Introduction: Many Americans today have used a chiropractor for a sore back or massage therapist for an ache or a pain. Complementary medicines and alternative therapies are a growing part of health care in America today. Americans spend billions of dollars a year on alternative treatments and most medical schools offer courses in alternative therapies. Not to mention in some countries complementary medicine may be the only form of healing available but in the west many people choose this from of treatment to supplement the services provided by otherwise orthodox medicine.
Complementary alternative medicine (CAM) encompasses a wide range of popular treatment modalities that are outside conventional practice and generally lack sufficient scientific evidence of their safety and effectiveness. These treatments include herbal agents, homeopathic preparations, chiropractic manipulations, massage, acupuncture, meditation, and prayer (Peter Curtis, 2012). The importance of complementary alternative medicines is reflected in the increasing use by medical doctors and the considerable demand for these therapies.
The use of CAM in the United States is widespread and growing and it is recognized in many developing nations, due to it being the dominant form of medical care. So where does complementary alternative medicine fit into the ethical structure of our health care system? Define the problem: There has been an increase in the use of complementary/alternative therapies that has occurred over the past decade. This situation has precipitated many ethical issues including those related to safety, scope of practice, and standard of practice.
Practitioners must be educated about the pros and cons of complementary/alternative therapies and be prepared to discuss and help resolve ethical issues surrounding them. Because of the popularity of complementary and alternative medicine (CAM) 42% of the citizens in the US use the method of treatment in accordance to 20% of the United Kingdom (E Ernest, 2012). There are very few differences in ethics of CAM and the more conventional way medicine; requirements like informed consent, confidentiality and privacy falls under the same category. A lot of the regulatory framework that governs conventional medicine that would incorporate ethical obligations in more ways than one converts over to complementary alternative medicines practices. An example of that would be but not limited to, legal rules that govern professional liability (informed consent), licensures, and malpractice procedures. Literature Review:
What was discovered after careful researching CAM is that in April 2003, the Therapeutic Goods Administration initiated the recall of more than 1600 complementary medicines from the Australian marketplace (Department of Health and Aging, 2012). This was the largest recall of medicines in Australia; the recall was a result of the failure of one medicine manufacturer to maintain appropriate manufacturing and quality control standards. Resulting from the recall, consumer groups, health professionals, as well as researchers and practitioners raised concerns regarding the level of trust for complementary medicines.
These concerns included doubts about the trust consumers would have in the information available about complementary medicines and confidence in their effectiveness. The role of complementary healthcare practitioners also came under scrutiny. The level of education and training of practitioners, lack of qualification and registration requirements, and the inconsistency of regulation across jurisdictions, raised questions about the degree to which the community can depend on their expertise and advice.
According to Kerry Breen author of “Ethical issues in the use of complementary medicines”, wrote that doctors who practice or recommend alternative or complementary medicine have additional ethical responsibilities which include:
- Special care must be taken to inform patients when therapy is unproven and to fully inform patients of any risks associated with such therapy;
- Patients who are offered alternative remedies must not be denied access to standard proven therapies of a type which would be provided by medical peers;
- When alternative therapies pose risks of serious side-effects, the patient should be advised to seek a second independent medical opinion;
- Doctors must not gain financial advantage by selling alternative therapeutic substances directly to patients
This holds significant weight because of the ethical issues that regard regulation of complementary medicine. Currently there are only two professions that have statutory regulations in the CAM arena; chiropractic and osteopathy. Practitioners within these professions must be registered with relevant regulatory body in order for them to practice. The ethical uses of complementary alternative medicines must have checks and balance the same as conventional medicine practices. The writer states that these practices protect the community and define what is expected from our medical professionals. The ethical issues that come into play are duly noted: honesty, integrity, informed consent, conflict of interest, etc…
For example, the issue of integrity is identified by one journalist who wrote, ‘There is no alternative medicine, only scientifically proven medicine’ and ‘Isn’t it time that this complementary medicine giant, and all other makers of alternative cures, were asked to show that their stuff works – just like manufacturers of boring old ‘Western’ medicines must’(Breen, 2003). At this time there is nothing stopping complementary medicine from entering mainstream medicine. If CAM wants to become a respected partner in the health care system, it must embrace all aspects of regulation and ethical standards the same as it applies to conventional medicine.
