3.15 Key ethical issues for CAM practitioners: respect for autonomy and consent
Many practitioners claim that the patient-centred nature of their therapy means they automatically respect the user's autonomy. On closer inspection, CAM practitioners’ commitment to respecting the users' wishes and values may be less patient-centred than they would like users to believe. Some CAM practitioners may fail to acknowledge users' rights, particularly in the area of risk disclosure and gaining consent to treat, or even touch, the user. Some CAM practitioners mistakenly believe that the mere fact the user has consulted them counts as implied consent and that it is not necessary to seek any further consent. Many health professionals (both conventional and CAM) also mistakenly think that the primary function of obtaining consent is to stop them from being sued. Some CAM practitioners assume that, because hardly any practitioners are sued, their users do not need to give express consent, even to invasive and potentially dangerous procedures.
As a matter of ethics and law, consent requirements include giving users adequate information, ensuring that they are competent to consent, and making sure the decision is voluntary. Ernst (1996) argues that, if the practitioner does not have evidence about risks and side effects, it is not possible to gain consent. Certainly, not all therapies have the sort of scientific evidence necessary to give a meaningful risk:benefit ratio. Then again, many of the procedures that users consent to in conventional medicine are only just starting to be evaluated scientifically.
Stone (2002) argues that a better interpretation of the information requirement is to provide as much information as the user feels is necessary to make an informed decision. This fits in with the consent process being fundamentally about enhancing and facilitating a user's autonomy, including the absolute right of competent people to make decisions for themselves that others would regard as foolhardy. It is, arguably, a user's right as an autonomous agent to deliberately choose a therapeutic modality that has not been scientifically validated to give risk:benefit ratios with any precision or to identify the full range of possible side effects. By moving outside a more empirically researched, reductionist framework, users must accept that the risks and benefits will be expressed within the paradigmatic framework of that therapy only.