https://orcid.org/0000-0002-0086-5819
Abstract
Background
Placebo-treatment acceptability is debated among ethicists, mostly due to conflict between respect-to-autonomy and beneficence principles. It is not clear how lay people balance these and other ethical principles.
Methods
One hundred and eighty-seven respondents rank-ordered 42 opinion statements covering various ethical aspects of placebo-treatment, according to a 9-category symmetrical distribution. We analyzed statements’ scores using averaging-analysis and by-person factor analysis (Q-methodology).
Results
Respondents’ mean (SD) age was 34.6 (10.6) years, 54% were women, 40% healthcare-related, 68% Muslims (31% Christians), and 39% received general education in Saudi Arabia (24% in the Philippines). On averaging-analysis, the most-agreeable statements were “Acceptable if benefit to patient large” and “Acceptable with physician intent to benefit patient”. The most-disagreeable statements were “Acceptable with physician self-benefit intent” and “Acceptable with large harm to other patients”. Muslims gave a higher rank to “Giving no description is acceptable”, “Acceptable with small benefit to patient”, and “Acceptable with physician intent to benefit patient” and a lower rank to “Acceptable to describe as inactive drug”, “Acceptable with physician intent to please patient caring relative”, and “Acceptable with moderate harm to other patients” (p<0.01). Q-methodology detected several ethical attitude models that were mostly multi-principled and consequentialism-dominated. The majority of Christian and Philippines-educated women loaded on a “relatively family and deception-concerned” model, whereas the majority of Muslim and Saudi Arabia-educated women loaded on a “relatively common-good-concerned” model. The majority of Christian and healthcare men loaded on a “relatively deception-concerned” model, whereas the majority of Muslim and non-healthcare men loaded on a “relatively motives-concerned” model. Of nine intent-related statements, ≥2 received extreme rank on averaging-analysis and in 100% of women and men models.
Conclusion
1) On averaging-analysis, patient’s beneficence (consequentialism) followed by physician’s intent (virtue ethics) were more important than deception (respect-to-autonomy). 2) Q-methodology identified several ethical attitude models that were mostly multi-principled and associated with respondents’ demographics.
Video abstract
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use:
Acknowledgment
The authors would like to thank the staff of the Clinical Studies and Empirical Ethics Department for their help in collecting data.
Abbreviations
ANOVA, Analysis of variance; KFSH&RC, King Faisal Specialist Hospital and Research Center; REC, Research Ethics Committee; SD, Standard deviation.
Ethics approval and consent to participate
The study was conducted in accordance with the Declaration of Helsinki after approval of the Research Ethics Committee (REC) of the King Faisal Specialist Hospital and Research Center (KFSH&RC). All respondents provided written informed consent as approved by the REC.
Availability of data and materials
Additional data are available under Supplementary File 1 and Supplementary File 2. Raw data are available upon request from the corresponding author.
Author contributions
MMH designed the study, performed data analysis, and wrote the manuscript. SH performed the literature review, managed data, co-analyzed data, and co-wrote the manuscript. RA and ASA contributed to the literature review, models interpretation, and manuscript drafting. All authors agree to be accountable for all aspects of the work and gave approval of the final version of the manuscript.
Disclosure
The authors declare that they have no competing interests in this work.