Allaxys Communications --- Transponder V --- Allaxys Forum 1
Aktuell im WWW => Webwanderers illustres Kabinett: Fundstuecke, Raritaeten und Exoten => Topic started by: Eule on December 10, 2011, 04:34:49 AM
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Wie hundsgemein, niederträchtig und verlogen die Scharlatane sind, zeigt ihre Sprache In Kanada probieren sie es gerade wieder und haben einen Entwurf ("Draft") vorgelegt, mit dem sie so richtig bescheiBen wollen: "Non-Allopathic (Non-Conventional) Therapies in Medical Practice (formerly, Complementary Medicine)"
Da wird nicht einmal mehr der Begriff "Complementary Medicine" verwendet, sondern der Hahnemannsche Kampfbegriff "allopathisch" für die wissenschaftliche Medizin benutzt, und alles, aber auch alles, was nicht wissenschaftlich ist, einfach als "nicht-allopathisch" bezeichnet.
Durch diese Tücke (durch den Hanemannsche Kampfbegriff) wird wissenschaftliche Medizin schon wieder diffamiert, und das schon im sprachlichen Ansatz.
Warum "nicht-allopathisch"? Nennt es doch gleich, und zutreffend: BETRUG!
Hier der Entwurf:
http://www.cpso.on.ca/uploadedFiles/policies/consultations/non-allopathic-consultation-draft.pdf
[*quote*]
The College of Physicians and Surgeons in Ontario
DRAFT
1
Non-Allopathic (Non-Conventional) Therapies in Medical Practice
(formerly, Complementary Medicine)
5
Policy Number: #1-00
Policy Category: Practice
Approved by Council:
Reviewed and Updated:
10 Publication Date:
College Contact: Advisory Services
Key Terms: Autonomy, Beneficence, Altruism, Exploitation, Conflict of Interest,
Informed Consent, Trustworthiness, Hippocratic Oath
15
Legislative References: Health Care Consent Act, 1996, S.O. 1996, c.2, Sched. A.;
Medicine Act,1991, S.O. 1991, c.30; O. Reg. 114/94 General, O.Reg. 856/93
Professional Misconduct, O.Reg. 865/93, Registration, enacted under the Medicine
Act, 1991, S.O. 1991, c.30.
20
Reference Materials: CPSO, Practice Guide: Medical Professionalism and College
Policies; CPSO, Consent to Medical Treatment policy; CPSO Medical Records
policy; CPSO, Changing Scope of Practice policy; Oath of Hippocrates. In: Harvard
Classics, Volume 38. Boston: P.F. Collier and Son, 1910.
25
Introduction
In increasing numbers, patients are looking beyond allopathic medicine to nonallopathic
therapies for answers to complex medical problems, strategies for
improved wellness, or relief from acute medical symptoms. Patients may seek
30 advice or treatment from a range of health care providers, including Ontario
physicians.
The College supports patient choice in setting treatment goals and in making health
care decisions, and has no intention or interest in depriving patients of non-allopathic
therapies that are safe and effective. As a medical regulator, the College does
35 however, have a duty to protect the public from harm. Thus, the object of this policy
is to prevent unsafe or ineffective non-allopathic therapies from being provided by
physicians, and to prohibit unprofessional or unethical physician conduct in relation to
these therapies.
This object is achieved through clear statements of expectation for physician
40 conduct, which are grounded in the profession’s commitment to ethical and
professional conduct and the pursuit of clinical excellence. This is a commitment the
College expects all physicians to embody in their practice, everyday.
2
This policy addresses issues that are relevant in the context of non-allopathic
therapies. However, physicians are expected to comply with all of their legal,
45 professional and ethical obligations and are advised to consult additional College
policies, the Practice Guide1, and other resources as necessary.
Terminology
Allopathic Medicine2: refers to the type of treatment, diagnostic analysis and
conceptualization of disease or ailment that is the primary focus of medical school
50 curricula and which is generally provided in hospitals and specialty or primary care
practice.
Non-Allopathic Therapies (Non-Conventional Therapies): refers to a broad range
of procedures or treatments that are not commonly used in allopathic medicine;3 this
includes those referred to as complementary or alternative. Non-allopathic
55 therapies tend to differ from allopathic medicine in terms of diagnostic techniques,
theories of illness and disease, and treatment paradigms. The categorization of
specific therapies as non-allopathic is fluid: as clinical evidence regarding efficacy is
accumulated, certain non-allopathic therapies may gain broad acceptance and thus
be accepted in allopathic medicine.
