プラシーボ使用の是非をめぐる考察
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概要
- 論文の詳細を見る
Something is called a placebo when it is used to cause a favorable effect on an unknowing patient, even though it is known to have no pharmacologically effective action. A favorable effect, if any, is called a placebo effect and is referred to in a non-medical context as well, where an act of comforting or pleasing with verbal or non-verbal expressions or gestures is found successful. This latter case may be quite innocuous and need no particular justification. Ethical problems arise when placebos are used either in a clinical setting or in medical experimentation. Clinically a placebo is given to a patient at the medical practitioner's discretion without informing him/her about its use. In 1955 Henry Beecher published a study on the placebo effect. He believed he could prove the existence of a placebo effect in the 30 to 40 percent of all patients. Two camps seem to have formed differing assessments of Beecher's thesis. One literally believes a placebo is effective as a result of the mysterious process of the human mind-body relationship, while the other camp wants to dismiss the whole thesis as groundless. For the latter, placebos are a form of deception or manipulation and should not be taken seriously or used at all. Physician-ethicist Howard Brody tries to make sense of the placebo effect philosophically. He shows that a reductionist approach cannot explain it, while giving credit to anti-positivist approaches that define a person in a culturally meaningful context. He states that a good medical practitioner can cause a placebo effect without using any placebos by engaging in simple good conversation. But as to the use of placebos in double-blind controlled studies, physicians, including Brody, are usually permissive and do not question the use of placebos or non-treatment for the research subjects, who are, at the same time, patients in need of medical care. The use of placebos or non-treatment for patient-subjects contradicts the idea and practice of informed consent. Only volunteers should take part in a medical experiment. What is puzzling is why things given to the control subjects are called placebos.
- 日本医学哲学・倫理学会の論文
- 2002-11-10
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