The ethics of therapeutic touch

Lest I forget to mention this one, Randy Cohen, a.k.a. The Ethicist, answers a question. Here’s the question:

I work at a hospital where several nurses practice therapies like healing touch and therapeutic touch, said to adjust a patient’s energy field and thereby decrease pain and improve healing, although there is no significant evidence for this. If those nurses believe in these treatments, may they tell the patient they are effective? If the treatments provide merely a placebo effect, telling patients about this lack of evidence might undermine that benefit. Would that justify withholding the information? — name withheld, St. Louis

Think about how you would answer the question and then flip below the fold for the answer:

Something needs to be adjusted here, but it is the nurses’ behavior, not the patients’ energy fields. These nurses, however well intentioned, should not perform unproven therapies — if these are unproven; opinions differ passionately — on unwitting patients. To do so is to tell a kind of lie to patients, who reasonably assume that their care meets hospital standards. And while the placebo effect can be beneficial, that is insufficient reason to routinely deprive patients of pertinent facts. Patients cannot give informed consent if they lack honest information about their treatment.

That the nurses sincerely believe in the efficacy of their methods is of no account. People sincerely believe all sorts of things. My imaginary uncle Milt sets great store by the potions he whips up in the bathroom sink under a full moon in his underwear. It is evidence, not sincerity, that is wanted here. (Or, in the case of my uncle Milt, trousers.)

What the nurses could do is explain that their techniques are unproved and unendorsed by the hospital (if this is the case; hospitals vary), offering patients, in effect, the sort of supplemental treatment available outside the hospital. But this approach is not without risk. A therapy provided in the hospital by its staff carries a sense of official approval, no matter what disclaimers are offered. In any case, these nurses must alert their colleagues and hospital administrators about such things. Both groups need to know how patients are being treated if they are to do their jobs well.

Not bad for a mainstream media commentary. I would only add that I saw a comment on this article on a blog somewhere (sorry, I can’t remember which) questioning why a nurse could administer a “therapy” that wasn’t ordered by a doctor. The reason is that there are nursing diagnoses and treatments that do not necessarily require a physician’s order, usually diagnoses having to do with issues like skin integrity or preventing decubitus ulcers and other patient issues for which nursing care is incredibly important. Unfortunately, some of these nursing diagnoses allow for “interventions” such as therapeutic touch.

That, however, is too big a topic for here. It will have to be a topic for another post in the future.