Ethics revisited...

Every Wednesday we have a philosophy and principles of chiropractic course hosted and/or taught (probably both) by Dr. Partna.  Dr. Partna talks to us about the issues related to the chiropractic world, many of which I have been familiar with for years now.  Some of the details we hear in this course are hard to listen to because they take the wind out of our sails, so to speak.  We all decided to go to chiropractic school for one reason or another (i.e., a different approach to health care, prevention versus sick-care, no MCAT's etc.) and when you learn there are deep ethical issues embedded in the profession it makes you stop and think twice about things.

This topic has been one that I have written about several times since beginning chiropractic school and will likely be one that plagues my blog space for many more posts, but I think it is important to address some of the issues from a student's perspective without being too cynical.  Remember, the definition of a cynic is, "a person who believes that people are motivated purely by self-interest rather than acting for honorable or unselfish reasons."  

Keeping the definition of a cynic in mind, I intend on chatting about what constitutes ethics in the health care environment.  I will try to tap into my long lost health science education from 2 years ago to see if our new profession is, in fact, breeding ethical doctors of chiropractic or a mixed bag.  From this context, what defines ethics in the first place?

I searched my Apple dictionary for a definition of ethics and this is what I found:  

Schools of ethics in Western philosophy can be divided, very roughly, into three sorts. The first, drawing on the work of Aristotle, holds that the virtues (such as justice, charity, and generosity) are dispositions to act in ways that benefit both the person possessing them and that person's society. The second, defended particularly by Kant, makes the concept of duty central to morality: humans are bound, from a knowledge of their duty as rational beings, to obey the categorical imperative to respect other rational beings. Thirdly, utilitarianism asserts that the guiding principle of conduct should be the greatest happiness or benefit of the greatest number.

To be ethical is a choice each person must make.  In our last philosophy topic, Dr. Partna spoke about whether to treat a problem such as gastritis or not with an adjustment of the thorax vertebrae.  My first thought was, absolutely not, there is no evidence to support such a treatment through research nor biologic plausibility.  The argument was that if there are no guidelines a possible "trial therapy" could be done to see if improvement occurs.  If the risk is lower than the benefits, then there is no reason not to give an adjustment for a visceral complaint such as gastritis.  

Why would someone get an adjustment for inflammation of the stomach you ask?  The theory is that a subluxed vertebrae causes impingement on a nerve and inhibits the function of an organ leading to pathology.  If the vertebra is pounded back into place then the nerves are restored to normal and allow for optimal function of the affected organ.  The problem is that this theory has yet to hold up under scientific investigation.  Schools looking to move the profession forward have left this theory behind to pursue other avenues of promise such as musculoskeletal care and conservative primary care.  Other schools hold this theory deep to heart and continue to preach subluxation theory amongst folks looking for an identity.  Their identity is found through the many profitable entrepreneurial "techniques" that give them all the answers to health and how chiropractic fits in the paradigm.  This is, of course, why the public has mixed feelings about chiropractic.  

There is a good side to chiropractic, mentioned previously, which focuses on relieving pain and even perhaps helping people move closer to the wellness end of health.  I think the motivation behind these individual's efforts is ethically based.  Their concern is the health of their patient population and not lining their wallets, which fits the definition of ethics.  I can not and will not give subluxation theorists and practitioners of this type any ethical credit.  It is a belief system, not a logic system that drives their every action.  They follow a set approach no matter what condition lands on their doorstep.  This is unethical behavior and unworthy of entitlement.  It is wrong to practice something that goes against all objectivity.  You can't just "hope" your adjustment does magical things.  Doesn't this violate the definition of ethics?  It goes against the "greater good" because the result from the action is unknown and the knowledge of the pathology (gastritis) is great enough to understand it is not caused by a subluxed vertebra.  Maybe it was a spicy meal, too much alcohol, too much coffee, etc., etc., etc.  My point is that there are DC's that believe a subluxation is the root cause for all health problems, no matter what the problem is.  They market their 'beliefs' and target unsuspecting consumers.  It is wrong and I can't believe they are going to be my colleagues.  

I will end by saying, its not all doom and gloom.  There is a definite place for chiropractors amongst the many HCP's.  I feel strongly that there needs to be a mass overhaul of the system and a new definition of what it is we as a profession are striving for.  End the useless, unethical practices of the profit driven subluxation theory technique systems that confuse the public.  To be good doctors we must keep our beliefs out of any decisions made on behalf of our patients.  

Please leave comments and tell me what you think.