Alternative Treatments

Alternative or complementary medicine is a common term for health practices which are generally not available from modern physicians and hospitals. The physician should not abandon the patient who elects to try an alternative treatment. Requests by patients for alternative treatment require balancing the medical standard of care with a patient’s right to choose care on the basis of his or her values and preferences.

Such a request warrants careful attention from the physician. Before advising a patient, the physician should ascertain the reason for the request, for example, whether it stems from dissatisfaction with current care. The physician should be sure that the patient understands his or her condition, standard medical treatment options and expected outcomes.

The physician should encourage the patient requesting alternative treatment to seek literature and information from reliable sources. The patient should be clearly informed if the option under consideration is likely to delay access to effective treatment or is known to be harmful. The physician need not participate in the monitoring or delivery of alternative care to the patient. However, physicians should recognize that some patients may select alternative forms of treatment. This decision alone should not be cause to sever the patient–physician relationship.

Disability Certification

Some patients have chronic, overwhelming or catastrophic illnesses. In these cases, society permits physicians to justify exemption from work and to legitimize other forms of financial support.

In keeping with the role of patient advocate, a physician should assist a patient who is medically disabled in obtaining the appropriate disability status. Disability evaluation forms should be completed factually, honestly and promptly.

Physicians will often find themselves confronted with a patient whose problems may not fit standard definitions of disability but who nevertheless seems deserving of assistance (for example, the patient may have very limited resources or poor housing). Physicians should not distort medical information or misrepresent the patient’s functional status in a misguided attempt to help these patients. The trustworthiness of the physician is jeopardized, as is his or her ability to advocate for patients who truly meet disability or exemption criteria.

Care of the Physician’s Family, Friends and Employees

Physicians should avoid treating themselves, close friends or members of their own families. Physicians should also be very cautious about assuming the care of closely associated employees. Problems may include inadequate history taking or physical examination as a result of role–related discomfort on the part of patient or physician. The physician’s emotional proximity can result in a loss of objectivity. If a physician does treat a close friend, family member or employee out of necessity, the patient should be transferred to another physician as soon as it is practical. Otherwise, requests for care on the part of employees, family members or friends should be resolved by assisting them in obtaining appropriate care. Fulfilling the role of informed and loving adviser, however, is not precluded.

Determination of Death

The irreversible cessation of all functions of the entire brain is an accepted legal standard for determining death when the use of life support precludes the use of traditional cardiopulmonary criteria. After a patient has been declared dead by brain-death criteria, medical support should ordinarily be discontinued. In some circumstances, such as the need to preserve organs for transplantation, to counsel or accommodate family preferences or to sustain a viable fetus, physicians may temporarily support bodily functions after death has been determined.