ABSTRACT: Ethical Considerations of Complementary and Alternative
Medical Therapies in Conventional Medical Settings
Increasing use of complementary and alternative medical (CAM)
therapies by patients, health care providers, and institutions
has made it imperative that physicians consider their ethical
obligations when recommending, tolerating, or proscribing these
therapies. The authors present a risk-benefit framework
that can be applied to determine the appropriateness of using
CAM therapies in various clinical scenarios. The major relevant
issues are the severity and acuteness of illness; the curability
of the illness by conventional forms of treatment; the degree
of invasiveness, associated toxicities, and side effects of the
conventional treatment; the availability and quality of evidence
of utility and safety of the desired CAM treatment; the level
of understanding of risks and benefits of the CAM treatment combined
with the patient's knowing and voluntary acceptance of those
risks; and the patient's persistence of intention to use CAM
therapies. Even in the absence of scientific evidence for CAM
therapies, by considering these relevant issues, providers can
formulate a plan that is clinically sound, ethically appropriate,
and targeted to the unique circumstances of individual patients.
Physicians are encouraged to remain engaged in problem-solving
with their patients and to attempt to elucidate and clarify the
patient's core values and beliefs when counseling about CAM therapies.
[10/17/2002; Annals of Internal Medicine]
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