Ethical medicine

Townsend Letter for Doctors and Patients,  April, 2004  by Katherine Duff

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Professionalism and Ethics in Complementary and Alternative Medicine

by John Crellin and Fernando Ania

Haworth Integrative Healing Press, 10 Alice Street

Binghamton, New York 13904-1580 USA

Hardcover, ISBN: 0-7890-1225-1, 2002, 252 pp., $49.95

In the rapidly changing world of health care, the need for a discussion of ethics has never been greater. The field of alternative medicine offers unique challenges that are addressed in the book, Professionalism and Ethics in Complementary and Alternative Medicine. Written by medical educators John Crellin and Fernando Ania, this book offers a look at the big picture of ethics through an historical perspective and a review of the literature that addresses ethics in mainstream and alternative medicine.

The authors want this book to impress upon those providing health care that there are many concerns about healthcare that are essential considerations in ethics and professionalism. They accomplish this in this small but densely written book.

Crellin and Ania point out that alternative medicine has been enjoying increased interest and growth over the last twenty years, largely as a result of patient demand for an emphasis on wellness. This has brought increased scrutiny from mainstream medicine and government bodies that regard therapies that do not adhere to "scientific medicine" as quackery. But at the same time, some in mainstream medicine are accepting some of the therapies and making referrals to alternative practitioners such as acupuncturists. This in turn has generated more demanding patients who have greater expectations.

In the first part of this book, the authors discuss the current trends in medicine. They are careful to note however, that alternative medicine and mainstream medicine are, at their roots, different approaches to health. So while some issues can be judged the same in both areas, those in alternative medicine face public scrutiny on several issues. There are concerns about the safety, quality and efficacy of alternative treatments and procedures. Another issue is the concern about an "unregulated practitioner" making diagnoses. Misleading labels and hype, such as miracle cures, is another cause for concern. The book addresses these issues and more, with an emphasis on the similarities and differences between attitudes in the United States, Canada and Britain.

The second part of this book concerns the role of professionalism. Here we find a discussion of the oaths and codes that have defined mainstream medicine's identity throughout history and those recently adopted by alternative medical groups. There is also an examination of several of the ethical approaches that have been utilized in medicine, such as autonomy, beneficence and justice. The section concludes with an examination of the many roles of the health practitioner in their relationship to patients.

And finally, there are twelve case studies that cover a variety of situations that call for ethical evaluation. At this point the authors reveal their five-point, "stepwise approach" for analyzing ethical issues. These five points are: 1) gathering full knowledge and facts; 2) consideration of guiding ethical principles and codes of ethics; 3) assessment of patient beliefs; 4) practitioner's evaluation of his or her own predispositions toward ethical analysis; 5) a consideration of how to negotiate decisions and particular views, with emphasis on effective communication with the patient.

Authors Crellin and Ania make the case in this book that the many changes in health care call for an examination of professionalism and ethics. This book raises the ethical questions and offers a method of evaluating that could be helpful for all practitioners, but its greatest use may be in generating the debate and discussions whose time has come.

review by Katherine Duff

COPYRIGHT 2004 The Townsend Letter Group
COPYRIGHT 2004 Gale Group