To my mind, there isn’t an obvious answer, but the conflict between these two is why there is debate about “using” the placebo effect as a treatment.
This is because studies have since found that amputations can cause a great deal of psychological harm and it can be better for the patient if they arrive at the conclusion to amputate of their own volition - even if that takes months of excrutiating agony spent realizing not having the limb is better than the pain.
It was an interesting additional dimension to consider - even if the doctor knows much better than the patient, sometimes the patient feeling a sense of autonomy could be important for their wellbeing, and that short term pain could be beneficial.
Atul Gawande talks about how much we have discovered in medicine in the last century, but that the next century is going to be about how to effectively implement that knowledge to help people. This applies to both the first world and to the developing world, though the challenges in both are different.
(also we probably wont stop discovering new treatments that we will them have to deploy...)
Yeah, but a lot of patients would consent to an offered treatment plan where they're locked up (and unable to sign themselves out!) and fed only 1300 calories of veggies.
The weird thing is, there are private businesses willing to provide exactly that kind of service (see: de-tox centers.) But doctors and hospitals generally don't see this as a valid form of in-patient medical treatment. Why is that? Do doctors think that patients have an inalienable right to bodily autonomy? (If so, how would surgery ever work?)
(The annoying point about this difference, to me, is that if a doctor were to diagnose you with X thing that keeps you at the hospital for a month, unable to leave—then your insurance would likely pay for that, and your employer would likely consider you on sick leave. But if a private business like a detox center keeps you for a month, then you have to pay for that out-of-pocket and you're likely to be fired from your job if you don't have the requisite vacation days saved up. From what I can see, it is in the patient's long-term interest if doctors get into this business!)
"We did procedure X, but your insurance covered all of it."
Last year I fell while mountain skiing and was in great pain at first (could barely move, standing up from lying down was excruciating, etc.)
The first day I didn't take any pain killer; the second day I did but it didn't really help. The third day I stopped taking the pills and just kind of "decided" I wouldn't suffer that much.
The pain didn't disappear completely, and it still hurt too much to get back on skis, but it stopped being so intense. When I got back home I did an x-ray exam and MRI and found I had broken a vertebra in two, that had lost 25% of its height. The doctor was super surprised I could walk normally and said: "do you not feel pain". I said I did but it was very manageable. She didn't investigate and just said "ok then, good for you!"
Also, I used to get hiccups that lasted a long time (30 minutes); and then I discovered you can make them stop very fast by being super calm and concentrating. Not only that, but since I found this out, I barely get hiccups at all anymore.
I think we can consciously control much more of our own body than we think, and we're only scratching the surface.
I am in two minds about it. On the one hand it would appear pretty ridiculous and there is no way that it should be paid for. On the other hand if it works via the placebo effect in a cost effective manner, is that a bad thing?
And what is the cure worth? How do you measure that?
In other words the lie is integral to the working of the placebo. This is the whole source of the issue.
https://www.forbes.com/sites/brucelee/2017/01/28/fda-toxic-b...
We see that all of the time... I recall working in a bakery in the mall in high school and chatting with a Vietnam veteran with chronic pain from a lung issue and a missing leg who would walk 8-10 miles on crutches every day at 5AM and sometimes do push-ups in our cafe area. He was the most positive person that I have ever met, which was striking when you'd see other folks with very minor issues grouse and complain and be visibly ill.
My mom was taught "therapeutic touch" in the 1960s in nursing school, which I believe isn't considered pseudoscience today. For certain types of patients, it was helpful, but the technique was mostly placebo.
Fundamentally, changing how people think is ethically problematic if it becomes manipulative, but it's a key factor for our well being as well.
This might simply be that the Vietnam veteran happens to have much better and more stable chemistry than people with, say, depression.
It seems one danger with this placebo discussion is that we may end up at square one, blaming depressed/anxious/ADHD/BPD people for their problems...
Now, they can say, "I may do A, and I may do B, and there is evidence that both are effective"
The idea itself isn't that controversial - age of majority laws for contracts, voting, and even medical treatment clearly acknowledge the idea that some people are too young to know what they are agreeing to, so the decision should be made by someone else who takes responsibility for them (most things), or there should be no decision because there doesn't need to be one (voting).
We just need to refine our understanding to reflect the reality that as old as you may get, you will never understand some things.
Without autonomy, the concepts of voluntary/involuntary lose meaning, which can enable some very nasty scenarios. Exceptions to autonomy are rare and come with stringent legal duties and obligations on the responsible party. Doctors are not responsible for their patients in that way; they are service providers.
Lack of understanding should not be sufficient to undercut an ethical principle like autonomy. Imagine if I had the power to decide that you don't sufficiently understand the concept of autonomy, and must be shipped off to a re-education center.
Talking about it outside of the specific conflict, is disingenuous. Everyone understands how important Autonomy is. That's part of the issue, not a supporting argument to value it over the health of a patient. If there's no patient, there's no Autonomy either.
So, I do not agree with you that "everyone understands how important autonomy is."
You don't see the irony in that, when talking about the Placebo effect? This discussion is about an implicit assumption.