3.16 Key ethical issues for CAM practitioners: consent for children receiving CAM
Growing numbers of parents seek CAM for their children, as witnessed by the development of paediatric specialities in some CAM therapies, such as neonatal and paediatric osteopathy. A key ethical issue is that, in the UK, as in other jurisdictions, parents are entrusted to act as proxy decision makers for their children's health decisions until they can make their own choices. Parents are bound by law to make decisions in their children's best interests. Although most CAM therapies are relatively safe and have few side effects, there may not be evidence to establish that the treatment is in the child's best interests, which is the supposed requirement of any treatment. In the UK there is an additional factor: the Children and Young Persons Act 1933 requires parents to provide ‘medical aid’ for their children. It has never been definitively tested whether this means parents should seek conventional medical treatment before seeking CAM, or should seek only conventional medicine when their child is seriously ill.
Significantly, the civil liberties aspect of parents’ right to prefer CAM over conventional medicine has not been adequately discussed. Since the courts are likely to adopt a more restrictive attitude than a liberal stance when a child's welfare is at stake, extra care is needed in making decisions for those who cannot decide for themselves. It is always wise for a practitioner to seek parental consent for immature minors and to explore the least risky therapeutic options first. The same cautious stance should be taken with a person who cannot give informed consent. In the case of an incompetent adult, nobody can consent to medical treatment (including CAM) on their behalf.