The original source – Complementary Therapies
Problem Analysis: Informed consent presents one of the major unresolved areas in the integration of complementary and alternative therapies into the health care system. Legal requirements of informed consent aim to protect the patient against non-consensual interference with his/her medical treatment. Informed consent requires that a patient has a right to know the potential risks, benefits, and alternatives of a proposed procedure (Pozar, 2012).
To satisfy informed consent physicians must disclose the nature of the health problem, proposed treatment, and the probability of its benefits and risks, whether it may be conventional or alternative treatment. Appropriate disclosure becomes more complex when treatment is concerned due to a patients decision to undergo or reject a specific medical procedure.
There must be acknowledgement to whether a primary care physician should disclose information about the possible benefits of nutritional therapies and if a reasonable patient uses the information regarding the complementary and alternative therapy to assist them in the decision to use or forgo that therapy. A widespread belief throughout the public, that the non-mainstream therapies pose a higher risk that conventional treatment.
The perception is that the adverse effects of complementary and alternative therapies are relatively infrequent compared to those of conventional medicine. There is evidence shows that conventional medicine has its problems in terms of patient safety. However, there are issues of safety in the practice of complementary and alternative medicine.
The following safety issues are of concern:
- Herbs and supplements are regulated as food rather than medicine, they lack the mandated efficiency and safety assurance mechanisms that are required of pharmaceuticals
- There are many different approaches to testing and diagnosing illness taken by complementary and alternative practitioners. The primary theory of any illness makes standardization of clinical practices much more difficult.
- Clinical competence are raised by the significant inconsistency in the training and standards of practice of practitioners
- Several safety issues related to the regulation and biological effectiveness of specific products and techniques (Peter Curtis, 2012).
The limited regulation of complementary alternative products and treatments has the increased in the number of patients who use CAM, has led to a number of broad safety concerns that deserve special attention, including misrepresentation, misapplication, misdiagnosis, and substitution (Peter Curtis, 2012).
Many complementary alternative practitioners have diagnostic procedures and testing processes that are quite different from those used by conventional clinicians, there are concerns about the accuracy and therefore the safety of their methods. For many of these procedures, although there is no research suggesting they are harmful, neither is there research that establishes their effectiveness. Consequently, questions about their usefulness and risk remain an ethical issue.
Possible Solution #1: When it comes to promoting health and safety, the public requires dependable scientific knowledge about the risk and benefit ratio of various CAM treatments. Research must identify effective and ineffective CAM treatments that will contribute to evidence based medicine that can improve how medical care is delivered.
Furthermore, because of the availability of many CAM products in the marketplace, convincing research findings will help consumers make more informed personal health choices. Only through research can these devices reveal the effectiveness of alternative therapies, and how it has the potential to enhance the understanding and treatment of a disease. Research is a key component to the success of complementary alternative medicine; not only for the consumer who is receiving it but also for the health care professional that is delivering patient care. Possible Solution #2 The education and training of healthcare practitioners is important due to the growth in patient use of complementary alternative medicine and the impact it has on conventional medical practices.
Today doctors need to know the potential benefits and limitations when advising their patients. There should be interaction among the disciplines in education and research as well as in clinical care. Recommendations for more evidence-based teaching about CAM approaches should be included in medical and other conventional health professional schools, postgraduate, and continuing medical education programs.
Furthermore, it is recommended that CAM professionals must obtain more education in conventional medicine and its research methodology. Possible Solution #3 There must be guidance in appropriate access and delivery of complementary alternative medicines. Patients should have access to qualified and accountable practitioners who are knowledgeable on services they offer whether it may be conventional or complementary alternative medicines. The federal government plays a unique role in making CAM available and accessible to patient in conjunction to conventional medicine.
By having state regulatory agencies or licensing boards for health care professionals providing information regarding practitioners, can assist in the safe access and delivery of legitimate care. Solution/Implementation The recommended solution to the issue with the ethical issues of complementary alternative medicine would be to cross- fertilize CAM with conventional medicine.
This could be done through education and training practitioners on the diversity of complementary alternative medicine and developing culture of safety. By educating practitioners on the concept of alternative medicines it ensures accountability and responsibility of the CAM care to said patients. This way a practitioner of conventional medicine have an opportunity to explore other treatments for their patients and it will validate the informed consent policies and procedures.
