HEALTH ETHICS TODAY

Volume 11, Number 3, November 2000

Bioethics and Complementary Medicine: An Overview and Personal Perspective

Steven KH Aung, MD, FAAFP

In recent years, complementary medicine has become increasingly important in the practice of medicine, especially family medicine. If complementary approaches are to be fully respected, assessed and integrated into the modern biomedical system, there are a number of bioethical concerns which must be addressed by physicians and other qualified health care practitioners. These may be viewed as issues surrounding complementary medicine itself as well as competent medical practice and a compassionate approach to primary health care.

It cannot be denied that complementary medicine has come to play a significant role in the modern biomedical system.1,2 The demand is there. As many as a third or more of patients have turned to complementary medicine at some time during their lives. Complementary therapeutic modalities appear generally less invasive than the pharmacological and surgical interventions characteristic of biomedicine. They are less iatrogenic in effect and they offer more personalized care.

An important consideration in keeping with the principle of respect for patient autonomy is for physicians and other practitioners not to turn a 'blind eye' to the needs of their patients who seek for complementary medicine. Physicians must respect these needs and become familiar with the various complementary 'treatments of choice' currently available. These range from accepted 'complementary' therapies such as acupuncture to less accepted and sometimes controversial 'alternative' therapies such as chelation to esoteric 'fringe' therapies' such as psychic surgery.1-6 It is incumbent upon physicians to be able to distinguish among complementary, alternative and fringe approaches and to advise their patients accordingly. It is also a basic ethical responsibility that physicians should not be biased either for or against non-conventional therapy, but should be prepared to evaluate each approach from an evidence-based perspective, based on the reports available in the current scientific literature.

If physicians are not familiar with a particular non-conventional therapy that a patient is interested in or that might 'add value' to the patient's biomedical treatment, they should be prepared to refer such patients to colleagues who have the required knowledge and experience. This professional requirement should encompass the following minimum criteria of competence in primary care complimentary therapy: 7,8

  • Respecting the desires and decisions of all parties involved in the therapeutic consultation process
  • Addressing the best interests of patients at all times and giving proper advice to them regarding the pros and cons of a specific non-conventional therapy
  • Explaining the full risks, complications, costs and any apparent benefits and deleterious side-effects of a specific approach
  • Not promoting unproven claims, but judiciously summarizing the current evidence-based information available
  • Providing the opportunity for a limited trial treatment, which would form the basis for the patient's decision to continue or discontinue the therapy

It must be noted that a specific complementary therapy may not be indicated or beneficial under certain circumstances. Although complimentary therapy may not in itself be harmful it may be harmful if it involves delaying or not using other appropriate therapies, notably in emergency. Moreover, it must be noted that distinct bioethical issues may arise within the scope of practice of a complementary therapy, which must be addressed by its practitioners. Examples include the concern about the use of ingredients from endangered plant and animal species in traditional Chinese herbal medicine and some herbal medicine lack proper quality control and may contain toxic substances. Research is now proceeding on trying to find effective, environmentally safe substitutes for these ingredients.

All appropriate clinical diagnostic and examination procedures must be followed in the practice of complementary medicine. Unnecessary procedures must be avoided. There must be referral to appropriate specialists when necessary. Practitioners must try to keep the lines of communication open with physicians in regard to non-conventional approaches. Practitioners who are not qualified physicians must encourage their patients to remain under medical care while undergoing non-conventional treatment in order to ensure optimal safety.

Physicians and other practitioners of the various complementary therapies must be competent in their practice. This means that they must be fully qualified and certified as acupuncturists, chiropractors, osteopaths, homeopaths, reflexologists, hypnotherapists and so on. It is important to have formal certification from the leading institutions and programs in the field. For an accepted complementary therapy such as medical acupuncture,9,10 this entails graduation from recognized courses such as those offered by the Certificate Program in Medical Acupuncture at the University of Alberta, the Acupuncture Foundation of Canada Institute, the American Academy of Medical Acupuncture and the British Medical Acupuncture Society. Such courses teach a theoretical basis, emphasize clinical safety (for example, clean needling techniques in medical acupuncture) and students are carefully instructed in the clinical indications and contraindications for specific therapies. Moreover, practitioners should always seek to upgrade their knowledge by reading the relevant literature, receiving additional training, attending conferences and engaging in professional interaction with colleagues.

