When Giants Meet—a Discourse on Contemporary and Alternative Therapy Use from an Ethical Perspective
In Singapore’s multicultural society, a sizable proportion of the population subscribes to complementary and alternative medicine (CAM). In this article, we discuss the impact this has on medical practice in the context of the four principles of medical ethics. To uphold the principle of autonomy, we propose a non-judgmental approach towards patients who use CAM. Nevertheless, in order to promote health (beneficence) and prevent harm (non-maleficence), the safety profiles of CAM must be studied through systematic research. In addition, the principle of justice is one concerned with the fair distribution of scarce healthcare resources, while granting equal access to healthcare regardless of beliefs. Understanding CAM from an ethical perspective allows for the provision of safe, holistic, and culturally relevant care.
KeywordsComplementary and alternative medicine Traditional medicine Traditional Chinese medicine (TCM) Ethical perspective Ethics Medical ethics
We would like to thank Dr. Thiru Thirumoorthy, Dr. Crystal Lim, and Dr. Anantham Devanand for fruitful discussions and constructive feedback throughout the writing of this article.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
- Bos, Korthals-de, B.C. Ingeborg, Marcus Müllner, Jan L. Hoving, Maurits W. Van Tulder, Maureen P.M.H. Rutten-van Mölken, Herman J. Adèr, Henrica C.W. de Vet, Bart W. Koes, Hindrik Vondeling, and Lex M. Bouter. 2003. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. BMJ 326 (7395): 911–914. https://doi.org/10.1136/bmj.326.7395.911.CrossRefGoogle Scholar
- Chee, Cynthia BE, and Lyn James. 2003. The Singapore tuberculosis elimination programme: the first five years. Bulletin of the World Health Organization, 217–221. http://www.who.int/bulletin/volumes/81/3/Chee0303.pdf.
- Chow, Wen Hann, Pearlly Chang, Soo Chin Lee, Alvin Wong, Han-Ming Shen, and Helena Marieke Verkooijen. 2010. Complementary and alternative medicine among Singapore cancer patients. Annals Academy of Medicine Singapore 39 (2): 129 http://www.annals.edu.sg/pdf/39VolNo2Feb2010/V39N2p129.pdf.Google Scholar
- Er, Chan Luo. 2017. S$10 million additional funding to support, develop TCM sector. Channel NewsAsia https://www.channelnewsasia.com/news/singapore/s-10-million-additional-funding-to-support-develop-tcm-sector-9084212at.
- Ernst, Edzard. 2011. How much of CAM is based on research evidence? Evidence-Based Complementary and Alternative Medicine 2011. https://doi.org/10.1093/ecam/nep044.
- Fuller, Robert C. 2004. Alternative therapies: I. Social History.Google Scholar
- Gillon, Raanan. 1994. Medical ethics: four principles plus attention to scope. BMJ: British Medical Journal 309 (6948): 184 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2540719/pdf/bmj00449-0050.pdf.CrossRefGoogle Scholar
- Harris, P.E., K.L. Cooper, Claire Relton, and K.J. Thomas. 2012. Prevalence of complementary and alternative medicine (CAM) use by the general population: a systematic review and update. International Journal of Clinical Practice 66 (10): 924–939. https://doi.org/10.1111/j.1742-1241.2012.02945.x.CrossRefGoogle Scholar
- Ho, N.K. 2001. Understanding traditional Chinese medicine—a doctor’s viewpoint. Singapore Medical Journal 42 (10): 487–492 http://www.smj.org.sg/sites/default/files/4210/4210ra1.pdf.Google Scholar
- Hussain, Amir. 2016. Cordyceps ‘likely led to post-op bleeding’. The Straits Times. http://www.straitstimes.com/singapore/courts-crime/cordyceps-likely-led-to-post-op-bleeding.
- Johnson, Skyler B., Henry S. Park, Cary P. Gross, and James B. Yu. 2018. Use of alternative medicine for cancer and its impact on survival. JNCI: Journal of the National Cancer Institute 110 (1). https://doi.org/10.1093/jnci/djx145.
- Joseph, Kurian, Sebastian Vrouwe, Anmmd Kamruzzaman, Ali Balbaid, David Fenton, Richard Berendt, Edward Yu, and Patricia Tai. 2012. Outcome analysis of breast cancer patients who declined evidence-based treatment. World Journal of Surgical Oncology 10 (1): 118. https://doi.org/10.1186/1477-7819-10-118.CrossRefGoogle Scholar
- Liew, Fereen, Li Wei Ang, Jeffery Cutter, Lyn James, and Kee Tai Goh. 2010. Evaluation on the effectiveness of the national childhood immunisation programme in Singapore, 1982–2007. Annals Academy of Medicine Singapore 39 (7): 532 http://www.annals.edu.sg/pdf/39VolNo7Jul2010/V39N7p532.pdf.Google Scholar
- McRae, C.A., K. Agarwal, D. Mutimer, and M.F. Bassendine. 2002. Hepatitis associated with Chinese herbs. European Journal of Gastroenterology & Hepatology 14 (5): 559–562 https://journals.lww.com/eurojgh/Abstract/2002/05000/Hepatitis_associated_with_Chinese_herbs.15.aspx.CrossRefGoogle Scholar
- Mui, Rachel. 2017. MOH provides additional funding to develop TCM sector in Singapore. Business Times. http://www.businesstimes.com.sg/government-economy/moh-provides-additional-funding-to-develop-tcm-sector-in-singapore.
- Runciman, William, Peter Hibbert, Richard Thomson, Tjerk Van Der Schaaf, Heather Sherman, and Pierre Lewalle. 2009. Towards an international classification for patient safety: key concepts and terms. International Journal for Quality in Health Care 21 (1): 18–26. https://doi.org/10.1093/intqhc/mzn057.CrossRefGoogle Scholar
- SGH. 2007. Clinic led by renowned Shanghai TCM physicians opens at SGH. Singhealth Newsroom. http://www.singhealth.com.sg/AboutSingHealth/CorporateOverview/Newsroom/NewsReleases/Year2007/Pages/ClinicledbyrenownedShanghaiTCMphysiciansopensatSGH.aspx.
- Tan, M.G., M.T. Win, and Shariq Ali Khan. 2013. The use of complementary and alternative medicine in chronic pain patients in Singapore: a single-centre study. Annals of the Academy of Medicine, Singapore 42 (3): 133–137 http://www.annals.edu.sg/pdf/42VolNo3Mar2013/V42N3p133.pdf.Google Scholar
- Tiran, Denise, and Fiona Mantle. 2009. A-Z of complementary and alternative medicine : a guide for health professionals. New York: Churchill Livingstone.Google Scholar
- UN. 2017a. Infant mortality rate, for both sexes combined (infant deaths per 1,000 live births). accessed 15/04/2018. http://data.un.org/Data.aspx?d=PopDiv&f=variableID%3A77.
- UN. 2017b. Life expectancy at birth for both sexes combined (years). accessed 15/04/2018. http://data.un.org/Data.aspx?q=life+expectancy&d=PopDiv&f=variableID%3a68.
- WHO. 2013. WHO Traditional Medicine Strategy 2014–2023. accessed 15/04/2018. http://www.who.int/medicines/publications/traditional/trm_strategy14_23/en/.
- WHO. 2016. WHO Malaria Factsheet. World Health Organization, accessed 08/18/2016. http://www.who.int/mediacentre/factsheets/fs094/en/