Use of Placebo

You are the primary treating psychiatrist for a 40-year- old man with schizophrenia which has proven difficult to control through ongoing treatment. Your patient has become convinced that he contracted syphilis through a recent sexual encounter, though he repeatedly tests negative for syphilis and other STDs. Confusingly, in other recent conversations he claimed not to have been sexually active in “a very long time.” He is becoming volatile and untrusting because you have not given him medicine for the syphilis.

What would you do and why or why not?

• Continue to try to explain why it would not be medically appropriate to provide the syphilis medication, offering to re-test if changes develop either in sexual practice or symptoms?
• Offer to provide a pill that you explicitly say has no known active ingredient and that you don’t expect to have an effect, for his concern about syphilis?
• Provide the syphilis medication to show you are “on board?”
• Give the patient pills that you claim are for treating syphilis, but which are really placebos (sugar pills)?
• Other?

Apply Theory (Specific Professional Healthcare Competencies + Clinical Medical Ethical Principles) to Practice in order to provide Optimal Patient-Centered Care (OPCC)

Source – Santa Clara University, Markkula Center for Applied Ethics