18 March 2005
The opinion deals with the subject of alternative medicine and the problem of informed consent. When the ICB uses the term alternative medicine, it refers exclusively to practices whose efficacy is not assessable when adopting the criteria of scientific medicine.
The Committee is aware of the increasingly widespread recourse to alternative medicine in the Western world: and deems these experiences worthy of attention and respect. The right to autonomy and freedom of treatment is a fundamental right of every citizen. However, the ICB emphasises that this freedom must be exercised within the fundamental perspective of the protection of the sick person’s health and therefore the physician, in primis, should propose the adoption of conventional remedies proven to be effective. Only in the event of a total absence of such remedies or a lack of efficacy in the actual clinical case or the existence of evident contraindications or following refusal by the adequately informed patient, could it seem legitimate, with the required consent of the patient, to change to other therapies, provided that, they are never the subjective or arbitrary choice of the therapist. It is an essential bioethical principle that the freedom of treatment must always be combined with the professional guarantees that the code of medical ethics imposes on the physician in relation to the patient. The ICB is unanimous in its belief that medical practices that are not founded on scientific evidence are unable to substitute those of scientific medicine. The ICB points out some significant and concerning cases, in which the use of alternative medicine must be considered objectively and specifically harmful, and recognises this occurrence as one of the most serious ethical problems which its supporters and practitioners need to face up to. With regard to this, it refers to the fundamental role of the public health service (established and regulated by European and national directives) concerning pharmaceutical trials and pharmacovigilance. It is essential that the remedies used by the practice of alternative medicine correspond to the same required standards of efficacy as the prescribed medicines used in conventional scientific medicine; the institutionalization of a double standard for the pharmaceutical market is unacceptable.
From an epistemological point of view, many members of the ICB hold the opinion that, given the fragility of alternative medicine (the greater part at least) which according to them seems currently demonstrated; this places a particular and further responsibility on the physicians that resort to these practices. In addition, as it is a duty to inform citizens about the statute, its progress, the successes and failures of scientific medicine; it is according to the ICB, equally dutiful to inform citizens that the practice of alternative medicine does not have an epistemological statute characterised by the same rigour. Indeed, many of these are elaborated in a philosophical and/or spiritual form, occasionally of a highly suggestive nature, but irreducible to all empirical tests.