Increasing use of CAM therapies in the United States provides an opportunity to reexamine the ethical foundations of western medical practice with renewed attention to the commitment physicians make when entering into a caring relationship with a patient. Physicians routinely balance risks and benefits in decision making, but the advent of CAM therapies challenges physicians to deal responsibly with paradigms of healing that fall outside the boundaries of conventional medical practice and to make decisions in these unfamiliar realms, often in the absence of evidence. Specific details of each case should be factored into a riskbenefit assessment so that a plan of treatment that is clinically reasonable and ethically appropriate can be developed.
The commitment to joint problem solving over time that is a central obligation of the physicianpatient relationship becomes even more important when considering the use of CAM therapies. Elucidating patients' experiences of illness, their hopes and values, and what they see as their best interests is vital if physicians and patients are to find common ground when making decisions in areas of uncertainty. As the body of evidence regarding CAM therapies grows, we hope that the model of decision making we have presented will provide an ethical structure for medical practice in which physicians routinely combine the powerful tools of conventional medicine with those CAM therapies shown to be worthy of clinical integration.
Author and Article Information
From Oregon Health and Science University, Portland, Oregon; Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; and University of Washington Medical Center, Seattle, Washington.
Acknowledgments: The authors thank the two patients who allowed us to share their stories, Debbie Mosley for invaluable technical assistance, and Martin Donohoe for critical comments.
Grant Support: By unrestricted educational grants from the American Specialty Health Plans, San Diego, California; the Medtronic Foundation, Minneapolis, Minnesota; and the Friends of Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Requests for Single Reprints: Karen E. Adams, MD, Department of Obstetrics and Gynecology UHNSO, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Adams: Department of Obstetrics and Gynecology UHNSO, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239.
Mr. Cohen and Dr. Eisenberg: Center for Alternative Medicine Research and Education, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215
Dr. Jonsen: University of Washington (Emeritus), 1333 Jones Street, San Francisco, CA 94109.
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