Journal
AMERICAN JOURNAL OF BIOETHICS
Volume 12, Issue 3, Pages 22-29Publisher
ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD
DOI: 10.1080/15265161.2011.652798
Keywords
decision making; informed consent; professional ethics; professional-patient relationship
Funding
- institutional National Research Service from the National Center for Complementary & Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) [T32AT000051]
- Beth Israel Deaconess Medical Center
- NCCAM at the NIH [K24 AT004095]
- National Center for Complementary & Integrative Health [K24AT004095, T32AT000051] Funding Source: NIH RePORTER
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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.
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