Abstract

The use of traditional and complementary medicines (T&CMs) is both ubiquitous in low and middle income countries and highly contested in some sections of high income countries. Whilst T&CMs are promoted as an accessible and affordable health care system by high level health policy makers (for example, the Director General of the World Health Organization), their use is simultaneously indicted as a waste of resources, non-scientific, and unethical. The aim of this thesis is to provide a calm, considered and well researched view on a highly emotional topic: What is the nature of the ethical challenges for the use and practice of TCMs and how might they be addressed? The methodology chosen for the ambitious topic of this thesis is the Ethical Matrix as developed by Ben Mepham in the UK in the 1990s. It is founded upon a principlist approach to ethical analysis and has been used widely in decision-making for new technologies. It requires the consideration of interests of stakeholders including, but also beyond, human beings. For the purpose of this thesis four groups were selected: human users of T&CM, the environment, animals, and low and middle income countries (LMICs). Ethical analysis reveals that: • Most ethical concerns associated with T&CMs are related to safety issues for human users; • there are also serious concerns about the way in which animals are routinely harmed through use in T&CM products and T&CM research; • the production and use of some T&CMs does have damaging impacts upon the environment and, • the ethical challenges associated with the use of T&CM in LMICs are different from those in high income countries. Based on the analysis, the thesis provides clear steps to be taken to reduce the potential for harm from both adverse drug reactions and adverse events for humans as well as recommendations to reduce the harm to animals and the environment from use of T&CMs.