Informed Consent: Advising Patients and Parents About Complementary and Alternative Medicine Therapies

Joan Gilmour; Christine Harrison; Leyla Asadi; Michael H. Cohen; Sunita Vohra

doi:10.1542/peds.2010-2720H

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Ethically; not a close call for Physicians
David R. Whitlock

Published on: 10 November 2011

Published on: (10 November 2011)

Ethically; not a close call for Physicians
David R. Whitlock, Researcher
There are treatments that have been sufficiently evaluated and have been demonstrated to be safe and effective such that they constitute "standard of care" treatments. Every treatment that has not been demonstrated to be safe and effective is not a "standard of care" treatment and so must be considered either experimental if tests have not been done or unsafe and ineffective if tests have been done and safety and effica...
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There are treatments that have been sufficiently evaluated and have been demonstrated to be safe and effective such that they constitute "standard of care" treatments. Every treatment that has not been demonstrated to be safe and effective is not a "standard of care" treatment and so must be considered either experimental if tests have not been done or unsafe and ineffective if tests have been done and safety and efficacy was not demonstrated.
What constitutes medical malpractice is doing something other than what is the "standard of care". There are infinitely many non-standard of care treatments for every condition. It can't be "standard of care" to inform patients about every single non-standard of care treatment and then tell them why it is not standard of care. In the example given, acupuncture is a placebo. Acupuncture with toothpicks works as well as with needles. Acupuncture off meridians works as well as on meridians. "Real" acupuncture is indistinguishable from placebo acupuncture. Acupuncture in all its forms is a placebo.
Physicians have the ethical default of "first do no harm". Suggesting a non-standard of care treatment that has not been demonstrated to be safe and effective is counter to that default because the non- standard of care treatment may not be safe or effective or may be harmful. Such a suggestion is unethical and would constitute malpractice.
The ethical duty of a Lawyer is of course different than the ethical duty of a Physician. Lawyers have the ethical duty to vigorously advocate for their client provided they do not cross the line into illegal activity. It may be considered ethical by Lawyers for a Lawyer representing a CAM proponent to suggest that Physicians behave unethically and commit malpractice by suggesting a particular CAM treatment modality to unsuspecting patients (Lawyer ethics only apply to clients). I do not understand Lawyer ethics sufficiently to evaluate whether such inducement to non-clients is ethical or not from a Lawyer's viewpoint. As a human being and as a sometimes patient I personally find such inducements morally, ethically and scientifically repugnant, no matter their legal status.
The reason there have been no successful lawsuits claiming malpractice for not suggesting CAM is because such suggestions would constitute malpractice. The suggestion of a Lawyer to a client that such a case would have legal merit is in my opinion legal malpractice, but I am not a Lawyer. If CAM proponents want their treatment modality to be accepted as standard of care, then they need to demonstrate that their CAM treatment is safer and more effective than any treatment it replaces so it becomes not "CAM" but "standard of care Medicine".
It is unethical for Physicians to administer placebos to patients. That CAM practitioners and their Lawyers have different ethical standards does not change the ethical standards Physicians must adhere to. This is not a close call. That some Physicians act unethically and suggest or even use CAM treatment modalities that have not been demonstrated to be safe and effective does not permit ethical Physicians to do likewise.
Conflict of Interest:
Commercializing use of ammonia oxidizing bacteria to treat conditions characterized by low basal nitric oxide.
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Competing Interests: None declared.