- Law and ethics in complementary medicine: A handbook for practitioners in Australia and New Zealand
- Ethics: Ethical Issues in Complementary/Alternative Therapies
- 1st Edition
- Code of Conduct. | GRCCT
Code of ethics for nurses with interpretive statements. Washington, DC: Author. Buckle, R. Clinical aromatherapy in nursing. London: Arnold. Continental Health Promotion, Inc. Vitamins: Mighty medicine or sure-fire insurance? The CommonHealth Compass. Richmond, VA: Author. Frisch, N. Online Journal of Issues in Nursing , 6 2 , manuscript 2. Retrieved June 15, , www.
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Standards for holistic practice: A way to think about our care that includes complementary and alternative modalities. Online Journal of Issues in Nursing , 6 2 , manuscript 4. Gaydos, H. Complementary and alternative therapies in nursing education: Trends and issues. Online Journal of Issues in Nursing , 6 2 , manuscript 5. Leonard, B.
Quality nursing care celebrates diversity. Online Journal of Issues in Nursing , 6 2 , manuscript 3. Ludwick, R. Nursing around the world. Online Journal of Issues in Nursing. Retrieved September 8, , from: www. Snyder, M. Issues in complementary therapies: How we got to where we are.
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Weston, A. A practical companion to ethics 2nd ed. New York: Oxford University Press. OJIN is a peer-reviewed, online publication that addresses current topics affecting nursing practice, research, education, and the wider health care sector. Find Out More Benefit for Members Members have access to current topic More Letter to the Editor Thank you for giving us the opportunity to respond to the letter to the editor written by Lisa Palucci. We are pleased to see her interest in older adults with multimorbidity and advancing models of care and care coordination for this growing population group.
Continue Reading View all Letters As a result, several ethical concerns surrounding safety arise: Although manufacturers of dietary supplements cannot claim prevention of or cure for diseases, they can easily circumvent this language by creative wording that promises more than the dietary supplement can deliver. Regarding names and advertising, there are no set standards. Therefore, legally but not ethically manufacturers can use clever names to make it appear they are targeting their product toward a specific group like the elderly.
As a result, some manufacturers of dietary supplements will add substances that have no daily value but will increase the cost. Also, some manufacturers will add large amounts of cheap nutrients but small amounts of expensive ones. In the current frenzied environment of megadoses of dietary supplements, some important safety factors are often overlooked.
He proposes the following integrative strategies as ethically viable: When truly opposite values conflict we can at least split the difference. Different values may still be compatible.grupoega.com/components/2020-02-12/7909-rastrear-celular-android.html
Law and ethics in complementary medicine: A handbook for practitioners in Australia and New Zealand
We can explore them with an eye to finding ways to satisfy both at the same time. It was recommended that the standard of care for giving information to patients remain the same as the current common law standard as explained in Rogers v Whitaker. These recommendations have been adopted, to varying extents, in most jurisdictions. Thus, CAM should not only be discussed with patients who directly ask questions about it, but also at other times when discussions of CAM may become more significant for patients.
Examples are where the burden of illness is substantial; where there is no proven conventional therapy available; where the therapy that is available is invasive or associated with minimal benefit or major toxicity; where complementary therapy may be of benefit and has few risks; and where the patient has expressed an interest in, or preference for, alternative therapies.
The question then becomes what should doctors know about CAM? This is particularly difficult to answer, as the degree of knowledge required of a doctor may vary according to his or her specialty and to the degree to which they incorporate CAM within their own practice. For example, oncologists may have a greater obligation to know about CAM used in cancer care than GPs, while those who use acupuncture in their own practice will have a greater obligation to understand the evidence relating to its risks and benefits than doctors who do not use it.
The issue of how much medical practitioners should know about CAM is made more complex because of real questions about the availability, quality and accessibility of evidence on its efficacy, risks and benefits. Simply asserting that medical practitioners should assess the appropriateness of CAM therapies and discuss proven alternative treatment options with their patients does not account for the lack of clear standardisation and regulation of CAM, the general lack of data about CAM therapies, the lack of discourse between patients and doctors about CAM therapies, and the lack of awareness of the evidence for CAM.
The regulation of medicines including complementary medicines in Australia is the responsibility of the Commonwealth Therapeutic Goods Administration TGA. In , the TGA established the Office of Complementary Medicines, which focuses exclusively on the regulation of complementary medicines and is responsible for recalls of faulty or potentially dangerous products.
While the federal government has funded some groups of CAM practitioners to explore avenues for self-regulation, at present the regulation of complementary practitioners remains the responsibility of state governments. However, all state jurisdictions have legislation with varying requirements for registration of chiropractors and osteopaths. Most CAM practitioners are therefore subject only to varying forms of professional self-regulation.
