The ethics of using alternative therapies in HIV/AIDS

Journal/Book: AIDS Patient Care. 1995; 9: 2 Madison Avenue, Larchmont, NY 10538. Mary Ann Liebert Inc Publ. 175-181.

Abstract: The use of alternative treatment modalities by persons with HIV/AIDS poses many ethical problems. Because the medical community and the AIDS community have differing opinions about alternative therapies, patients and physicians can have difficulty deciding exactly how they ought to deal with alternative treatments. On one hand, many doctors feel that all alternative treatments are either examples of the placebo effect or that they are fraudulent. On the other hand, there are patients who feel that no alternative treatments are beyond reason, and that most of these therapies are better than traditional medical therapies. Because of such widely differing opinions, the therapeutic alliance between physician and patient can be greatly strained. This strain has its roots in the power struggle between physicians and patients. ''Ethical problems are embedded in a matrix of competing social, political, and economic forces. Competition for power, resources, and influence is part of the context for ethics. The actual approaches to ethical problems in any age and culture, including the approaches to HIV infection and AIDS, cannot be adequately understood apart from issues of power.''(1) Because physicians have traditionally had more power than patients in medical settings, some doctors find it difficult to share power with patients.(2) Many physicians argue that because they are guardians of health for the entire population, it is important for them to maintain control over patients to a certain extent. Their years of training and clinical experience make them far more qualified than patients to make decisions about health care. This seems to be an especially common argument with regard to infectious disease control. However, HIV/AIDS patients have avoided this control and maintained a good deal of autonomy throughout the course of the epidemic. Political activism within the gay community, and a desire on the part of physicians to have full patient cooperation, has been largely responsible for the establishment and maintenance of this autonomy. HIV/AIDS patients have been given this autonomy in a setting where other patients normally would not. This approach has been called HIV exceptionalism.(3) Some might argue that HIV exceptionalism has placed individual interests above those of society. Individuals have been favored in policy decisions regarding such ethical issues as prevention strategies, confidentiality, screening, and obligation to inform. Unfortunately, evidence has begun to appear that HIV exceptionalism is being abandoned in favor of a public health ''control strategy.'' Because alternative treatment modalities offer patients large amounts of control over their own health care, it would seem that the promotion or support of such modalities would fit in with HIV exceptionalism. An in-depth analysis of alternative therapy decision making and use may reveal the relationship between alternative treatment and AIDS exceptionalism. It may also suggest several reasons why HIV exceptionalism continues to be essential to the well-being of HIV/AIDS patients and why the principles of exceptionalism may be valuable to the rest of society as well. HIV exceptionalism is based on the idea that HIV/AIDS patients and HIV are somehow ''special.'' Patients have become involved in decision-making processes traditionally open to physicians only. This involvement has given patients power. Alternative therapy use has given many patients this same power over their disease. There are other diseases where a similar approach has been applied. The disease of alcoholism/substance abuse is one such example. Organizations such as Alcoholics Anonymous and Narcotics Anonymous have been the most successful treatment modalities for alcoholics and drug abusers. These organizations put a premium on patient involvement in treatment. Patients must be motivated and involved. The power patients derive from taking control of their own disease seems to be paramount to successful recovery. Even alcohol treatment centers based in hospitals have adopted the self-help approach these organizations use to help addicts recover. Certainly there are other areas of medicine where similar involvement by patients would help them with their disease and promote improved quality of life. Patient involvement in decision making must be encouraged. Alternative therapy use by HIV patients can serve as a model for patient empowerment.

Note: Article KA Greiner, Univ Kansas, Med Ctr, Lawrence, KS 66045 USA

Keyword(s): COMPLEMENTARY MEDICINE; INFECTION; PRACTITIONERS; UNORTHODOX; HEALTH

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