Pediatric use of complementary therapies: ethical and policy choices.
OBJECTIVE
Many pediatricians and parents are beginning to integrate use of complementary and alternative medical (CAM) therapies with conventional care. This article addresses ethical and policy issues involving parental choices of CAM therapies for their children.


METHODS
We conducted a literature search to assess existing law involving parental choice of CAM therapies for their children. We also selected a convenience sample of 18 states of varying sizes and geographic locations. In each state, we inquired within the Department of Health and Human Services whether staff were aware of (1) any internal policies concerning these issues or (2) any cases in the previous 5 years in which either (a) the state initiated proceedings against parents for using CAM therapies for their children or (b) the department received telephone calls or other information reporting abuse and neglect in this domain. We asked the American Academy of Pediatrics and the leading CAM professional organizations concerning any relevant, reported cases.


RESULTS
Of the 18 state Departments of Health and Human Services departments surveyed, 6 reported being aware of cases in the previous 5 years. Of 9 reported cases in these 6 states, 3 involved restrictive dietary practices (eg, limiting children variously to a watermelon or raw foods diet), 1 involved dietary supplements, 3 involved children with terminal cancer, and 2 involved religious practices rather than CAM per se. None of the professional organizations surveyed had initiated proceedings or received telephone calls regarding abuse or neglect concerning parental use of CAM therapies.


CONCLUSIONS
Pediatric use of CAM therapies raises complex issues. Clinicians, hospitals, state agencies, courts, and professional organizations may benefit from a policy framework to help guide decision making.
Cohen
Michael H
MH
Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School, Boston, Massachusetts, USA.
Kemper
Kathi J
KJ
Stevens
Laura
L
Hashimoto
Dean
D
Gilmour
Joan
J
D002648:Child; D002649:Child Abuse / Q000331:legislation & jurisprudence; D002651:Child Advocacy / Q000331:legislation & jurisprudence*; D000529:Complementary Therapies / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D003657:Decision Making; D004989:Ethics; D006761:Hospitals; D006801:Humans; D016134:Organizational Policy; D010290:Parents; D016312:Treatment Refusal; D014481:United States