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Within the health care profession, as practitioners, we find ourselves in a sector that is subject to the most intensive and sensitive regulation. We are entrusted with the highest good of all, the life of human beings. This confidence in our credentials requires sincere monitoring, directing, and legislative and ethical boundaries. We are dealing with a patients´ most vulnerable existence, illness, a state when his vitality is weakened by imbalance.  Whether practicing in general medicine or complementary and alternative fields, we are all dealing with this highest good and have to prove our worthiness and are required to abide to the rules that assure the patients security.

Samuel Hahnemann laid out the initial rules of professional practice in the field of homeopathy, in his first aphorisms of his Organon [1]. Aphorism 1 states that it is a practitioners´ highest good and only profession to retrieve the sick man from illness and render healthy again. Aphorism 2 then tells us that the highest ideal of curing is to do it quickly, gentle and such that the healing is of permanence. We are to remove and abolish in entirety the disease and are to do this most rapidly, reliably and following precise, comprehensive motives. These words can well be translated into our times and are contingent to many professional codes of the health practices, ever since first pledged in the oath of Hippocrates [2]; and today manifest in the declaration of Geneva [3]. These phrases constitute the ethical principle of beneficence.

Beneficence, whether to the allopath or the homeopath, in practice, means the same thing; that it is our duty to our patients, to act in their best interest and to do good [4]. But at the same time of laying out an ethical boundary for the practitioner, it is here perceivable that these boundaries are liable to flexibility. Because, with Beneficence, what is good for the patient is left to be declared by whom? Is the practitioner competent enough to explain to the patient all aspects of a therapy such that he, the patient can make the decision for or against a therapy himself? Is the autonomy, the ability of the patient to actively make his own decisions [5], at all times sustained with the patient? What about non-maleficience, that requires us to do no harm to our patients [4]? With vaccinations, for example, patients are receiving injections of a harmful nature. Is the general practitioner committing non-maleficience?

For a general practitioner abiding to the code of ethics seems slightly more complicated than it is for the homeopath. What if the general practitioner has to treat a patient that is brought into his care unconsciously [6]; who decides on beneficence and where does that leave autonomy? An overall rule that needs to be followed is that whatever a practitioner decides on, the benefits of a treatment have to outweigh the risks.

In homeopathic practice, to fully explain to the patient all aspects of homeopathy and all effects that a remedy reaction may bring forth would exceed the time available for a consultation. So are we practicing unethically? We cannot possibly provide all information that there is. But we are required to provide enough information for our patient to understand and be able to make an autonomous decision [7].This decision the patient then makes has to be respected, even if it should, to our beliefs, be inappropriate to the patients´ positive health development. We are complying with the principle of autonomy. But it is here that beneficence and autonomy may clash. Especially in general medicine, this clash is apparent, so for example where patients need, yet refuse to have a blood transfusion because their religious believes prohibit them to [8]. In order to protect the practitioner it is therefore, important to have the patient sign a consent form where he declares his abstinence from treatment or therapy. Likewise if the patient wishes to proceed with a treatment, in order to protect the practitioner, the former should have to sign a form of contract where he declares his approval and understanding of the procedure and the possible consequences [5].

Where such “contracts”, or consent forms, have not been signed, from a legislative aspect, a practitioner may be exposed to claims of civil liability. This may also occur where tort of negligence of the practitioner towards the patient is claimed. But to be proven guilty of negligence the principles of negligence must have been violated. 1. To owe a duty of care, 2. To breach that duty,3. This breach of duty must have caused the damage complained of [9].

What about ethical justice? Are we able to provide our services to everybody on equal terms [5]? The diverse health systems of many countries have shown us that this is impossible. We already have medical systems today that at the most provide essential medicinal services rather than fulfil the necessary requirements [10]. The discrepancy in the health care system lies in deep confrontation to the ethical principle of justice which states that all patients have to be treated equally and have to be given access to the same resources [5]. Therapies of complementary and alternative practice though are not integrated into the health care systems and have to be disbursed privately by the patient and are therefore not obtainable for every patient. From this point of view justice is not met.

The issue of ethics is not a simple one and it is evident that stretchable boundaries are necessary. To assure that these boundaries are maintained, a health care professional is a member of a board or society monitoring professional practice within the practitioners´ field of competence. Ethics is the code of behavior that guides our actions in our professional environment [11]. To abide by these rules is essential for any practitioner in the health care sector. What is important to remember is that at all times the benefit has to outweigh the risk.

So can we as homeopaths, meet the ethical demands that our professional body codified for us, fully and at all times? We have to attempt to fully comply, but have to accept and be aware of the fact that the ethical principles overlap and their restrictive boundaries are slightly flexible.

[Thanks to Jean Duckworth, University of Central Lancashire, for assistance with this assignment]

References:

[1] Hahnemann, S., 1974. Organon der Heilkunst. 2te Auflage. Heidelberg: Karl F. Haug Verlag.

[2] Bauer, A., Anon. Der Hippocratische Eid [online] last accessed 24 January 2009 at URL http://www.rzuser.uni-heidelberg.de

[3] Jones, D., 2006. The Hippocratic Oath II [online] last accessed 09 February 2009 at URL http://www.catholicdoctors.org.uk

[4] Pantilat, S., 2008. Beneficence vs. Nonmaleficence [online] last accessed 05 February 2009 at URL http://missinglink.ucsf.edu

[5] Swagerty, D. Anon. Ethics: Terms [online] last accessed 10 February 2009 at URL http://classes.kumc.edu

[6] Davenport, J. 1997. Ethical principles in clinical practice [online] last accessed 05 February 2009 at URL http://xnet.kp.org

[7] Ernst, E., Cohen, M., and Stone, J., 2003. Ethical problems arising in evidence based complementary and alternative medicine [online] last accessed 19 January 2009 at URL http://jme.bmj.com

[8] Gardiner, P., 2003. A virtue ethics approach to moral dilemmas in medicine [online] last accessed 07 February 2009 at URL http://jme.bmj.com

[9] Duhaime, L., 2006. Negligence an Introduction [online] last accessed 07 February 2009 at URL http://www.duhaime.org

[10] Schulz-Ehring, F., Weber, C., 2008. Zwei-Klassen-Medizin [online] last accessed 24 January 2009 at URL http://www.pkv.de

[11] Fieser, J., 2006. The Internet Encyclopedia of Philosophy [online] last accessed 10 February 2009 at URL http://www.iep.utm.edu


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