3.10 Difficulties in applying conventional bioethics to the CAM relationship
Much of the literature in bioethics views the doctor/patient relationship as the paradigmatic example of a health care encounter. Various assumptions are made about the roles of ‘good’ doctors and ‘good’ patients, gender, dominant cultural values, patient expectations and a shared (western) understanding of health and disease. These assumptions may not be shared by many CAM practitioners or, indeed, CAM patients. Can the language and constructs of bioethics be invoked in analysing CAM relationships? Bioethics is grounded in, and a product of, the dominant biomedical paradigm. Western values and western preoccupation with the rights of the individual underpin traditional discussions of what it means to be an ethical health practitioner.
(Stone, 2002, pp. ix–x)
In view of Stone's words, it may not make sense to apply conventional medical ethics to such diverse CAM practices as traditional Chinese medicine or shamanistic healing. If this is done uncritically, several problems emerge, including the following.
There is no reason to assume that the autonomy-focused ethics of western, liberal democracies should automatically provide the theoretical underpinnings for CAM, much of which is grounded in different, non-rational, non-scientific cosmologies.
The dynamics of the CAM therapeutic relationship may mean users are far more willing to trust their CAM practitioner than their conventional doctor and are less inclined to take a hostile, litigious approach if the therapy is unsuccessful. This requires an ethical framework that goes beyond the confines of most duty-based, professional codes of ethics and embraces the notion of mutual trust and mutual responsibility, in which users are active participants in their own healing process.
Much of the current debate about ethics concerns the use of hi-tech, orthodox medicine. The low-tech or relatively low-cost nature of CAM interventions raises fewer of these issues, although the therapeutic relationship may generate as many, if not more, ethical issues than the typical doctor–patient relationship.
Many aspects of CAM treatment are not evidence-based, so it may be very difficult to provide information, for example about known side effects, to users and to provide that information in the percentage terms preferred by law.
Not all users of CAM are ill. The ethics of preventive medicine and wellness maintenance may require a separate ethical approach. In conventional ethics, the duties of the practitioner derive specifically from the fact that the patient is ill and their autonomy and decision-making ability may be compromised. This may not be the case when the user seeks treatment to prevent ill health and to maximise their autonomy.