60 Principles
In accordance with the Practice Guide, the professional expectations in this policy
are based on the following principles:
1. Act in patients’ best interests, in accordance with fiduciary duties;
2. Respect patient autonomy with respect to health care goals, and treatment
65 decisions;
3. Communicate effectively and openly with patients and others involved in the
provision of health care;
4. Maintain patient trust through a commitment to altruism, compassion and
service.
70 Scope
This policy applies to physicians who provide non-allopathic therapies, physicians
whose patients pursue non-allopathic therapies, and physicians who form
professional affiliations with non-allopathic clinics, therapies, or devices.
1 The Practice Guide: Medical Professionalism and College Policies, CPSO:
http://www.cpso.on.ca/policies/guide/default.aspx?id=1696
2 Also referred to as ‘conventional medicine’.
3 Modified from Model Guidelines for the Use of Complementary and Alternative Therapies in Medical
Practice, Federation of State Medical Boards of the United States, Inc., 2002.
3
75 Policy
The College expects that when acting in a professional capacity, physicians do so
competently, in accordance with their legal, ethical and professional obligations.
This policy sets out general expectations for physician conduct, based on broad
principles of ethics and professionalism. It also sets out specific expectations,
80 tailored to three unique contexts of physician involvement in non-allopathic therapies
contemplated in this document.
A. General Expectations for Physician Conduct
The general expectations for physician conduct expressed in this section mirror
existing obligations contained in the CPSO’s Practice Guide, and the Hippocratic
85 Oath4.
Grounded in principles of ethics and professionalism, these expectations translate
into specific obligations for physician conduct: obligations to respect patient
autonomy, to act in patients’ best interests, to refrain from exploiting patients, and to
avoid conflicts of interest.
90 These principles and obligations are broadly applicable to all medical practice. They
are highlighted here to underscore their relevance and application to non-allopathic
care since they will have particular importance to this area of medicine.5
i) Respect Patient Autonomy
Patients are entitled to make treatment decisions and to set health care goals that
95 accord with their own wishes, values and beliefs. This includes decisions to pursue
or to refuse allopathic or non-allopathic therapies.
The College expects physicians to respect patients’ treatment goals and decisions,
even those which physicians deem to be unfounded or unwise. In doing so,
physicians should state their best professional opinion about the goal or decision, but
100 must refrain from expressing non-clinical judgements.
ii) Act in Patients’ Best Interests
When acting in a professional capacity, physicians must always be motivated by a
regard for what is best for the patient. This expectation applies equally to situations
in which physicians are treating patients, and situations where physicians may not
105 have an identifiable patient, but are affiliated with a clinic, therapy or device.
4 Oath of Hippocrates. In: Harvard Classics, Volume 38. Boston: P.F. Collier and Son, 1910.
5 Characteristics of non-allopathic care, including the experimental nature of some therapies, the fact
that many therapies are privately funded, and that patients may pursue treatment as a matter of last
resort, suggest that these principles and obligations will be relevant.
4
iii) Refrain from Exploitation
Exploitation occurs when a physician, in his or her professional capacity, dominates
and influences patients to further the physician’s own personal interests.6
Exploitation is an abuse of power, and is directly contrary to the profession’s
110 commitment to altruism and beneficence. It undermines the trust and confidence
individuals and the public at large have in the medical profession and is never
acceptable.
iv) Avoid Conflicts of Interest
Conflicts of interest may occur when physicians obtain a personal benefit from
115 interactions with patients. Physicians are expected to avoid situations in which their
own personal interests may conflict with their duties to their patients.7
This includes refraining from charging excessive fees for services or products8, and
refraining from advocating for the preferential use of treatment options or products
that will generate a personal benefit for themselves-financial or otherwise.
120 B. Specific Expectations for Physician Conduct
In addition to the general expectations above, the College has specific expectations
for physician conduct which relate to the three physician roles contemplated in this
policy: providing non-allopathic therapies; treating patients who use non-allopathic
125 therapies, and forming professional affiliations.
1) Providing Non-Allopathic Therapies
When providing non-allopathic therapies, physicians are expected to demonstrate the
same commitment to clinical excellence and ethical practice, as they would when
130 providing allopathic care.
i) Clinical Competence: Knowledge, Skill and Judgement
Physicians must always act within the limits of their knowledge, skill and judgement9
and never provide care that is beyond the scope of their clinical competence.10
6 Norberg v. Wynrib, [1992] 2 S.C.R. 226.
7 See O.Reg. 114/94 General, Part IV, Conflicts of Interest, and O.Reg. 856/93 Professional
Misconduct, enacted under the Medicine Act, 1991, S.O. 1991, c.30.
