3.4.2 CAM practitioners are more ethical than conventional doctors
Proponents of CAM argue that because it is safer and has fewer side effects than conventional medicine, CAM practitioners must be inherently more ethical than doctors. This is a false argument in several respects. While CAM is generally very safe compared with some powerful conventional remedies (a point acknowledged in para. 4.21 of the House of Lords Report, 2000), all therapies can cause harm in unskilled hands. Some side effects of CAM are potentially serious, particularly if there is a clinical reason for not giving a user a form of treatment that the practitioner has not ascertained or lacks the medical knowledge to appreciate. For example, a CAM practitioner might give a remedy that increases the effect of a conventional drug that the user is also taking.
However, in terms of whether CAM practitioners are more ethical than doctors, ethical practice is not only about having necessary technical skills. Ethical practice requires appropriate knowledge, skills and attitudes, including the consideration of users' rights and values, being non-judgemental, developing listening skills, and delivering culturally sensitive care. All of these attributes need to be acquired during the process of professional training and/or apprenticeship. They are every bit as important as practitioners’ technical skills. To be a ‘good’ practitioner requires both technical skills and ethical awareness.
Every health profession has its share of unethical practitioners and CAM is no exception. Most CAM encounters involve a private practitioner seeing users either alone in his or her own home or behind closed doors in a clinic. Thus there may not be the collective responsibility found in a National Health Service setting. No one can look over a practitioner's shoulder all of the time. There is ample scope and opportunity for unethical practitioners to abuse their users' trust. Work in the UK with abused people suggests that abuse occurs across a range of CAM professions and that much poor practice currently goes unreported (POPAN, 2003). The absence of litigation against CAM practitioners is no indication of their propriety because of the practical and theoretical barriers to mounting a legal action. Unethical practice may only come to light in the aftermath of a dramatic legal case or disciplinary hearing which the media choose to report.
Also, despite the claim that CAM is patient-centred (that is, puts the user's views, wishes and needs at the heart of the therapeutic encounter), some CAM practitioners can be just as paternalistic as doctors, if not more so. As Cant and Sharma (1996, p. 12) observe, while commentators tend to focus on the liberating aspects of complementary medicine:
Complementary medicines have the capacity to be involved simultaneously in … both the increase and the decrease of dependence on therapeutic experts.