The Position Statement on the Use of Placebos for Pain Management
in Patients with Cancer, developed recently by the Oncology Nursing
Society (ONS), has been endorsed by 24 nursing and other healthcare organizations.
When the statement was initially published in June 1996, ONS invited
a variety of organizations to endorse it. The position statement was developed
to support clinicians and enhance the care of patients with cancer. Between
50% to 80% of patients with cancer experience pain that require analgesics.
The use of placebos in their treatment is quite common. The Society, however,
believes that placebos should not be used in the assessment and management
of cancer pain.
Position Statement Based on Several Issues
The Oncology Nursing Society bases its position statement on several
issues. First, there are many misconceptions about the use of placebos.
In particular, some believe that placebos can be used to accurately assess
whether pain is real and to adequately treat pain without harmful side
effects. Positive response to placebos is often viewed as evidence of malingering,
exaggerating, or faking pain. These assumptions are incorrect.
Also, placebos are often used in a punitive sense for patients who have
exhibited manipulative or demanding behaviors or in vulnerable populations,
such as those with histories of psychiatric problems or substance abuse.
In addition, the use of placebos necessarily involves deception, which
automatically raises serious ethical concerns. The use of placebos threatens
the inherent ethical values and norms of health-care professionals as articulated
in the ANA Code for Nurses.
Based on these assumptions, the ONS believes that placebos should not
be used to assess or manage cancer pain, to determine whether the pain
is "real," or to diagnose psychological symptoms, such as anxiety
associated with pain. The Society asserts that nurses should not administer
placebos in these circumstances even if there is a medical order to do
The position statement also includes recommendations to assist health-care
providers with making decisions regarding the use of placebos.
For a complimentary copy of the position statement, contact ONS, 501
Holiday Drive, Pittsburgh, PA 15220, or call (412) 921-7373 or FAX (412)