Physicians' Ethical obligations to Patients - Brief Article

Even doctors who subscribe to only conventional medical therapies have an ethical obligation to help their patients who are considering non-traditional treatments, maintain two physicians at Duke University Medical Center, Durham, N.C. Medical ethicist Jeremy Sugarman and Larry Burk, director of the Office of Integrative Medicine Education, emphasize that clinicians' obligations regarding alternative medicine center on whether those therapies have been shown through rigorous examination to be safe and effective. If the therapies are not tested and proven, doctors do not have the same obligation.

They argue that it is important to examine the principles of care common to both conventional and alternative treatment. Clinicians following conventional medicine rely on scientific methods in making decisions about appropriate therapy, while practitioners of alternative medical treatments, such as acupuncture and therapeutic touch, generally do not. The health-related goals of the two approaches may not differ radically, though. For instance, both promote prevention of illness and relief of pain or suffering.

The first principle to consider is the patients' right to be informed so they can make the best decisions regarding their treatment. While clinicians' knowledge of an alternative medicine may not be expansive, they are obligated to help patients understand issues of the safety of treatments and how to get more information on options that they may be considering.

"It may be easier for clinicians to accept a patient's choice of alternative therapy if there are no known effective conventional ways to treat a condition. And there are cases when we would be remiss as physicians if we didn't counsel a patient to avoid alternative therapies in specific cases," Sugarman points out, such as a case where a patient wanted to self-treat with herb tea for an infection that is a serious threat to health.

Nonmaleficence, or the principle of "doing no harm," clearly stands as an enduring obligation of physicians, he notes. Besides offering information, doctors must take a careful history to determine any alternative therapies the patient is using to screen for possible adverse effects. For example, a patient may be taking St. John's Wort on his or her own, something which could influence a clinician's decision to prescribe an antidepressant. Without eliciting information about the patient's alternative therapy choices, that individual's health could be jeopardized.

Clinicians also are obliged to help patients reach their health-related goals, which is the essence of the principle of beneficence, Sugarman says. In following that principle, physicians may feel the need to learn to prescribe known beneficial alternative medicine therapies. Pursuing adequate and appropriate training would be another professional obligation for the conventional clinician who wanted to include alternative methods in medical practice. Finally, clinicians are bound by the principle of justice that dictates patients should have fair access to alternative therapies, as well as conventional treatments, that are known to be safe, effective, and appropriate for their particular condition.

[ILLUSTRATION OMITTED]

COPYRIGHT 2000 Society for the Advancement of Education
COPYRIGHT 2000 Gale Group