title: The placebo phenomenon: implications for the ethics of shared decision-making.
abstract: Recent research into the placebo effect has implications for the ethics of shared decision-making (SDM). The older biomedical model views SDM as affecting which therapy is chosen, but not the nature or likelihood of any health outcomes produced by the therapy. Research indicates, however, that both the content and manner in which information is shared with the patient, and the patient's experience of being involved in the decision, can directly alter therapeutic outcomes via placebo responses. An ethical tension is thereby created between SDM aimed strictly and solely at conveying accurate information, and "outcome engineering" in which SDM is adapted toward therapeutic goals. Several practical strategies mitigate this tension and promote respect for autonomous decision-making while still utilizing the therapeutic potential of SDM.
authors.affiliation: Institute for the Medical Humanities and Department of Family Medicine, University of Texas Medical Branch, Galveston, TX, USA. habrody@utmb.edu
authors.forename: Howard
authors.initials: H
authors.lastname: Brody
authors.forename: Luana
authors.initials: L
authors.lastname: Colloca
authors.forename: Franklin G
authors.initials: FG
authors.lastname: Miller
mesh_terms: D003657:Decision Making / Q000941:ethics*; D004992:Ethics, Medical; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D008962:Models, Theoretical; D010358:Patient Participation; D015990:Placebo Effect; D016896:Treatment Outcome