I’m proud of my colleague and friend Karen Adams, M.D., as lead author of Adams KE, Cohen MH, Jonsen AR, Eisenberg DM. Ethical considerations of complementary and alternative medical therapies in conventional medical settings. Ann Intern Med; 2002;137:660-664. We all worked hard to come up with a framework that balanced all the interests at stake–including the patient’s–when clinicians have to make ethical decisions about recommending use or avoidance of specific CAM therapies.
The factors we urge clinicians to address are seven: 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.
In the full article, we apply these factors to specific cases and show how the analysis can yield workable results. This, I hope, creates a more beneficial plan than simply dismissing therapies as “unscientific” or ignoring the patient’s requests on one hand, and acquiescing blankly on the other. We tried to come up with a framework that yields judgments that are “clinically sound, ethically appropriate, and targeted to the unique circumstances of individual patients.” We also noted: “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.”