Complementary medicine in intensive care: Ethical and legal perspectives

Complementary medicine continues to increase in popularity in the general c ommunity. As a result it is likely that requests for the administration of complementary medicine to intensive care patients will be more frequent in the future. It is therefore prudent for intensive care clinicians to addres s this issue and develop an approach that is consistent. Complementary medicine has not been subjected to well conducted trials to d etermine its efficacy and risks. Consequently decisions about its use canno t be based on risk/benefit analyses and genuine informed consent cannot be achieved. Therefore complementary medicine should not be incorporated into intensive care practice. Strict adherence to a policy of negating requests for administration of com plementary medicine in intensive care patients may result in significant co nflicts between intensive care clinicians, patients and families. On occasi ons the patient or family may insist on the use of complementary medicine a nd it may be seen as important to their psychological wellbeing to accede t o the request. The intensive care clinician is still legally responsible fo r any treatment administered to the patient, even if it is against medical advice. Nevertheless if there is no demonstrable risk to the patient, compl ementary medicine can be administered following appropriate counselling and documentation. This review addresses the legal and ethical difficulties that may arise and an approach that may be followed when requests are made for complementary medicine in intensive care patients.