As with conventional medical practitioners, the practices of complementary practitioners may also be subject to review through healthcare complaints bodies and, where something has gone wrong, by the courts. While the ingredients of listed and registered complementary medicines are assessed for safety and quality, most have not been rigorously assessed for efficacy, and there are very limited data on potential interactions between complementary medicines and conventional therapies.
Literature from the US suggests that most doctors have limited knowledge of CAM therapies, and this may be primarily determined by their beliefs about the legitimacy of the therapies. Overemphasis on evidence, regulation or integration fails to appreciate the substantial differences between allopathic and complementary medicine, including differences in the meaning and context of health and illness; in methods, language and culture; and in the relationship to science.
The history and philosophy of Western medicine shows that, while conventional and complementary medicine share various historical features, such as reference to vitalism, holism and humoral balance, an enormous gulf exists between the two. This is accentuated by the absence of a common language between complementary and alternative therapies because of their heterogeneity. While government, the AMA and others appear to support the integration of evidence-based CAM, such an approach has significant implications. Integration may actually mean subjugation, disintegration or marginalisation; may fail to account for difference; and may fundamentally alter CAM practice by emphasising standardisation, efficiency and generality at the expense of communication and individualised care.
If part of the attraction of CAM is its uniqueness, or its non-biomedical conceptions of health and disease, then integration might result in the loss of this alternative, or more likely it may result in the expansion of conventional medicine as it absorbs evidence-based CAM and the reshaping, shrinking and marginalisation of the CAM modalities that remain.
It remains to be seen whether an Australian court will find that a doctor has acted negligently in failing to disclose information and advice about CAM options. However, both the profession and individual doctors should reflect on the issues raised by CAM and should discuss use of CAM with their patients. CAM is likely to remain popular with the Australian public, and, while it may become more or less integrated with conventional medicine, CAM will not disappear and medical practitioners will never have the same skills and knowledge of CAM as complementary therapists.
While major questions remain about the evidence for CAM, the regulation of CAM practitioners and the legal obligations of conventional practitioners in relation to CAM, medical practitioners and students no longer have any choice but to gain some knowledge about CAM and the interface between conventional and complementary medicine. Summary of the case McGroder v Maguire , 11 illustrating that, before referral, it is essential to perform adequate clinical assessment and fully inform patients of the risks and benefits of any proposed treatments.
The patient Maguire injured his neck when he hit his head on the roof of a truck cabin while driving over a bump. Despite treatment he continued to suffer from tingling in one arm. Two years after the original injury he attended the employer's consultant general practitioner McGroder , who referred him to a chiropractor Ayscough. The GP did not carry out a physical examination and probably did not refer to the medical records held by the employer. He underwent surgery, but, two years later, a neurosurgeon concluded he was permanently unfit for work.
At trial, his neurosurgeon and orthopaedic surgeon both gave expert medical evidence that, in light of his condition, he should not have been referred for chiropractic treatment. The trial judge found that the GP had negligently referred the plaintiff to the chiropractor and the chiropractor had negligently treated him.
Ethics: Ethical Issues in Complementary/Alternative Therapies
The GP lost the appeal. His [GP] negligence generated the risk of injury by referring him [the patient] for inappropriate treatment. When referring a patient to another healthcare provider for treatment, it is advisable to obtain a thorough history, perform a relevant physical examination and review any available medical records first.
Negligence by another healthcare provider may not relieve referring doctors of responsibility for their own conduct. Publication of your online response is subject to the Medical Journal of Australia 's editorial discretion. You will be notified by email within five working days should your response be accepted.
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Code of Conduct. | GRCCT
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Article type. Author's surname. First page. Short reports. Guidelines and statements. Narrative reviews. Ethics and law. Medical education. Complementary and alternative medicine. Volume Issue 3. Ethical and legal issues at the interface of complementary and conventional medicine. Med J Aust ; 3 : Topics Ethics and law. Abstract Doctors should:.
Complementary medicine and consent Medical practitioners are ethically and legally obliged to provide patients with enough information to make adequately informed healthcare decisions and valid consent to treatment. Evidence, regulation and integration The issue of how much medical practitioners should know about CAM is made more complex because of real questions about the availability, quality and accessibility of evidence on its efficacy, risks and benefits. Regulation of complementary practitioners The regulation of medicines including complementary medicines in Australia is the responsibility of the Commonwealth Therapeutic Goods Administration TGA.
Irreducible differences between conventional and complementary medicine While the ingredients of listed and registered complementary medicines are assessed for safety and quality, most have not been rigorously assessed for efficacy, and there are very limited data on potential interactions between complementary medicines and conventional therapies. Is integrating proven CAM into conventional medicine the answer? Conclusion It remains to be seen whether an Australian court will find that a doctor has acted negligently in failing to disclose information and advice about CAM options.
Summary of the case McGroder v Maguire , 11 illustrating that, before referral, it is essential to perform adequate clinical assessment and fully inform patients of the risks and benefits of any proposed treatments The patient Maguire injured his neck when he hit his head on the roof of a truck cabin while driving over a bump.