Osgoode Hall Law School, York University, Toronto, Ontario, Canada.
Pediatrics. 2011 Nov;128 Suppl 4:S206-12. doi: 10.1542/peds.2010-2720K.
Our goal for this supplemental issue of Pediatrics was to consider what practitioners, parents, patients, institutions, and policy-makers need to take into account to make good decisions about using complementary and alternative medicine (CAM) to treat children and to develop guidelines for appropriate use. We began by explaining underlying concepts and principles in ethical, legal, and clinical reasoning and then used case scenarios to explore how they apply and identify gaps that remain in practice and policy. In this concluding article, we review our major findings, summarize our recommendations, and suggest further research. We focus on several key areas: practitioner and patient/parent relationships; decision-making; dispute resolution; standards of practice; hospital/health facility policies; patient safety; education; and research. Ethical principles, standards, and rules applicable when making decisions about conventional care for children apply to decision-making about CAM as well. The same is true of legal reasoning. Although CAM use has seldom led to litigation, general legal principles relied on in cases involving conventional medical care provide the starting point for analysis. Similarly, with respect to clinical decision-making, clinicians are guided by clinical judgment and the best interests of their patient. Whether a therapy is CAM or conventional, clinicians must weigh the relative risks and benefits of therapeutic options and take into account their patient's values, beliefs, and preferences. Consequently, many of our observations apply to conventional and CAM care and to both adult and pediatric patients.
我们本期刊物的目标是考虑从业者、家长、患者、机构和决策者需要考虑哪些因素，以便就使用补充和替代医学（CAM）治疗儿童做出明智决策，并制定适当使用的指南。我们首先解释了伦理、法律和临床推理中的基本概念和原则，然后使用案例情景来探讨它们的应用，并确定实践和政策中仍然存在的差距。在这篇结论性文章中，我们回顾了我们的主要发现，总结了我们的建议，并提出了进一步的研究。我们重点关注几个关键领域：从业者和患者/家长的关系；决策；争议解决；实践标准；医院/医疗机构政策；患者安全；教育；和研究。适用于儿童常规护理决策的伦理原则、标准和规则同样适用于 CAM 决策。法律推理也是如此。尽管 CAM 的使用很少导致诉讼，但在涉及常规医疗保健的案件中所依赖的一般法律原则为分析提供了起点。同样，在临床决策方面，临床医生受到临床判断和患者最佳利益的指导。无论治疗方法是 CAM 还是常规方法，临床医生都必须权衡治疗选择的相对风险和益处，并考虑患者的价值观、信仰和偏好。因此，我们的许多观察结果既适用于常规和 CAM 护理，也适用于成人和儿科患者。
