Tilburt Jon C, Miller Franklin G
Department of Clinical Bioethics, National Center for Complementary and Alternative Medicine, National Institutes of Health, Bethesda, MD 20892, USA.
J Am Board Fam Med. 2007 Sep-Oct;20(5):489-94. doi: 10.3122/jabfm.2007.05.060205.
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.
补充和替代医学（CAM）的流行给执业临床医生带来了一系列伦理问题。生物医学伦理原则界定了医疗保健专业人员的义务，但在补充和替代医学与生物医学的交叉领域将这些原则应用于具体案例可能极具挑战性。“认识医学多元性”有助于临床医生进行与补充和替代医学相关的伦理思考。在此，我们概述一种基于医学多元性应用生物医学伦理基本原则的三点实用方法：（1）询问补充和替代医学的使用情况以及与补充和替代医学相关的科学证据，（2）承认患者的健康观念和做法，（3）接纳多种治疗方法。如此理解的话，认识医学多元性鼓励以务实的态度审视与使用补充和替代医学相关的个人和文化意义、生物医学的偏见和假设，以及补充和替代医学疗法的风险效益比。通过这种方式，认识医学多元性可以帮助临床医生以符合基本伦理原则的方式提高患者护理水平。
