To Tell the Truth, the Whole Truth, May Do Patients Harm: The Problem of the Nocebo Effect for Informed Consent
- 14 March 2012
- journal article
- research article
- Published by Informa UK Limited in American Journal of Bioethics
- Vol. 12 (3), 22-29
- https://doi.org/10.1080/15265161.2011.652798
Abstract
The principle of informed consent obligates physicians to explain possible side effects when prescribing medications. This disclosure may itself induce adverse effects through expectancy mechanisms known as nocebo effects, contradicting the principle of nonmaleficence. Rigorous research suggests that providing patients with a detailed enumeration of every possible adverse event—especially subjective self-appraised symptoms—can actually increase side effects. Describing one version of what might happen (clinical “facts”) may actually create outcomes that are different from what would have happened without this information (another version of “facts”). This essay argues that the perceived tension between balancing informed consent with nonmaleficence might be resolved by recognizing that adverse effects have no clear black or white “truth.” This essay suggests a pragmatic approach for providers to minimize nocebo responses while still maintaining patient autonomy through “contextualized informed consent,” which takes into account possible side effects, the patient being treated, and the particular diagnosis involved.Keywords
This publication has 49 references indexed in Scilit:
- Placebo expectations and the detection of somatic informationJournal of Behavioral Medicine, 2010
- Prediction of nonspecific side effects in rheumatoid arthritis patients by beliefs about medicinesArthritis Care & Research, 2010
- Limits to truth-telling: Neurologists’ communication in conversion disorderPatient Education and Counseling, 2009
- Placebo and nocebo effects in randomized double‐blind clinical trials of agents for the therapy for fatigue in patients with advanced cancerCancer, 2009
- Differences in Adverse Effect Reporting in Placebo Groups in SSRI and Tricyclic Antidepressant TrialsDrug Safety, 2009
- A Functional Magnetic Resonance Imaging Study on the Neural Mechanisms of Hyperalgesic Nocebo EffectJournal of Neuroscience, 2008
- Formal and effective autonomy in healthcareJournal of Medical Ethics, 2006
- Medication-Attributed Adverse Effects in Placebo GroupsArchives of Internal Medicine, 2006
- On the Elicitation of Preferences for Alternative TherapiesNew England Journal of Medicine, 1982
- Disclosure of Information to Patients in Medical CareMedical Care, 1981