[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Medical ethics](https://durgical.com/en/medical-ethics/) › [Autonomy and consent](https://durgical.com/en/medical-ethics/areas/autonomy/) › Placebos and deception in clinical practice # Placebos and deception in clinical practice - Topic Giving a placebo while letting the patient believe it is an active treatment is deception. There are honest options, such as open-label placebo. Updated Nov 13, 2026 ## Key points - Deceptive placebo: letting the patient believe they are receiving an active treatment; it violates truthfulness and consent. - Impure placebo: an active treatment used without an indication; it also exposes the patient to adverse effects. - Open-label placebo: the patient is told it is a placebo; it showed benefit in irritable bowel syndrome (Kaptchuk and colleagues, 2010). - The legitimate placebo effect is harnessed through a good relationship, realistic expectations and clear explanations. - In Colombia, the doctor uses only accepted diagnostic or therapeutic means (Ley 23 de 1981, art. 12). ## What it is The placebo effect is real: expectations and the relationship with the doctor change symptoms such as pain or nausea. The ethical problem is deception: giving something inert while letting the patient believe it is an active treatment violates truthfulness and consent, and if discovered it destroys trust. Impure placebos are also common: an active treatment used without an indication (for example, an antibiotic for a viral infection), which also exposes the patient to harm. An honest alternative is open-label placebo: the patient is told it is a placebo; in a 2010 trial in irritable bowel syndrome it improved symptoms compared with no treatment. The therapeutic privilege page covers another form of non-disclosure; placebo in research is covered under equipoise and placebo controls. ## Key facts - Forms of deception: lying, withholding something important, or partial disclosure that misleads; all three can damage trust. - In favour of deceptive placebo it is said that it relieves without adverse effects; against it, that it violates autonomy, risks trust and feeds paternalism. - Nocebo effect: mentioning adverse effects can make them more likely; this does not justify withholding them, but it does call for care in how they are said. - Prescribing without an indication «to give something» exposes the patient to adverse effects and, with antibiotics, to bacterial resistance. - Placebo in research is different: the participant knows they may receive it and consents. ## In clinical practice - A patient with chronic pain asks for «something more»: explain, offer evidence-based measures and close follow-up, rather than a drug without an indication. - If an open-label placebo is offered, say: «this is a pill with no active ingredient; some people improve with it», and the patient decides. - A relative asks «give him water and tell him it's a painkiller»: this is not done; the cause of the symptom is sought and treated. - To reduce nocebo, present adverse effects with frequencies and explain what will be done if they occur. ## Legal framework in Colombia - Ley 23 de 1981, art. 12: the doctor uses only diagnostic or therapeutic means accepted by legally recognized scientific institutions. - Ley 23 de 1981, art. 10, parágrafo: the doctor does not subject the patient to medical or surgical treatments that are not justified. - Ley 1751 de 2015, art. 10 d): right to clear, appropriate and sufficient information about procedures and their risks. - Official texts checked on 2026-11-13 at minsalud.gov.co and normograma.supersalud.gov.co. ## Test yourself Think of the answer, then tap the question to see it. ## Why is deceptive placebo ethically problematic? Because the patient does not consent to what they receive: it violates truthfulness and autonomy, and if discovered it destroys trust in the doctor. ## What is an impure placebo? An active treatment used without an indication for that problem, such as an antibiotic for a viral infection; it also exposes the patient to adverse effects. ## What did the 2010 open-label placebo trial in irritable bowel syndrome show? That people who took pills knowing they were placebos improved more than those who received no treatment. ## Which article of Ley 23 de 1981 limits the doctor to accepted therapeutic means? Article 12: the doctor uses only diagnostic or therapeutic means accepted by legally recognized scientific institutions. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/medical-ethics/placebos-and-deception-in-clinical-practice/) ## Elsewhere in DurgiPedia - [Placebo and nocebo effects](https://durgical.com/en/behavioral-science/placebo-and-nocebo-effects/) ## Connections ## Related 5 - [Therapeutic privilege and the right not to know](https://durgical.com/en/medical-ethics/therapeutic-privilege-and-the-right-not-to-know/) - [Truthfulness: telling the patient the truth](https://durgical.com/en/medical-ethics/truthfulness-telling-the-patient-the-truth/) - [Clinical equipoise and placebo controls](https://durgical.com/en/medical-ethics/clinical-equipoise-and-placebo-controls/) - [Paternalism: soft, hard and why it declined](https://durgical.com/en/medical-ethics/paternalism-soft-hard-and-why-it-declined/) - [Informed consent: elements and how to obtain it](https://durgical.com/en/medical-ethics/informed-consent-elements-and-how-to-obtain-it/) [← All of medical ethics](https://durgical.com/en/medical-ethics/) Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal. Sources: [Placebos without Deception: A Randomized Controlled Trial in Irritable Bowel Syndrome](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0015591) (PLOS ONE, 2010); [Informed Consent](https://plato.stanford.edu/entries/informed-consent/) (Stanford Encyclopedia of Philosophy, 2025); [Ley 23 de 1981, por la cual se dictan normas en materia de ética médica](https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/INEC/IGUB/ley-23-de-1981.pdf) (Ministerio de Salud y Protección Social, 1981); [Ley Estatutaria 1751 de 2015, que regula el derecho fundamental a la salud](https://normograma.supersalud.gov.co/compilacion/docs/ley_1751_2015.htm) (Superintendencia Nacional de Salud, Normograma, 2015). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/medical-ethics/placebos-and-deception-in-clinical-practice/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/medical-ethics/placebos-and-deception-in-clinical-practice/