Negative thinking might really be bad for your health. An
recent article in the American Journal of Bioethics by bioethics Rebecca Erwin
Wellsa & Ted J. Kaptchuk describe the “nocebo” effect. The article cites
extensive research which shows that physicians who stress possible negative
side effects of treatment to their patients may cause their patients to feel
those side effects more intensely – the nocebo effect. Physicians are, among
other standards, abide by the principles of informed consent and nonmaleficence.
If informing a patient of negative side effects may worsen side effects, then
these two principles find themselves in contradict. The question then is which
principal prevails? Wellsa and Kaptchuck stay on the fence of the issue. They
argue that physician ought to provide “contextualized informed consent,”
meaning physician should stay away from simply bombarding patients with lists
of negative side effects but instead should tailor their discussion on a
case-by-case basis. I think there’s a problem here – for both the patient and
the doctor. A physician may choose to leave out or understate a certain side
effect because it seems insignificant and yet the side effect in question may
have implications important to the patient. On the other side of the coin, it
puts a lot of responsibility and liability on the physician. If a patient
experiences a severe side effect that was not outlined by his or her physician,
accusations of malpractice may ensue. There doesn’t seem to be a clear cut
solution to this issue, but in light of the problems just presented, the answer
Wellsa and Kaptchuk provide leaves much to be desired. It is therefore
important to continue to discuss the issue in hopes of creating a set of
guidelines that will protect physicians and patients alike from the “nocebo effect.”
http://www.tandfonline.com/doi/full/10.1080/15265161.2011.652798
1 comment:
This “nocebo” effect really brings to question some of the most basic principles of medical ethics. Namely, it highlights certain problems with informed consent and the right to autonomy – both of which are considered unalienable rights in medical ethics. If the “nocebo” effect truly does increase the likelihood that patients will suffer from side effects, then it would actually be in the patient’s best interest to not be informed – an idea that is rarely even touched upon in medical ethics. The “nocebo” effect will really challenge existing views and force people to stop taking the notions of informed consent and autonomy for granted. Even if the “nocebo” effect does turn out to be minimal, the important thing is that it will force medical ethics to go beyond simply relying on traditional notions of right and wrong and reach underlying moral principals in a more conclusive manner.
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