutic use; D002140:California; D026690:Ethics, Clinical; D004993:Ethics, Nursing; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000188:drug therapy*; D033282:Parental Consent; D010290:Parents / Q000523:psychology; D015990:Placebo Effect; D010919:Placebos / Q000627:therapeutic use*; D028743:Professional Misconduct; D014342:Truth Disclosure
D000700:Analgesics; D010919:Placebos