Sunday, December 2, 2007

Alternative Medicine & Hospital Ethics

In today's New York Times "The Ethicist" column, the always engaging Randy Cohen provides a model terse analysis of a complex organizational ethics question:

I work at a hospital where several nurses practice therapies like healing touch and therapeutic touch, said to adjust a patient’s energy field and thereby decrease pain and improve healing, although there is no significant evidence for this. If those nurses believe in these treatments, may they tell the patient they are effective? If the treatments provide merely a placebo effect, telling patients about this lack of evidence might undermine that benefit. Would that justify withholding the information?

Cohen starts by making the obvious point about informed consent: if the alternative treatments are offered, the nurses must inform the patients that the treatments are based on "non-standard" theories and have not been validated by research. Their personal conviction that the treatments work is just that -- personal conviction -- not evidence.

What I like most in Cohen's response is the way he thinks about individuals and the organization. Here is his concluding paragraph, with my comments in boldface:

What the nurses could do is explain that their techniques are unproved and unendorsed by the hospital (if this is the case; hospitals vary), offering patients, in effect, the sort of supplemental treatment available outside the hospital. But this approach is not without risk. A therapy provided in the hospital by its staff carries a sense of official approval, no matter what disclaimers are offered. [Cohen is right -- both the nurses as individuals and the hospital as an organizational entity have ethical obligations to the patient. The perspectives of both parties -- nurses and hospital -- must be presented to the patient.] In any case, these nurses must alert their colleagues and hospital administrators about such things. Both groups need to know how patients are being treated if they are to do their jobs well. [Cohen believes, correctly, that a well-functioning hospital can be a big tent. Patients can be offered science-based "western" care and tradition-based alternative "eastern" care if the nurses, their colleagues, and the hospital leadership, can allow their different perspectives to live side-by-side.]

Hospitals, like orchestras, benefit from having players with a wide range of talents and styles. Ethically excellent hospitals learn how to harness this variety on behalf of their patients. If in the future I were in a hospital for chemotherapy, I would hope to have "healing touch" available as well.

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