Osgoode Hall Law School Professor Joan Gilmour is involved in a three-year project funded by the Toronto Hospital for Sick Children Foundation, examining legal, clinical and ethical issues surrounding the use of complementary and alternative medicine with children.
Right: Joan Gilmour
Like motherhood, complementary and alternative medicine (CAM) can't be bad -- or can it? After all, it's perceived as natural and, therefore, "safe". It is that sort of issue that has led Gilmour, a professor of law, to specialize in the broad field of health law, a growing area of practice.
Currently, Gilmour is nearing the end of a research project that began in 2004, which is not only looking at issues surrounding the use of CAM with respect to children, but is also making recommendations. She and her fellow researchers, with expertise in bioethics, pediatrics, complementary and alternative medicine as well as law, know that people involved in the treatment of sick children are faced with some very tough choices.
"We are putting together a series of case scenarios for parents and health-care providers, as well as institutions that are making policies about this. And we are talking in practical terms, so that they can think about how decisions would apply in their situations," said Gilmour.
"For instance, if a child has been prescribed conventional medicine for a serious, underlying health condition, and if the young person is also taking a natural health product, what is the interaction between the two? Is it up to the doctor to ask parents whether a child is taking a natural remedy as well as the prescribed one? And, under what circumstances ought that be a part of the health-care provider's legal and ethical obligations?" said Gilmour.
Out of thousands of natural health products, doctors may be familiar with ones that many people choose to use to treat certain health problems. But they cannot know about all alternative care products, said Gilmour.
"In another scenario we have developed, parents might ask their doctor about referrals to CAM health-care practitioners. If the child, for example, is nauseated from chemotherapy, and if conventional medication doesn't help, perhaps the parents would want to try acupuncture for the child, since that treatment has been known to help in some cases," explained Gilmour. "The question then might be, can parents expect the conventional physician to advise them of this type of complementary, alternative care?"
In another case, Gilmour said parents may want CAM to be provided alongside traditional treatment within the hospital, or else to bring in a CAM practitioner for a child who is an inpatient. Gilmour is considering what should the physician's and hospital's response be to that request.
"We have also developed scenarios about children who have life-threatening illness for whom various forms of conventional treatments may not be working," she said.
"What if the parents then decide to try a type of complementary care, either as a true alternative or along with conventional care? What are the limitations on a parent's ability to make that decision, especially if it would entail not continuing with a physician's recommended treatment?
"People may differ about where a child's best interests lie," Gilmour points out. "There are different cultures and religions -- but at the same time, do we say that what is permissible differs for a child of one culture than another?"
Gilmour and her colleagues are developing recommendations for both parents and health-care providers, as well as for hospitals. "These are the things you have to take into account, these are the limits on your abilities to make decisions, and this is the range of decisions that would be permissible," said Gilmour.
"It's a huge project, and now that we're at the point of developing information for publication, I find that it's difficult to get the material down to the essence," she said. "It's a useful discipline for me, though. As an academic, I'm out of the habit of being succinct."
For more information about Joan Gilmour and her research, click here.
This article was submitted by Cathy Carlyle, a frequent contributor to YFile.