Reclaiming the full story of human health : the ethical significance of complementary and alternative medicines

This thesis investigates the moral content of illness ontologies in different healing systems, in particular biomedicine and homeopathy. It was motivated by the wish to gain a greater understanding of the possible meaning and ethical significance underlying the increasing popularity of complementary and alternative medicine (CAM) in Western countries. CAM is an umbrella term for a diverse group of therapeutic approaches, indicating their marginalized status in relation to conventional, scientific medicine. However, despite their diversity most CAM share a common bond by subscribing to a holistic perspective on life, health and illness. It is for this reason that this thesis concentrates on the conceptual level. The subject is approached by making use of interview material from five homeopathic doctors from Austria. Their perspective on different aspects of non-conventional, as well as biomedical, practice and underlying theory provides the springboard for theoretical investigations. The demand for scientific evidence of CAM is critically examined. The issue of increasing pluralism in health care is explored, along with its challenge of finding appropriate epistemological approaches for therapeutic systems that are based on different illness ontologies. The favored approach in this thesis is based on the recognition by medical historians that there are four basic illness axioms: "illness as loss of balance", "illness as disruption of interpersonal communication", "illness as a physical defect" and "illness as pathic creation". These axioms are matched respectively with four different epistemic pathways: the dialectical, the hermeneutical, the analytical and the phenomenological. The interviewees considered the more humane quality of the doctor/patient relationship in their homeopathic practices to be due to the holistic premises of homeopathy, which place the subjective dimension of patients at their center. The difficulty of achieving informed consent in the commonly used sense in homeopathic practice was solved by engaging in a shared decision-making process. Life was explained by the interviewees in vitalistic terms. Although rejected by science, the notion of vitalism appears to hold significance for the public. Illness was always perceived as a multidimensional process and not as a purely physico-chemical dysfunction. It became evident that the holistic perspective takes account of the many dimensions of human illness, of which neither the conventional reductionist conception nor the dualistic mind/body approach are capable. However, the unmanageable complexity of holism poses a problem for therapeutic practice. A conceptual approach providing some structure for the holistic multidimensionality is found in the four illness axioms and in analogous observations by Aristotle. It is concluded that there could be a connection between the increased popularity of CAM and their underlying holistic perspective, since this theoretical foundation allows the practitioner to address the patient in a whole-person way. At the same time the holistic perspective provides a much broader scope than biomedicine for patients to influence their health. The recognition that human multidimensionality needs to be appreciated at the level of illness ontology may also provide an impetus for bioethics to approach contemporary ethical challenges from a perspective of an ethics of the good life, instead of concerning itself predominantly with setting limits in the arena of technological medicine