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Medicolegal considerations in the use of complementary therapies in children

Medicolegal considerations in the use of complementary therapies in children
Do parents or guardians elect to abandon effective care when the child's condition is serious or life-threatening?
Courts are likely to respect parental or guardian choices that are supported by some medical authority and that present reasonable alternatives as long as the child's life is not in danger and conventional care is not imminently necessary. The child's condition should be monitored so that conventional interventions can be used if necessary.
Will the use of complementary therapy otherwise divert the child from imminently necessary conventional treatment?
If not, a "time-limited" trial of the proposed approach may be appropriate[1,2], provided that the child can be monitored conventionally and conventional therapy can be continued as appropriate[3,4].
Are the complementary therapies that have been selected known to be unsafe or ineffective?
The medical evidence can be categorized as follows, with increasing risk of liability[3]:
  1. Medical evidence supports efficacy and safety – the therapy can be recommended; efficacy should be monitored.
  2. Medical evidence supports safety, but evidence regarding efficacy is inconclusive – the therapy can be tolerated; efficacy should be monitored.
  3. Medical evidence supports efficacy, but evidence regarding safety is inconclusive – the therapy should be monitored closely or discouraged.
  4. Medical evidence indicates serious risk and inefficacy – the therapy should be avoided and actively discouraged.
The clinician caring for the patient should continue to monitor the patient and the literature for new information that would change the category.
Have the proper parties consented to the use of the complementary therapy?
Informed consent is particularly important when informing the patient about complementary therapies that may affect the patient's choice of treatment[5].
Is the risk-benefit ratio of the proposed complementary therapy acceptable to a reasonable, similarly situated clinician, and does the therapy have at least minority acceptance or support in the medical literature?
References:
  1. American Academy of Pediatrics: Counseling families who choose complementary and alternative medicine for their child with chronic illness or disability. Committee on Children With Disabilities. Pediatrics 2001; 107:598.
  2. Adams KE, Cohen MH, Eisenberg D, Jonsen AR. Ethical considerations of complementary and alternative medical therapies in conventional medical settings. Ann Intern Med 2002; 137:660.
  3. Cohen MH, Eisenberg DM. Potential physician malpractice liability associated with complementary and integrative medical therapies. Ann Intern Med 2002; 136:596.
  4. Eisenberg DM. Advising patients who seek alternative medical therapies. Ann Intern Med 1997; 127:61.
  5. Ernst E, Cohen MH. Informed consent in complementary and alternative medicine. Arch Intern Med 2001; 161:2288.

Adapted from: Cohen MH, Kemper KJ. Complementary therapies in pediatrics: A legal perspective. Pediatrics 2005; 115:774.

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