보완대체의학의 윤리적 성찰*

The increasing use of complementary and alternative medical (CAM) therapies by patients, health care providers, and medical institutions has made it imperative that physicians consider their ethical obligations when recommending, tolerating, or proscribing these therapies. When CAM and conventional medical therapies intersect, there is the potential for serious physician–patient conflicts as well as harm to patients. Some CAM therapies in and of themselves can be hazardous, but harm can also occur indirectly when patients choose less effective CAM treatments instead of conventional methods that have demonstrated efficacy. Physician–patient conflicts arising from issues related to CAM therapies are common, but the physician-patient relationship is more likely to remain intact if physicians are willing to engage creatively with patients when problems seem unsolvable. Even in the absence of scientific evidence for CAM therapies, providers can formulate a plan that is clinically sound, ethically appropriate, and targeted to the unique circumstances of individual patients. Physicians are encouraged to remain engaged in problem-solving with their patients and to attempt to clarify the patient’s core values and beliefs when counseling about CAM therapies. The commitment to joint problem-solving over time, which is a central obligation of the physician–patient relationship, becomes even more important when considering the use of CAM therapies. A long-standing, carefully nurtured partnership between a physician and a patient that has grown over time may be strained or completely destroyed if common ground in such situations cannot be found. The way forward for physicians involves not only preventing negligence and fraud, but also facilitating therapeutic exchanges between various healthcare providers and their patients. The use of case-based reasoning in questions of CAM therapy allows a fuller appreciation of the way in which circumstances play an intrinsic role in moral judgments.

This paper presents two prototypical cases that illustrate the challenges already discussed as well as other ethical challenges that will arise as CAM therapies gain popularity in Korea.