What legal and ethical issues apply to spirituality in medical care generally as well as mental healthcare? Consider, for example, practices such as energy healing (Reiki, Therapeutic Touch, Polarity).
The same legal and ethical issues apply as they do to CAM generally, only they loom larger. For example, the following questions may arise concerning potential liability.
Legal and Ethical Issues Relating to Spiritual Health Care
is spiritual care within the standard of care for the patient’s condition (and if the patient’s condition deteriorates might inclusion of such care constitute malpractice)
is the physician neglecting necessary conventional care or creating undue reliance on spiritual rather than medical care
are important boundaries being crossed (e.g., touch vs. non-touch; issues of confidentiality and privacy)
is the physician using evidence-based practice and is the information “reliable”
could use of “intuition,” “channeling” or other sources of non-medical information potentially be categorized by a patient (or jury) as fraudulent, deceptive, manipulative, or misleading
what kinds of claims can the clinician make regarding the treatment and what kinds of statements could set up an action for breach of contract or misrepresentation
could the advertising of services be perceived as misleading, untruthful, fraudulent, or deceptive
what is the line between working within the patient’s spiritual framework (and thereby enhancing the therapeutic encounter) and coercing the patient (Harold Koenig, MD among others has written about this)
risk of professional discipline: could the state medical (or other pertinent regulatory) board view the practice as “unprofessional conduct,” the generic catch-all for unacceptable practices
is proper informed consent being given, and what would it look like; how does one describe risks and benefits for spiritual practices
are there potential contraindications to spiritual care and/or adverse interactions with conventional therapies
is it legally safer to describe spiritual care as “medicine” or as “religion”; what are benefits and dangers of each
if children are involved, is there a risk of liability for “abuse and neglect”
is the distinction between “curing” and “healing” legally valid
do disclaimers and signed assumption of risk forms (or waivers) help protect providers against potential liability
when spiritual therapies are routinely integrated in healthcare by a substantial number of providers, do they become standard of care
are clinicians in malpractice cases involving spiritual care judged by conventional standards or by a “mixed” standard incorporating these therapies
how does the provider’s profession (and how will juries) judge competence (or lack thereof) in energy healing and can standards be established that are generally recognized
what kind of credentialing standards are or should be required in hospitals to allow physicians (vs. nurses vs. massage therapists) to practice energy healing
what models of integrative care are hospitals using to bring spiritual therapies into the conventional domain and which strategies are successful in overcoming institutional (and cultural) obstacles and barriers
to what extent do the Federation of State Medical Board Guidelines on physician practices involving CAM use apply or bear on spiritual care
what liability risks might attend referral of patients to a non-licensed practitioner of Reiki, Qigong, etc.
These are just some examples of how the topics could apply to spirituality in medical care or mental healthcare.
Integrative Mental Healthcare: Legal and Ethical Issues and Healing at the Borderland of Medicine and Religion offer more formal discussion of some of these topics. Future Medicine also offers lengthy analysis.