Lay People’s Ethical Attitudes To Placebo Treatment: A Q-Methodology Study
Received 21 May 2019
Accepted for publication 6 September 2019
Published 27 September 2019 Volume 2019:13 Pages 1599—1617
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Nicola Ludin
Peer reviewer comments 2
Editor who approved publication: Dr Johnny Chen
Muhammad M Hammami,1,2 Safa Hammami,3 Reem Aboushaar,4 Ahmed S Aljomah1
1Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; 2Alfaisal University College of Medicine, Riyadh, Saudi Arabia; 3St. Mary Medical Center, San Francisco, CA, USA; 4MS IV, Florida Atlantic University, Boca Raton, FL, USA
Correspondence: Muhammad M Hammami
Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh 11211, Saudi Arabia
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.
Keywords: lay people attitude, placebo treatment, virtue, common good, principlism, Q-methodology
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