Pediatrics recently published our article on complementary therapies in pediatric care. The article offers a framework for clinical decision-making.
Increasing use of complementary and alternative medicine (CAM) therapies such as chiropractic, massage therapy, and herbal medicine, raises questions about the clinically appropriate use of CAM in pediatrics. Nonjudicious use of CAM therapies may cause either direct harm or, by creating an unwarranted financial and emotional burden, indirect harm. When advising patients concerning CAM therapies, pediatricians face 2 major legal risks: medical malpractice and professional discipline. Pediatricians can incorporate these considerations into advising and clinical decision-making about CAM therapies to address the best interest of the pediatric patient while helping to manage potential liability risk. This article provides a suggested framework, including asking the following questions: (1) Do parents elect to abandon effective care when the child’s condition is serious or life-threatening? (2) Will use of the CAM therapy otherwise divert the child from imminently necessary conventional treatment? (3) Are the CAM therapies selected known to be unsafe and/or ineffective? (4) Have the proper parties consented to the use of the CAM therapy? (5) Is the risk-benefit ratio of the proposed CAM therapy acceptable to a reasonable, similarly situated clinician, and does the therapy have at least minority acceptance or support in the medical literature? Such an approach ideally can help guide the pediatrician toward clinical conduct that is clinically responsible, ethically appropriate, and legally defensible.
PEDIATRICS Vol. 115 No. 3 March 2005, pp. 774-780 (doi:10.1542/peds.2004-1093
Michael H. Cohen, JD, MBA* and Kathi J. Kemper, MD, MPH
* Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School, Boston, Massachusetts
Department of Pediatrics, Brenner Children’s Hospital, Wake Forest University Health Sciences, Winston-Salem, North Carolina
Key Words: alternative • complementary • integrative • liability • malpractice • negligence • pediatric • holistic • policy • legal
Abbreviations: CAM, complementary and alternative medicine • AAP, American Academy of Pediatrics