Maintaining a good 'bedside manner' is absolutely essential for all healing. This involves providing tender loving care and compassion in order to enhance the healing process and well being of our patients.11 Patients, and their families, and loved ones, are rightfully extremely sensitive to this aspect of their care. While this cannot be easily measured quantitatively, it is a well reported fact of everyday clinical experience which must never be downplayed. Furthermore, from the perspective of the practitioner, it is often the case that our so called most difficult patients have the most to teach us, as we strive to become genuine healers rather than mere medical technicians. When the situation arises where a non-conventional or complementary treatment appears to be in direct conflict with a standard biomedical approach, it is hoped that the patient and practitioners will strive to work out the best solution for all concerned. They will involve attention to the prevailing community standards of medical and primary complimentary care as well as legal considerations

The personal bioethical perspective elucidated in this brief paper is not especially controversial. It is simply based a strong sense of complementarity, competence and compassion that has informed all medical practice-east, west, north or south-since the beginning of human history. It is my hope that this sense will continue to inform the art and science of medicine and the ongoing, challenge of medical ethics throughout the 21st century and beyond.

References

1. Eisenberg D, Kessler RC, Foster C, Norlock FE, Calkins DR and Delbanco TL. 1993. Unconventional Medicine in the United States: Prevalence, Costs and Patterns of Use. New England Journal of Medicine 328: 246-252.

2. Driedger SD. 1998. Cover/Maclean's/CBC News Poll: Healthy Options. Maclean's 12: 36.

3. Ernst E. 1995. Complementary Medicine: Common Misconceptions. Journal of the Royal Society of Medicine 88: 244-247.

4. Fulder S. 1996. The Handbook of Alternative and Complementary Therapies. Oxford: Oxford University Press (3rd Edition).

5. Aung SKH. 1996. Complementary Medicine and Primary Care: Enhancing the Quality of Life, Canadian Journal of Clinical Medicine 3 (7): 4-15.

6. Aung SKH. 1997. Toward Integrated Medicine for All in the 21st Century (Abstract), FACT (Focus on Alternative and Complementary Therapies) 2 (4): 184-185.

7. Ernst E. 1995. Bitter Pills of Nature: Safety Issues in Complementary Medicine. Pain 60: 237-238.

8. Ernst E and Kaptchuk T. 1997. Complementary Medicine: The Case for Dialogue. Journal of the Royal College of Physicians of London 30 (5): 410-412.

9. Aung SKH. 1994. The Clinical Use of Acupuncture in Family Medicine. Acupuncture in Medicine 12 (2): 104-107.

10. Frank BL. 1997. Medical Acupuncture: A Model of Integrated Healthcare from Alternative to Mainstream Medicine. Colorado Medicine 94 (7): 252-254.

11. Aung SKH. 1996. Loving Kindness-The Essential Buddhist Contribution to Primary Care. Humane Health Care International 12 (2): 81-84.

 

Dr Steven KH Aung practices integrative traditional Chinese medicine and biomedicine in his clinic in Edmonton, Alberta, Canada. He is the founder and instructor of the Certificate Program in Medical Acupuncture, Faculty of Extension, University of Alberta, Edmonton. He is associate clinical professor in the Departments of Medicine and Family Medicine, University of Alberta, as well as a World Health Organization advisor on medical acupuncture.

Steven KH Aung, MD, FAAFP
9904 - 106 Street NW
EDMONTON, AB T5K 1C4
Canada

Tel (780) 426-2760
Fax (780) 426-5650
Email: skha@aung.com
http://www.aung.com

 

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