title: Unproven stem cell-based interventions & physicians' professional obligations; a qualitative study with medical regulatory authorities in Canada.
abstract: BACKGROUND
  The pursuit of unproven stem cell-based interventions ("stem cell tourism") is an emerging issue that raises various concerns. Physicians play different roles in this market, many of which engage their legal, ethical and professional obligations. In Canada, physicians are members of a self-regulated profession and their professional regulatory bodies are responsible for regulating the practice of medicine and protecting the public interest. They also provide policy guidance to their members and discipline members for unprofessional conduct.
  
  
  METHODS
  We conducted semi-structured telephone interviews with representatives from six different provincial Colleges of Physicians and Surgeons in Canada to discuss their experiences and perspectives regarding stem cell tourism. Our focus was on exploring how different types of physician involvement in this market would be viewed by physicians' professional regulatory bodies in Canada.
  
  
  RESULTS
  When considering physicians' professional obligations, participants drew analogies between stem cell tourism and other areas of medical tourism as well as with some aspects of complementary alternative medicine where existing policies, codes of ethics and regulations provide some guidance. Canadian physicians are required to act in the best interests of their patients, respect patient autonomy, avoid conflicts of interest and pursue evidence-based practice in accordance with accepted standards of care. Physicians who provide unproven treatments falling outside the standard of care, not in the context of an approved research protocol, could be subject to professional discipline. Other types of problematic conduct include referrals involving financial conflict of interest and failure to provide urgent medically necessary care. Areas of ambiguity include physicians' obligations when asked for information and advice about seeking unproven medical treatments, in terms of providing non-urgent follow-up care, and when asked to support efforts to go abroad by providing tests or procedures in advance that would not otherwise be medically indicated.
  
  
  CONCLUSIONS
  Specific policy guidance regarding the identified areas of tension or ambiguity may prove helpful for physicians struggling with these issues. Further consideration of the complex interplay of factors at issue in how physicians may (should) respond to patient demands related to unproven medical interventions while meeting their professional, legal and ethical obligations, is warranted.
authors.affiliation: Johnson-Shoyama Graduate School of Public Policy, University of Regina, Regina, Canada. amy.zarzeczny@uregina.ca.
authors.forename: Amy
authors.initials: A
authors.lastname: Zarzeczny
authors.forename: Marianne
authors.initials: M
authors.lastname: Clark
mesh_terms: D001291:Attitude of Health Personnel; D002170:Canada; D004992:Ethics, Medical; D006801:Humans; D057193:Medical Tourism / Q000941:ethics*; D028681:Moral Obligations; D010817:Physician-Patient Relations; D010820:Physicians / Q000941:ethics*; D017009:Professional Autonomy; D011640:Public Policy; D036301:Qualitative Research; D033581:Stem Cell Transplantation; D013234:Stem Cells; D035703:Therapies, Investigational / Q000941:ethics