Asian Bioethics Review

In this essay, we discuss a typical scenario where a patient sought an "alternative" treatment regime (as opposed to conventional "western" medicine) and healthcare professionals (HCP) who were "system apartheid" and less tolerant towards other care systems.

Alternative treatment is typically defined as any healing regime that does not fall within the realm of conventional medicine. Alternative treatments, also known as Complementary/Alternative Medicine (CAM), have been either used as an adjunct/additional treatment with conventional medicine or as a complete replacement of conventional medicine. Some of these alternative treatments include natural medicine such as herbal or mineral-based products, mind and body medicine such as meditation and faith healing, and manipulative and body-based practices like massage and chiropractics.

Patients seeking alternative care other than conventional medicine are not uncommon. This has been illustrated in a systematic review of published studies, which concluded that 31% of all cancer patients used some form of complementary and alternative medicine (Ernst and Cassileth 1998). A more recent systemic review reported that the prevalence of any CAM use in paediatric cancer ranged from 6% to as high as 91% (Bishop et al. 2010).

There are many reasons why patients seek complementary or alternative medicine even when they are seeing conventional medical doctors. People seek out alternatives when (1) they are dissatisfied in some way with conventional treatment; (2) they see CAM as offering more personal autonomy and control over healthcare decisions; and (3) CAM are seen as more compatible with the patients' values, worldview, or beliefs regarding the nature and meaning of health and illness (Astin 1998). [End Page 132]

Contrary to conventional belief, HCP had a very small role in deciding the care treatments as they were already advocates for their own care system and most of them had little or no knowledge of others. It has always been the role of the patient and his family to decide on the best care they wanted and HCPs have to respect their decisions. Providing the best care is the practice of medicine, and the choice of whether such care is accepted lies with the patient and his family. Overly promoting their trade and advising against some other alternative treatments which they have no knowledge of can be considered unprofessional and may create conflict of interest. Further, it is important for HCPs to understand that they need to respect a patient's choice over his healthcare decision.

Some patients may prefer CAM treatment because of their "holistic" approach in the treatment regime as compared to specialised conventional medicine. "Holistic treatment" encompasses the whole physical, mental and social health of patients and does not just treat a specific diagnosed condition. The general perception is that conventional "western" medicine tends to focus on certain specialised disease categories (i.e., oncology), diseased organs (i.e., cardiology), types of patients (i.e., paediatrics) or methods of treatments (i.e., surgery), and thus do not treat a body or a medical condition as a whole. Coupled with the fact that patients with one specific medical condition or the same patient with multiple conditions, were asked to seek different medical specialties in the current conventional medical system, it certainly does not help to conclude that this sub-specialisation is an additional burden to the patient. This is normally compared with CAM treatment which is usually a one-stop treatment centre providing total care, where one doctor provides all the answers you need. The emergence of advanced medical specialisation in conventional medicine has resulted in a complicated and expensive treatment regime whereby specialists sometimes forget that their primary role is to care for a patient as a whole person, rather than just a diseased organ or a specific medical condition. Patients are expected to have the required information to decide on the right specialty rather than going around being referred from one specialty to the other.

In the end, it boils down to one element — a patient's "trust" for the practitioner of a treatment regime that they can relieve suffering and provide compassionate care.

In conclusion, I quote a saying from the Buddha through the Gilana sutta...