There is a duty in patient care to provide the most effective treatment possible. Sometimes these treatments may lie outside of the traditional realm of therapeutically practices. These types of practices are complementary and alternative therapies which are aimed at helping patients with unconventional approaches. The National Library of Medicine defines complementary and alternative medicine as “Complementary and alternative medicine (CAM) or “complementary health approaches” are a group of diverse medical and health care practices and products that are not presently considered to be part of conventional medicine” (NLM, 2013).
Beneficence and nonmaleficence. Since there are potential benefits to CAM, it is advantageous for patients to explore their options when it comes to advancing their own treatment. The risk of harm is mitigated by the potential benefits of complementary and alternative therapy. The responsibility for the caregiver is to provide patient education is the key to mitigating that risk. There is beneficence in advising CAM because some patients may not be culturally accepting of conventional medical practices, but would be accepting of CAM (Anderson, 2017). There is a greater risk of not advising CAM when patients are not employing traditional methods. Additionally, there are often less invasive CAMs that can replace aggressive conventional therapy.
Some patients cannot afford conventional therapy, and CAMs can replace therapies that would otherwise be inaccessible for disadvantaged patients; however, the inverse of this is true, because often there is little possibility for reimbursement which leaves the patient without options. However, because there is a broader possibility of successful treatments it is important to include CAMs in patient choices. It is also critical to adhere to the principle of nonmaleficence and not create unrealistic hopes for successful treatments in CAMs with patients who have had failed conventional treatments.
Patient autonomy and diversity. Patients need to know all of their options in order to make a well-informed decision about their care. It is possible to restrict patient autonomy by withholding options for care, or by persuading the patient to accept one form of care over another (Anderson, 2017). There is a duty to foster a patient’s ability to make informed and non-coerced choices; therefore, it is critical that patients understand all their treatment options. There are patients who need to be educated about the choices that they have, or else they will be coerced into accepting the known treatments—this situation does not reflect patient autonomy.
Culturally, patients have different needs depending upon their religion, their country of origin, and the cultural beliefs that they hold. For these patients, it is important to fully inform them of all treatments, even those that they will reject because of cultural beliefs (Anderson, 2017). One of the benefits of CAM is that there is flexibility in the offerings of biomedicine and complementary therapy options—a sort of hybrid approach can be used that infuses multiple CAMs with conventional medicine (Gale, 2014). The hybridity is able to access a greater patient population without being affected by diversity while promoting patient autonomy.
How to maintain respect for cultural diversity during CAM. Personally, to maintain respect for cultural diversity, it is necessary to be patient when discussing treatments with patients who have conflicting perspectives. One must remain committed to fully informing the patient, but one can also be aware of cultural and religious inclinations in the recommendations for CAM. There are some cultures who will be unable to access certain therapies due to socioeconomic restrictions. Therefore, it would be disrespectful to suggest a CAM that is financially not feasible for a patient.
Not all CAMs are reimbursed. Because CAMs do not uphold medical standards of practice, they are usually not covered by traditional insurances (Cohen, 2015). These policies are changing as insurance companies are relieved of liability and malpractice suits the more that CAMs are included in medical schooling (Anderson, 2017). Furthermore, CAMs are not always classified as “medically necessary” and this leaves insurance companies without any reason to pay (Cohen, 2015). CAMs are considered “experimental” and this also makes it difficult to get insurance companies to pay for any CAM services (Cohen, 2015).
CAM research and conventional research. Conventional research is peer-reviewed and subjected to rigorous standards that have proven reliable over time. CAM research is often experimental and projects potential results prior to the results being proven. CAM research has not been performed in medical schools until recently (Anderson, 2017). Once CAM research is verified through medical schooling, there will likely be a change in the way that insurance reimbursement is settled.
Licensure, malpractice, and legal rules. Practitioners are opening themselves up to liability be suggesting medical treatments that are not in accordance with medical standards (Anderson, 2017). Malpractice liability rules indicate that the practitioner is liable for wrong-doing if not performing up to medical standards—therefore the more that CAMs are deemed safe by medical schools, the more accepted they will be legally. There is no licensure that is permitted through medical schools, at this point, that vouchsafes the practice of CAMs.
CAMs are popular alternatives to conventional medicine; however, they are not covered by insurances, they open practitioners up to malpractice suits, and they increase physician liability and jeopardize licensure. However, because practitioners have a duty to give patients a fully informed choice, it is imperative that patients are informed of their “options.” Many patients will be unable to avail themselves to these options because of reimbursement issues; however, these reimbursement issues will clear up once CAMs remain a part of medical schooling.
- Anderson, E. (2017). Modifiers of complementary therapy: Legal, ethical, and cultural issues. Musculoskeletal Key. Retrieved from https://musculoskeletalkey.com/modifiers-of-complementary-therapy-legal-ethical-and-cultural-issues/
- Cohen, M. (2015). Insurance reimbursement for complementary and alternative modalities. CAM Law. Retrieved from http://www.camlawblog.com/articles/insurance/insurance-reimbursement-for-complementary-and-alternative-medicine-modalities/
- Gale, N. (2014). The sociology of traditional, complementary and alternative medicine. Sociology Compass, 805–822. DOI: 10.1111/soc4.12182
- US National Library of Medicine (NLM). (2013). Complementary and alternative medicine. US National Library of Medicine. Retrieved from https://www.nlm.nih.gov/tsd/acquisitions/cdm/subjects24.html