Theme 1: ethical considerations
pain
MINOR, BLIND
Trust within the patient-clinician relationship was viewed as foundational to the use of placebos in appropriate conditions and contexts. Primarily, trusting that a clinician would be using the placebo for an appropriate condition—i.e. one that would not be worsened by substituting a placebo—and in a context that was beneficial for the patient. Participants suggested increasing levels of societal enculturation to build trust, via public health campaigns and clinician-based education during consultations. However, some participants expressed concern that the offer of a placebo could undermine the seriousness a patient had attached to their complaint, and erode the relationship and trust between the patient and clinician, especially in vulnerable communities with low health adherence. Participants also considered the ethical concerns of deontological and utilitarian aspects of placebo use. They generally preferred open-label placebos to the inherently deceptive use of blind placebos, which they perceived as violating the professional duties of care by not keeping the patient fully informed—regardless of being potentially more efficacious. Participants identified specific circumstances where placebo use could be ethically acceptable, such as mental health contexts, while pain alleviation was viewed as an unsuitable application. The expected temporality of the illness played a role in how ethically suitable placebo use was perceived, with short-term applications for minor acute illnesses viewed as relatively low risk, while long-term use of placebos was seen as high risk for a patient.