Question

Seveny-four-year old Mrs. Abraham had been getting the prescription filled for years. She had a malignancy of the colon 4 years previously. An operation had corrected the problem, but in the emotional and physical distress that followed, Mrs. Abraham had a terrible time sleeping. She had received a prescription from her internist, Dr. Raymond Siemens for Seconal® to help her sleep and continued taking them to the point at which she could not sleep without them. Her physician, after several months, realized that he had caused her to become addicted and felt that it was his duty to help her break the habit. He had arranged with the pharmacist to take Seconal® capsules and gradually replace more and more of the active ingredient, until some months later she was on pure lactose packaged in the distinctive Seconal® capsules. She still claimed, however, that she could not sleep without her sleeping pills.

Dr. Siemens firmly believed that it was in his patient’s best interest, but he felt uncomfortable about the placebo prescription he was writing. He was concerned about potential legal implications of lack of informed consent. (He surely had not informed his patient of the treatment strategy and the risks and benefits of the “drug” he was now prescribing.) Furthermore, he was asking the pharmacist to mislabel the prescription, placing the drug name on the prescription label when, in fact, it contained nothing but inert lactose. Mislabeling was against the law. He was concerned about the fact that Mrs. Abraham was paying monthly for the prescription that contained no active ingredients. The charge was modest, barely covering the cost of the capsule’s ingredients which were being discarded, surely not compensating the pharmacist for the extra time involved in emptying the capsules and refilling them. But most of all he was concerned about whether he was being dishonest.

Do placebo prescriptions such as Mrs. Abraham’s involve lying and, if so, are they morally wrong? While there are clearly ways in which what Dr. Siemens is doing is illegal. I want us to focus on the question of whether his actions are immoral or fulfill his obligations of beneficence toward Mrs. Abrahams. Compare and contrast your ethical analysis of this case to how you think Goldman, Ackerman, or Emanuel and Emanuel from your readings would think about this case.

Answer 1

When a new drug has to come in the market against a drug which has been previously present, the new drug has to be good against it competitor and thus it takes a years-long process and several numbers of a test before launching the medicine in the market. Clinical trials are the procedures that have to be mandatorily followed for testing, wherein which some trial phases involve use of placebo drug. A placebo drug mimics the action of the drug but does not contain any active ingredient of the drug i.e. it deals with the psychology of the patient that a drug is been given but factually the drug has no application for the purpose it is been given.

In this case, we can see that Dr. Siemens realizes his mistake which led Mrs. Abraham addicted to sleeping drugs (Seconal) without which later she had difficulty in sleeping. Therefore he uses the approach of placebo phenomenon, where the doctor claims to Mrs. Abraham that the medication she is receiving is for her sleeping disorder by actually the medicine contains nothing but lactose powder. The approach of Dr. Siemens was excellent as a humans psychology is much powerful than any drug against a disease. However, by an ethical point of view, the method he adopted was inappropriate because Mrs. Abraham was not noticed about what medication she was receiving. She was paying a price quite higher for medicine which just had lactose powder in it. If we observe through a Dr. Siemens view he used to a method to get her patient out of the sleeping drug abuse but the ethics community demands the rights to be followed. Every patient should be priorly informed or should have complete knowledge about the medical practice going to be practiced.