ETHICS FEATURE Responding to Medical Pluralism in Practice: A Principled Ethical Approach

The popularity of complementary and alternative medicine (CAM) raises a range of ethical issues for practicing clinicians. Principles of biomedical ethics define obligations of health care professionals, but applying principles in particular cases at the interface of CAM and biomedicine may be particularly chal-lenging. “Recognition of medical pluralism ” can help clinicians ’ ethical deliberations related to CAM. Here we outline a 3-point practical approach to applying basic principles of biomedical ethics in light of medical pluralism: (1) inquiring about CAM use and the scientific evidence related to CAM, (2) ac-knowledging the health beliefs and practices of patients, and (3) accommodating diverse healing prac-tices. Construed as such, recognition of medical pluralism encourages pragmatic willingness to examine the personal and cultural meaning associated with CAM use, the biases and assumptions of biomedicine, as well as the risk-benefit ratio of CAM practices. In this way, recognition of medical pluralism can help clinicians enhance patient care in a manner consistent with basic ethical principles. (J Am Board Fam Med 2007;20:489–494.) Shared medical decision making offers a helpful framework for applying the ethical obligations of primary care clinicians articulated in the 4 princi