Despite accumulating evidence indicating that paracetamol is no more efficacious than placebo for acute uncomplicated low back pain and symptomatic osteoarthritis, it is still prescribed for these conditions. This is likely due to perceived clinical improvement in pain observed when the medicine is taken and the known harms associated with pharmacological alternatives. The benefits observed in the majority of patients are, however, likely to be placebo effects. This scenario poses an ethical dilemma between respecting patient autonomy by providing complete information while also promoting clinical benefit (beneficence). This article discusses this situation and considers a framework in which paracetamol might continue to be prescribed for these conditions in an ethical manner, namely through discussing the evidence and the benefit that some patients experience from it.