Background Evidence suggests that the use of complementary or alternative medicine (CAM) is widespread, particularly for children with autistic spectrum disorders. A wide range of treatments exist encompassing those provided by regulated medical practitioners within the NHS such as homeopathy to those that are unregulated or potentially hazardous. Paediatricians may be involved in discussions about CAM with families and this may raise ethical issues.
Objective To explore some of the main ethical issues raised by the use of CAM in patients with autistic spectrum disorders using a case report as the starting point for discussion.
Results I will briefly summarise some of the controversies in the use of CAM for autism, including the case of a 5-year-old boy who died following chelation therapy. I will discuss two major ethical themes that arise:
1) The role of parents in making healthcare decisions about their non-autonomous children. I will argue that parental autonomy may be constrained due to incomplete understanding of the scientific issues or incomplete/inaccurate information about the proposed treatment. Paediatricians have a key role in helping families to interpret information about CAM.
2) Protecting the best interests of the child: Any individual CAM treatment may come with both benefits and harms attached for the child and family. Conflicts may arise between an individual physician's weighing of these benefits and harms and the opinions of the family. I will explore ways in which doctors can use ethical principles including beneficence and non-maleficence to help determine the best course of action for the child.
Conclusions The use of CAM in children with autism raises complex ethical issues. Paediatricians should actively attempt to engage families in discussions about CAM and should strive to maintain a good relationship with families even in the face of disagreement about the proposed therapy. However, this should be balanced with a need to consider the best interests of the child including crucially the ethical obligation to protect children from harm.
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