Full Disclosure: the Case for CAM in Informed Consent

The Article:

This interesting article describes the ethical and legal considerations for informed consent and disclosure of complementary and alternative medicine (CAM) treatments by medical physicians, specifically pediatricians.  The author uses a case study of a chemotherapy-induced naseau and vomiting (CINV) in a pediatric patient to illustrate where disclosure and discussion of acupuncture, which has been shown to be efficacious in adults with CINV, is appropriate.

The article outlines two ethical obligations that physicians have regarding informed consent; an obligation to fully educate a patient and a duty to promote good, preserve life, and ease suffering.  Discussions about treatment decisions that include CAM fully inform a patient and potentially promote good care and ease suffering, especially in supportive or palliative oncology care.  Legally, physicians must ensure that they are obtaining full informed consent from the patient or family.  Currently, there is little law regarding the disclosure of CAM modalities in treatment decisions.   

In the conclusion, the authors suggest that with the growing amount of CAM research, pediatric physicians should keep abreast of the research findings and apply that knowledge to their clinical practice.  In certain situations, the discussion of CAM use may be limited to only those therapies and symptoms where enough evidence-based research exists.

What it Means:

Informed consent is the belief and legal obligation to ensure that a person has adequate faculty, comprehensive information, and a clear understanding of the available choices and consequences of an action.  In medicine, it is the cornerstone of physician counseling and medical decision making.  When advising a patient, a physician is ethically obligated to describe all risks and benefits of all possible courses of action, including the possibility of taking no action.  The addition of CAM modalities into informed consent decisions is a rather new concept in the medication community.

My Take:

This article is an exciting step forward for the education and acceptance of CAM for medical physicians.  I believe that physicians cannot argue with the importance of adequate knowledge of treatment choices for their patients.  However, it is likely unrealistic to expect physicians to keep abreast of CAM research, especially considering the multiple modalities and varying findings in medical literature (see my previous posts on the efficacy of aromatherapy).

When a physician is not comfortable with a certain aspect of a patient’s care, he/she will often refer the patient to another physician, often a specialist in the area of question.  This admittance of discomfort and consult to peers is an integral part of Western medicine.  CAM consults are a potential way to educate patients and collaborate with medical providers.  Here at ITPCU, we are implementing that model.   Physicians and patients can request CAM consults and consequent treatment; inter-department CAM consults are also completed.  As a result, each provider has a list of primary patients that they care for.  At our meetings, we discuss patient treatment plans with both a Western medical and CAM perspective.  The interaction between ITPCU and the physicians and nurse practitioners results in an integrated system, CAM-friendly and educated providers, and happy patients!

Gilmour J, Harrison C, Asadi L, Cohen MH, Vohra S.  Informed consent: advising patients and parents about complementary and alternative medicine therapies. Pediatrics. 2011 Nov;128 Suppl 4:S187-92.