8 Section 1(1), paragraph 21, O.Reg. 856/93 Professional Misconduct, enacted under the Medicine
Act, 1991 S.O. 1991, c.30.
9 Section 2(5), O.Reg. 865/93, Registration, enacted under the Medicine Act, 1991, S.O. 1991, c.30;
Changing Scope of Practice policy: http://www.cpso.on.ca/policies/policies/default.aspx?ID=1622;
Practice Guide, see note 1.
10 This expectation applies to all non-emergent situations. In emergency situations, physicians may be
permitted to act outside their scope of expertise in some circumstances. See the Physicians and
5
This expectation applies equally to treatments or therapies that the physician
135 proposes and those that may be requested directly by patients. Where patients seek
care that is beyond the physician’s clinical competence, physicians must clearly
indicate that they are unable to provide the care. Physicians should consider
whether a referral can be made to another physician or health care provider for care
the physician is unable to provide directly.
140 ii) Clinical Assessment and Diagnosis
When assessing patients and forming a diagnosis, physicians are expected to act in
accordance with the standards of allopathic medicine.
Clinical Assessments
To act in accordance with the standards of allopathic medicine, physicians providing
145 non-allopathic care must ensure that clinical assessments they conduct involve
taking a complete patient history, and performing any necessary medical or
laboratory examinations or investigations that are required to obtain relevant and
comprehensive information about the patient’s ailment or condition.
There may be some instances in which the patient has seen other health care
150 practitioners for the same ailment, and has had a clinical assessment completed.
Physicians may not have to conduct their own independent assessment in these
circumstances, provided they have reviewed the previous assessment and have
determined that it meets the standards of allopathic medicine. Should physicians
have any doubts in this regard, the College expects them to err on the side of caution
155 and complete their own clinical assessment.
Diagnosis
To act in accordance with the standards of allopathic medicine, physicians providing
non-allopathic care must reach an allopathic diagnosis.
If physicians also form a non-allopathic diagnosis, such diagnosis must be objectively
160 justifiable, based on the clinical assessment conducted and other relevant
information available to the physician.
A demonstrable and reasonable connection, supported by sound clinical judgement
must exist between the condition or symptoms for which the patient is seeking care,
and the non-allopathic diagnosis reached.
165
Health Emergencies policy for more detail:
http://www.cpso.on.ca/policies/policies/default.aspx?ID=3510 .
6
iii) Treating the Patient: Therapeutic Options and Informed Consent
Although consent is an important and necessary requirement to authorize therapeutic
intervention, consent alone will not discharge the sum total of physician obligations
170 that are applicable at this phase of the health care encounter. Physicians must also
comply with the expectations relating to therapeutic options set out below.
Therapeutic Options
Physicians are expected to propose both allopathic and non-allopathic therapeutic
options that are clinically indicated or appropriate.
175 Any non-allopathic therapeutic options that physicians propose to patients must:
have a demonstrable and reasonable connection, supported by sound clinical
judgement, to the diagnosis reached;
possess a favourable risk/benefit ratio, based on the merits of the option, the
potential interactions with other treatments the patient is receiving, and other
180 considerations the physician deems relevant;
take into account the patient’s socio-economic status when the cost will be
borne by the patient directly; and
have a reasonable expectation of remedying or alleviating the patient’s health
condition or symptoms.
185 Reasonable expectations of efficacy must be supported by sound evidence. The
type of evidence required will depend on the nature of the therapeutic option in
question, including, the risks posed to patients, and the cost of the therapy. Those
options that pose greater risks than a comparable allopathic treatment or that will
impose a financial burden, based on the patient’s socio-economic status, must be
190 supported by evidence obtained through a randomized clinical trial that has been
peer-reviewed.
Physicians must never propose therapeutic options that have been proven to be
ineffective.
If the effectiveness of a therapeutic option or associated risks is unknown, the
195 College expects physicians to proceed in a cautious and ethical manner. Physicians
are encouraged to consult with a teaching hospital or an academic facility to discuss
the possibility of convening a research ethics board to oversee the clinical trials of the
therapeutic option.
200
7
Informed Consent & Communication
Before providing non-allopathic therapies to patients, physicians must obtain
consent, in accordance with the legal and policy requirements set out in the Health
205 Care Consent Act, 199611 and the Consent to Medical Treatment policy12.
In addition, the College expects that through the consent process, physicians will
convey the following to patients:
the physician’s rationale for recommending the therapeutic option in question;
reasonable expectations about the clinical efficacy of the therapeutic option;
210 whether the therapeutic option is supported by the allopathic medical
community, along with the level of support provided by the non-allopathic
medical community; and
a description of how the therapeutic option compares to allopathic
interventions that would be offered to treat the same symptoms or condition
215 (comparison of risks, side effects, therapeutic efficacy, etc.).