A formal recognition of clinical competence for those practitioners of complementary alternative therapies must have completed approved training programs and national board exams in their discipline to satisfy state licensing expectations.
Through the implementation of creating and maintaining a culture of safety reduces the risk of patient’s injuries and deaths that are associated with conventional medicine and CAM (Pozar, 2012). State medical licensing laws are to protect the public from abuse, fraud, and mistreatment. These laws are linked to the process of ensuring reasonable and ethical standards of practice.
Again, research and education of all risk factors that pertain to CAM will satisfy any ethical issues considerably. The idea of integrating conventional and complementary medicine into the health care system can pose as a benefit and decrease health care risks. Justification Patients want their conventional healthcare practitioners to help them make wise decisions about whether to use complementary and alternative therapies and which ones to use.
They want their practitioners to be responsive and informed of all mainstream medical treatments. The integration of safe and effective complementary and alternative therapies into conventional medicine must ensure a respectful collaboration and cooperation between conventional healthcare professionals and those whose practices are shaped by other healing traditions. In general, risks arise as the result of incomplete knowledge on the part of the clinician, leading to errors in decision-making and therapy. In general, risks arise as the result of incomplete knowledge on the part of the clinician, leading to errors in decision-making and therapy.
Clinicians must have a reverence for life and understand the consequential theory of ethics that emphasizes that the ‘morally right action is whatever action that leads to the maximum balance of good over evil’ (Pozar, 2012). There must be more communication between health professional so that there isn’t any conflicting diagnosis, advice, or therapy. Furthermore, respect between conventional medicine and complementary alternative medicine, because the general outcome is to ensure that the patient benefits from the treatment. In summary, the convergence of complementary alternative medicine and conventional medicine into our health care system raises important questions about safety.
Conventional clinicians must educate themselves on unfamiliar therapies and understand how to implicate multiple systems of care. The best way to address these safety issues is for clinicians and patients must be informed and learn about the various treatments that are in use. They must also know how to find and evaluate their information sources and it is imperative that they share this information effectively with colleagues and patients. “Ethics, too, are nothing but reverence for life. This is what gives me the fundamental principle of morality, namely, that good consists in maintaining, promoting, and enhancing life, and that destroying, injuring, and limiting life are evil”. Albert Schweitzer (Pozar, 2012)
- Berman, J. D. , ; Straus, S. E. (2012, June 11). Implementing Research Agenda for Complementary and Alternative Medicine. Retrieved from http://www. lclmllc. com/documents/BermanetalImplementingaresearchagendaforcomplementaryandalternativemedicine2004. pdf
- Breen, K. J. (2003). Ethical issues in the use of complementary medicines. Climacteric, 6(4), 268-72. http://search. proquest. com/docview/198673057? accountid=4175
- Department of Health and Aging. (2012, May 20). Retrieved from Threapeutic Goods Administration: http://www. tga. gov. au/archive/committees-eccmhs. htm
- E Ernest, M. H. (2012, May 20). Symposium on evidence based medicine. Retrieved from Ethical problems arising in evidence based complementary and alternative medicine: http://jme. bmj. com/content/30/2/156. full
- Gordon, J. S. (2002). The white house commission on complementary and alternative medicine policy: Final report and next steps. Alternative Therapies in Health and Medicine, 8(3), 28-31. http://search. proquest. com/docview/204824846? accountid=4175
- Martin, W. M. , ; Long, H. W. (2007). Complementary and alternative medicine: Opportunities and challenges. Journal of Health Care Finance, 34(2), 89-104. http://search. proquest. com/docview/235177688? accountid=4175 NCCAM. (2012, June 10).
- What is Complimentary and Alternative Medicine. Retrieved from National Center for Complementary and Alternative Medicine: http://nccam. nih. gov/health/whatiscam
- Owen, D. K. , Lewith, G. , Stephens, C. R. , ; Bryden, H. (2001). Can doctors respond to patients increasing interest in complementary and alternative medicine? / commentary. British Medical Journal, 322(7279), 154-8. http://search. proquest. com/docview/204028934? accountid=4175
- Peter Curtis, M. P. (2012, June 5). Safety Issues in Complementary ; Alternative Health Care. Retrieved from http://www. med. unc. edu/phyrehab/pim/files/Safety. pdf
- Pozar, G. D. (2012). Legal Aspects of Health Care Administration 11th Edition. Maryland: Jones ; Barlett Learning.