Placebo therapy?

**pammer** · 01-07-2008, 08:21 AM

Knowing that sometimes placebos work, do you think it is unethical to give a patient a placebo? What is the nurse's role if someone prescribes a placebo?

see more at http://www.webmd.com/news/20080103/many-doctors-use-placebos-on-patients?ecd=wnl_day_010708

**Gracie2** · 01-07-2008, 09:56 AM

Oh boy. Yes, I think it is ok. There are instances it is appropriate. ie the hypochondriac It carefully needs to be done and monitored.
Years ago, I did something may would consider unethical. I had a new admit. We got her all settled in. After hs cares (back in the day), she starts in on her call light. Consistently, every few minutes. She needed her sleeping pill, she ALWAYS takes a sleeping pill. Approaching 2300, we were worn out from this, even though we had told her we would have to wait for the next day. Mind you, this was a very small town, small hosp and the on call drs would often not respond to certain calls at all. This would have been one. I became fed up, finally took one of my nutritious tan M&M's, put it in a med cup and gave it to her. Never heard a peep out of her again, she seemed to sleep like a baby.

**peady2** · 01-07-2008, 06:19 PM

Although many years ago I did see this in my practice (and only that one time), I would no longer participate in giving a patient a placebo unless it was in a clinical trial and the patient was aware of and signed informed consent for this possibility. I believe that giving a placebo undermines the trust of a patient/health care provider relationship and is unethical and immoral. The nurse's present role in the event of an order for a placebo is to call the prescriber, explain that a placebo is not accepted practice (citing examples if needed) and tell the prescriber that s/he will not participate. If the prescriber does not back down, notify your supervisor and the medical director. I would not give the placebo under any circumstance.
Although I did participate that one time as a very new nurse, I was uncomfortable and decided I never would again. I truly doubt this is as common as that "study" in Chicago made it out to be. I have no doubt that if the question was worded "did you ever prescribe a placebo" many providers, especially older physicians, would answer "yes." This doesn't mean it is current practice and indeed I have never seen it again in 20 years of nursing. Since the AMA, ANA and other organizations have issued statements against the use of placebos, I really doubt the practice is common today.
From the Position Statement on Use of Placebos in Pain Management,
The American Society for Pain Management Nursing (ASPMN):
In 1996, the Oncology Nursing Society (ONS) issued a position statement against the use of placebos in managing cancer pain (ONS, 1996). This position was endorsed by twenty-seven other professional organizations including the American Nurses Association (ANA) (1996). Within a year, the American Society of Pain Management Nurses (1996) published its first position statement opposing the deceptive use of , regardless of age or diagnosis. In 2000, the American Medical Association (AMA) established strict guidelines that limited the use of placebos in medical and surgical patients to well-designed, IRB-approved clinical trials.
(AMA 2001)

According the the AOA (American Osteopathic Association), they are also against the use of placebos, as are other organizations, and the following is from their position statement:
A number of organizations have advised against the use of placebo substitution, including the American Pain Society, Agency for Healthcare Policy and Research, World Health Organization, Healthcare Facilities Accreditation Program, Joint Commission on Accreditation of Healthcare Organizations, and Education for Physicians on End-of-Life Care Project (cosponsored by the American Medical Association and The Robert Wood Johnson Foundation)....

**Gracie2** · 01-08-2008, 08:59 AM

Oh my gosh! NEVER should a placebo be given in management of cancer pain. How horrible! Obviously, there is much more to this than I can think through at this time (HA with this bug I've got for four days now and can't take anything more than tylenol due to upcoming surgery......).
That is horrific in my view.

**Tarheel23** · 01-08-2008, 09:43 AM

Hey there ya'll, first time post - long time RN.
Personally I love the practice of using Placebo's. Used to use them on the Marines all the time.

**Gracie2** · 01-08-2008, 10:11 AM

No wonder we thought our medical care was Crappy when we were in and the reputation has Not changed!
Welcome to the board.

**Tarheel23** · 01-08-2008, 11:38 AM

Not sure I'd call it "Crappy". All I did was cut moleskin into circles (with a dime and #11 blade) and placed them behind the ears of 63 Marines before deployment. Thinking they were getting Scopalamine patches, none of them got sea sick. I call that Preventative Medicine.
Improvise, Adapt and Overcome.

**Gracie2** · 01-08-2008, 05:29 PM

OK, I laughed on that one. Our care was ......well, as I said. That was a few years before your time I am sure.

**Hepburn** · 01-09-2008, 04:51 AM

Never. I have WANTED to, but that doesn't make it right. In my long years of nursing and living, I have come to understand that pain and discomfort, physical or psychological, is very, very real to the person experiencing it even when others cannot figure it out or don't believe it. That kind requires some kind of treatment, not policing. To give a placebo without a persons knowledge and consent is to falsify that treatment and I think that's wrong.