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An alternative medicine treatment is causing harm to a child. Would an ethics committee classify this as child abuse?
Scenario:
You are a general practitioner and a mother comes into your office with her child who is complaining of flu-like symptoms. Upon entering the room, you ask the boy to remove his shirt and you notice a pattern of very distinct bruises on the boy's torso. You ask the mother where the bruises came from, and she tells you that they are from a procedure she performed on him known as "cao gio," which is also known as "coining." The procedure involves rubbing warm oils or gels on a person's skin with a coin or other flat metal object. The mother explains that cao gio is used to raise out bad blood, and improve circulation and healing. When you touch the boy's back with your stethoscope, he winces in pain from the bruises. You debate whether or not you should call Child Protective Services and report the mother.
Questions for Case 2:
Should we completely discount this treatment as useless, or could there be something gained from it?
When should a physician step in to stop a cultural practice? (If someone answers "when it harms the child" remind that person that there is some pain in many of our medical procedures, for example, having one's tonsils removed)
Should the physician be concerned about alienating the mother and other people of her ethnicity from modern medicine?
Do you think that the physician should report the mother?
You are a general practitioner and a mother comes into your office with her child who is complaining of flu-like symptoms. Upon entering the room, you ask the boy to remove his shirt and you notice a pattern of very distinct bruises on the boy's torso. You ask the mother where the bruises came from, and she tells you that they are from a procedure she performed on him known as "cao gio," which is also known as "coining." The procedure involves rubbing warm oils or gels on a person's skin with a coin or other flat metal object. The mother explains that cao gio is used to raise out bad blood, and improve circulation and healing. When you touch the boy's back with your stethoscope, he winces in pain from the bruises. You debate whether or not you should call Child Protective Services and report the mother.
Questions for Case 2:
Should we completely discount this treatment as useless, or could there be something gained from it?
When should a physician step in to stop a cultural practice? (If someone answers "when it harms the child" remind that person that there is some pain in many of our medical procedures, for example, having one's tonsils removed)
Should the physician be concerned about alienating the mother and other people of her ethnicity from modern medicine?
Do you think that the physician should report the mother?
asked Jan 17 at 02:41PM in Other
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1VotesFirst, I don't think that this initial discovery of the use of an unproven method of treatment rises to the level of child abuse at this time, and any reporting would be premature. There was no intent to harm the child, nor was anything "covered up." The fact that the mother is insufficiently educated to realize she is using an unsupported and potentially harmful process to treat an antiquated concept of "bad blood," is a problem of education, not crime.
It is incumbent upon the physician to educate her about the appropriate diagnoses involved and accepted treatments that are available before taking any other action. Remember, the two most important things to be considered at this point are that her "alternative treatment" did not keep her from bringing the child into the physician's office for accepted treatment and that one of the dictionary definitions of "doctor" is a "teacher;" a function greatly needed in a society in which we have grossly neglected to teach our children (who then become parents) the art and science of critical thinking.
In answer to your second question, I offer the two most important words in all science, and indeed in all situations involving critical thinking - "prove it." We should not discount any treatment, just because it seems unreasonable. Should be have refused to consider the effect of bread mold on infection because it sounded ridiculous? Where would we have been without the discovery of penicillin? On the other hand, we should demand proof that a treatment is safe and effective before allowing its use, especially within the most vulnerable segments of our population - the very young, and the elderly. If a middle aged man want's to have hot oils rubbed on him with coins, and he has been informed of its potential benefit versus harm, it is his right to have it. On the other hand, the child has neither the knowledge or experience to make such a decision, and so must be protected from anything which would cause him or her harm.
Finally, I need to take exception to your example of "harm" because having tonsils removed causes pain. Simply causing pain for a short period of time in order to effect the greater good is not "ipso facto" harmful. Many effective therapies are unpleasant or painful (chemotherapy for example), but have been proven to serve the greater good. If "cao gio" were a proven method of treatment, the painful bruises would be a relatively minor, transient and acceptable side effect of the treatment. If it remains unproven, then its potential harm must be called into question. Should an individual's ethnic background be taken into account when treating a patient? Certainly, but not to the exclusion of our multicultural norms. I would not remove a mother's right to "treat" her child's viral respiratory infection with chicken soup. On the other hand, I will vehemently oppose a parent taking a child with leukemia to a Latin American country for treatment with ground apricot pits rather than submit him to therapy that is known to be effective and potentially curative. -
0Votes
answered Jan 18 at 10:27AMI would fully agree with Doctor Shore's response to the various aspects of your question. Unfortunately, what Eric has described as appropriate responses would be true in the peace and rationality of "your office" but I wonder if the responses would be the same if the mother brought the child into a ER physician in a usually busy and hectic hospital emergency room. The question is whether there will be time and motivation to "teach" and "educate" and whether there would be the incentive or mechanism within the hospital ER to followup on the case. I worry that the ER approach would be to pass the case on with a phone call to the Child Protective Service and let them evaluate and follow through. I am not an ER doctor and this response of mine may be too cynical of an environment in which I have been only present on occasions professionally to attend to my own private patients. ..Maurice. -
1Votes
answered Jan 18 at 12:34PMI've been the Director of Critical/Emergent Care at a Hospital in Houston TX, as well as New Orleans, LA. The scenario you present, while not identical to my experience, is not all that uncommon. I concur with the two Doc's before me. This doesn't rise to the level of a report to Child Protective Services. Dr Bernstein is concerned about many ER Docs not having the time to educate the Parent/s. I agree with him, however this is certainly the purview of the RN. We can arrange for continuing care with a Community Clinic having the requisite familiarity with the Ethnicity of the Mom. I would also attempt to let the Mom know that she did the "Right" thing by bringing her child to the Doctor's Office/ER, thus reinforcing her desire to help her child. -
1Votesanswered Jan 18 at 09:09PMI forgot to answer one point that was brought up in the original question: "Would an ethics committee classify this as child abuse?" Child abuse is really a legal decision based on the facts and in the case of physical abuse, it rests upon medical consultation by physicians for providing medical facts. A hospital ethics committee has no responsibility in primary investigation and developing of the necessary facts. It has no responsibility of defining whether the mother's acts are within legal parameters or illegal. It has no responsibility in the examining for any physical or mental injuries, if any, of the child. The ethics committee duty would be to see an ethical, fair and just conclusion is attained between the the parties involved, such as the parents, physician and nursing staff and hospital administration by facilitating communication between these parties, to assure all important issues are covered. This facilitation can be provided with the use of education regarding attention that the elements of ethics such as autonomy, beneficence, non-maleficence and justice are considered in the case. For example, these elements are really part of decisions regarding "alternative treatment". The elements must be part of the consideration as to whether such treatment decisions and actions are within accepted ethical behavior. Specifically, does the mother have the "right" to make a decision regarding therapy (autonomy), is the goal to provide benefit for the child (beneficence), was the mother aware that the therapy would cause no harm (non-maleficence) or is it fair for society to, without a rational basis exclude, by law, all cultural norms, because they differ with those in the society where the family lives (justice)? It is helping the parties with answers to these questions where an ethics committee can play an important role. But, again, whether child abuse exists and the cops called..that is no primary decision for the ethics committee. ..Maurice.
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