title: Responding to medical pluralism in practice: a principled ethical approach.
abstract: The popularity of complementary and alternative medicine (CAM) raises a range of ethical issues for practicing clinicians. Principles of biomedical ethics define obligations of health care professionals, but applying principles in particular cases at the interface of CAM and biomedicine may be particularly challenging. "Recognition of medical pluralism" can help clinicians' ethical deliberations related to CAM. Here we outline a 3-point practical approach to applying basic principles of biomedical ethics in light of medical pluralism: (1) inquiring about CAM use and the scientific evidence related to CAM, (2) acknowledging the health beliefs and practices of patients, and (3) accommodating diverse healing practices. Construed as such, recognition of medical pluralism encourages pragmatic willingness to examine the personal and cultural meaning associated with CAM use, the biases and assumptions of biomedicine, as well as the risk-benefit ratio of CAM practices. In this way, recognition of medical pluralism can help clinicians enhance patient care in a manner consistent with basic ethical principles.
authors.affiliation: Department of Clinical Bioethics, National Center for Complementary and Alternative Medicine, National Institutes of Health, Bethesda, MD 20892, USA. tilbertj@cc.nih.gov
authors.forename: Jon C
authors.initials: JC
authors.lastname: Tilburt
authors.forename: Franklin G
authors.initials: FG
authors.lastname: Miller
mesh_terms: D015670:Acupuncture Therapy; D000328:Adult; D001943:Breast Neoplasms / Q000628:therapy; D003113:Colonoscopy / Q000009:adverse effects / Q000191:economics / Q000941:ethics; D000529:Complementary Therapies / Q000941:ethics*; D003657:Decision Making / Q000941:ethics*; D005194:Family Practice / Q000941:ethics*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012017:Referral and Consultation / Q000941:ethics*