Treatment of chronic pain is challenging for both patients and physicians alike. Interventional management of pain is often indicated for patients who are not helped by pharmacotherapy, and can include procedures such as neurectomy and vertebroplasty. However, randomized controlled trials of these procedures often demonstrate a significant improvement in symptomology among patients in the control arm who have instead undergone a sham surgery, which eliminates the perceived surgical steps required for benefit but mimics the surgery in every other way. We examine whether an ethical framework might exist for sham surgeries to hypothetically be performed for clinical benefit of chronic pain. Once all evidence-based options are exhausted, performing sham surgeries may be justified under beneficence and non-maleficence since sham procedures are often equally efficacious but considerably safer than their true intervention counterparts. Physicians must only recommend such procedures with the intent of ameliorating patient suffering. Some degree of disclosure of a possible placebo effect prior to a sham surgery may satisfy the principle of autonomy while still maintaining the placebo response.

A 2017 survey of 529 psychiatrists in Canada found that while 72% of psychiatrists supported medical assistance in dying (MAID) in some cases, only 29.4% supported MAID solely on the basis of mental disorders.  Understanding and addressing the concerns of mental health professionals will be crucial in deciding whether and how to expand MAID solely for a mental disorder in Canada. The report, “The State of Knowledge on Medical Assistance in Dying Where a Mental Disorder Is the Sole Underlying Medical Condition,” authored by The Council of Canadian Academies, highlights some concerns that mental health professionals might harbour. These include potentially feeling that there is a conflict between providing MAID and their duties as mental health care workers, the subjectivity of the current law, and Canada’s inequitable mental health care system.