Ethical considerations with using placebo treatments and effects in clinical practice

Placebo effects have garnered increasing attention in recent decades. Research has demonstrated the existence of neurobiologic and neuropsychologic mechanisms underlying these effects, suggesting their genuine psychobiological nature. Harnessing these mechanisms by increasing placebo and minimizing nocebo effects in clinical practice is not possible without careful ethical consideration. This chapter explores the ethical dimensions surrounding the use of placebo effects in healthcare. It examines two kinds of placebo interventions - first through the use of placebo treatments and second by enhancing contextual factors - and gives an overview of the ethical questions pertinent to clinicians for each approach. Emphasizing the importance of clinician training in medical ethics, the chapter advocates for integrating placebo and nocebo effect awareness into standard training curriculum and introduces the fundamental concepts that should be considered by educators and clinicians alike. By fostering a nuanced understanding of placebo effects and their ethical implications, healthcare providers could optimize care without compromising on ethical integrity. Such an approach could be viewed as the "icing on the cake" of an evidence-based patient-centered care.