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Published online by Cambridge University Press: 11 March 2020
Nocebo effects occur when an individual experiences undesirable physiological reactions caused by doxastic states that are not a treatment’s core or characteristic features.1 As Scott Gelfand2 points out, there are numerous studies that have shown that the disclosure of a treatment’s side effects to a patient increases the risk of the side effects. From an ethical point of view, nocebo effects caused by the disclosures of side effects present a challenging problem. On the one hand, clinicians’ duty to inform patients of the consequences (including possible side effects) of their treatments is critical in ensuring that patients’ autonomy is respected. Patients cannot act autonomously if relevant information is withheld from them (without their consent, perhaps). On the other hand, clinicians also ought to minimize harm to patients.
1. This is a rough sketch of what constitutes a nocebo. See Howick, J. The relativity of ‘placebos’: Defending a modified version of grünbaum’s definition. Synthese 2017;194(4):1363–96CrossRefGoogle Scholar for some of the philosophical challenges that confront attempts to define ‘placebo’ and ‘nocebo’ properly.
2. Gelfand, S. The nocebo effect and informed consent: Taking autonomy seriously. Cambridge Quarterly of Healthcare Ethics 2019 Google Scholar.
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12. One might suggest that the institution of medicine is such that participants are largely aware of the implicit rules. As such, when a patient seeks help he assumes that his care-providers will behave (including the disclosure of risks) in a manner that is in his best interest while respecting his autonomy. Nondisclosure is not itself a sufficient reason to doubt clinicians’ fidelity.
13. The State of Queensland. Consent form for laparotomy. Quesland Health. Queensland, Australia; 2018; available at https://www.health.qld.gov.au/__data/assets/pdf_file/0034/149497/shared_file_47.pdf (last accessed 9 Sept 2019).
14. See note 3, Colloca, Miller 2011.
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