The details of the consent process, including the above information should be
documented in the patient’s medical record.
When communicating with patients about therapeutic options, physicians must
always provide patients with accurate and objective information. They must never
220 inflate or exaggerate the potential therapeutic outcome that can be achieved,
misrepresent the proven benefits of allopathic care or make claims regarding
therapeutic efficacy that are not substantiated by evidence.
Clinical concerns must always be highlighted, however physicians must refrain from
expressing personal non-clinical judgements or comments about the therapeutic
225 options, or the patient’s health care goals or preferences unless that input is
specifically requested by the patient.
2) Treating Patients who pursue Non-Allopathic Therapies
Physicians in allopathic practice should be alert to the reality that their patients may
be pursuing non-allopathic therapies from other practitioners, or may seek their
230 advice about these therapies.
11 Health Care Consent Act, 1996, S.O. 1996, c.2, Sched. A.
12 Available online at: http://www.cpso.on.ca/policies/policies/default.aspx?ID=1544. Physicians are
reminded that this policy articulates consent requirements pertaining to medical treatment. Separate
obligations will apply when patients are consenting to medical research. The College recommends
that physicians seek the guidance of their legal counsel or the CMPA for further detail.
8
i) Patient Use of Non-Allopathic Therapies & Documentation
In order to provide safe, high quality allopathic care, physicians must have complete,
235 accurate information about their patients. This includes information about any nonallopathic
therapies patients may be pursuing.
The College advises physicians to inquire about patient use of non-allopathic
therapies on a regular basis. This might involve incorporating questions about nonallopathic
therapies into annual health exams, and/or patient assessments for
240 specific health conditions or ailments.
Where patients are pursuing non-allopathic therapies, physicians should note this
fact in the patient’s medical record, along with any details of the therapy the patient is
able to provide.
ii) Discussing Non-Allopathic Therapies
245 When asked for information about non-allopathic therapies, physicians must respond
in a professional manner, within the limits of their knowledge, skill and judgement.
Where physicians are unfamiliar with the non-allopathic therapy in question, they
must indicate as much to the patient, and explain that they are consequently unable
to comment on the matter. Physicians may wish to consider whether they can assist
250 patients in obtaining information. This may involve suggesting potential resources13,
or referring patients to other practitioners.
iii) Implications for Allopathic Therapeutic Options
The College does not expect allopathic physicians to be knowledgeable about every
non-allopathic therapy their patients may be pursuing or about which they may
255 inquire.
If physicians are aware that a patient is receiving non-allopathic therapies, they must
weigh this fact when determining which allopathic therapeutic options may be
suitable. In particular, physicians must consider whether any potential negative
interactions may arise between the allopathic treatment and non-allopathic therapy
260 and take reasonable steps14 to ensure that by recommending allopathic treatment,
the patient’s health or clinical outcome will not be compromised due to a negative or
otherwise adverse reaction between allopathic and non-allopathic care.
Where physicians have been unable to determine conclusively whether the potential
exists for negative or adverse interactions between allopathic and non-allopathic
13 This may include directing patients to journal articles, scientific studies and/or websites or providing
them with more general resources, such as the contact information of regulatory colleges which
govern practitioners of the desired therapy.
14 Reasonable steps may include conducting basic research into the matter, or consulting with the nonallopathic
practitioner, with the patient’s consent.
9
265 care, they must communicate this to the patient, and include a corresponding
notation in the patient’s medical record.
3) Professional Affiliations
There may be circumstances where physicians are asked to form a professional
affiliation with a non-allopathic clinic, therapy or device.
270 Physicians should be aware that patients might equate the affiliation with a
professional endorsement of efficacy or safety.
As such, before physicians form a professional affiliation, they must critically assess
the clinical basis for the care offered by the clinic, or the therapeutic benefit to be
obtained from the therapy or device. Professional affiliations must only be formed if:
275 physicians are satisfied on the basis of evidence, and sound clinical
judgement that the proposed care or health benefit is safe or at minimum, is
not more risky than comparable allopathic interventions; and
there is a reasonable expectation that the care provided will be clinically
effective.
280 If physicians have met these requirements, and proceed to form a professional
affiliation, they must ensure that any advertising materials accord with the
requirements in regulation.15
15 See section 6 of O.Reg. 114/94 General, enacted under the Medicine Act, 1991, S.O. 1991, c.30.
[*/quote*]
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