Biomedical Ethics — Placebo Effect and BCIs

Part I:

The labeling of medications in a certain way can create a placebo effect, improving a patient’s condition. However, in this paper I will be arguing how the placebo effect should be utilized ethically by using the Nurofen case to provide an example of drug mislabeling.

A placebo effect is when a person has an improved experience as a result of their expectations or conditioning for a placebo. A placebo is most usually a sugar pill that does not have any effect on the person, but psychologically is deemed effective to the patient (Ho, p.24), However it is also essential to note that placebo effects are not always expectational or found through conditioning (Ho, p. 28). For example, suppose a patient visits her doctor with complaints of, what she believes to be, chronic migraines. She advises her doctor that over-the-counter pain relievers have been ineffective. Her doctor prescribes a medication claiming it is specifically for migraines. However, it has the same active ingredients in OTC Tylenol. In turn, a few days later the patient tells the doctor that her headaches are gone, unknowing that she was given the same painkillers she believed did not help. The placebo effect takes place here as the patient is fully convinced that she has a migraine. Therefore, her expectations that only a migraine medication will help cause her physical health to improve. This example illustrates that labeling a drug in a certain way can precondition the person into believing that their experiences will improve. According to the psychological concept of classical conditioning, humans associate a neutral stimulus with another that creates a response (Ho, p.25). The placebo effect is possible due to classical conditioning because a person associates the placebo (the stimulus) with a positive improvement (the response). Although the placebo does not truly have any mechanical effect, the person’s association of the pill with relief, they condition themselves to feel the improvement.

Nurofen, a medication company, mislabelled its drugs with the same dosage and painkillers with different labels for each such as migraine and back pain. On behalf of the consumer, Nurofen has lied to its consumers in its labeling practice as the labeling is unclear and ambiguous of its content. By mislabeling the drugs, the intended consumer could make the mistake of purchasing one of each type of medication which is really just the same, with different labels. By doing so, Nurofen is taking advantage of its consumers economically as they are not clearly labeled to have the same painkiller and dosage. On the other hand, on behalf of Nurofen, one can argue that Nurofen’s mislabeling is intended for the well-being of its consumers by inducing the placebo effect. In other words, by labeling the product in this particular way where each formula is for a specific type of pain, consumers are more likely to feel pain relief, therefore benefiting the customer. Through the utilitarian lens, one can consider that by providing consumers with a variety of labels and the placebo effect, they are maximizing the good, or benefit for the consumers as the company is providing pain relief. However, I argue that Nurofen is indeed taking advantage of its consumers by mislabeling its medications. By mislabeling the drugs, Nurofen is lying about the effectiveness of the drug on the physiological aspect of the consumer and is therefore false advertising (Wade, 07/22/2024). By doing so, the company is using their consumers as merely a means to gain economic profit according to Kant as they seek to gain more money through selling products of the same content with different labels. Although it may seem as if they are benefitting the consumer by helping their health, it is unethical to lie to a consumer about a medical prescription that could save them money.

Part II:

In this paper, I will be arguing how people who use neural prosthetics such as Brain-Computer Interfaces (BCI) cannot be fully blamed for their crimes using John’s murder case as a foundational example.

Brain-computer interfaces (BCI) are computer systems that transmit signals from the brain and then translate them into physical actions (Glannon, p. 82). The criminalization of John’s murder is not obvious due to the two stipulations of the US Model Penal Code. The first stipulation requires an act to be a bodily movement caused by a volition or will. One can not criminalize John’s murder as he is not in complete control of his BCI. The BCI programs the actions a person makes directly, therefore giving John no executory control (Wade, lecture 7/12/2024). Therefore, one can not blame him completely for the murder as the BCI just translates his thoughts into actions. Usually, a person who has full bodily autonomy is able to think before acting. For example, if John did not have BCI or was not quadriplegic, he would have had the time to think about the consequences of punching Bill and therefore not do so. However, because of the BCI, John does not have the free will to think carefully about his actions as the technology automatically translates his thoughts into bodily actions. Therefore, the murder is certainly not obvious due to the first stipulation as it requires the act to be one caused by will, however we can not be sure that punching was John’s pure will, but rather a violent thought come to life despite his will. Furthermore, the second stipulation states that there is no penalty without a law. In other words, one can not be criminalized if there is no law against it at the time. Since the signals that are associated with John’s thoughts are translated into motor outputs (Glannon, p. 87), to criminalize the murder, his thoughts of punching another person would be considered illegal. However, this can not be so as one can not be punished for their thoughts, violating their freedom of thought (Wade, lecture 7/12/2024).

Additionally, if there was a proposal to revise stipulation 1 to include “mental actions with effects on the external world,” this would violate a person with BCI’s freedom of thought as mentioned previously. This is immoral because according to Kant’s categorical imperative of universality (Crash Course, 11/14/2017), if John’s thoughts of punching Bill are illegal, then every person’s thoughts of violence should be illegal as well or that would be treating John differently than all other people who are not quadriplegic. One can not place constraints on a person’s thoughts as it is their personal liberty to believe and think what they want, as long as it does not harm others. In the case of John, he does not have the physical autonomy because of the machine which is why we can not say that the murder of Bill is completely his fault. I’d argue that stipulation 1 does constitute a genuine violation of a BCI patient’s mental autonomy as one can not restrict another’s thoughts. It is unfair to use a person’s physical disability against them and entail that they must restrict their thoughts to receive motor abilities. In other words, I think it to be impermissible to prohibit a person from thinking particular thoughts because it in turn limits the person’s autonomy and human rights. It is merely impossible to control a person’s thoughts, even if they have BCI. One cannot truly foresee if a person’s thoughts are going to have detrimental effects on others unless there are external factors present that show this such as a verbal cue that they have a violent intention to harm others.

Works Cited

Fu, Yang (Wade). Phil 7 Lecture, 12 July 2024

Fu, Yang (Wade). Phil 7 Lecture 22 July 2024

Glannon, W. Neural Prosthetics: Neuroscientific and Philosophical Aspects of Changing the Brain.

Oxford University Press, 2021.

Ho, D. What Placebos Teach Us about Health and Care: A Philosopher Pops a Pill. Cambridge University Press, 2023.

“Kant & Categorical Imperatives: Crash Course Philosophy #35” Youtube, uploaded by Crash Course, November 14, 2016. https://www.youtube.com/watch?v=8bIys6JoEDw