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The Ethical Justification of Extending Holistic Care to Complementary Duquesne University Duquesne Scholarship Collection Electronic Theses and Dissertations 2016 The thicE al Justification of Extending Holistic Care to Complementary and Alternative Medicine Kaneen Bree Allen Follow this and additional works at: https://dsc.duq.edu/etd Recommended Citation Allen, K. (2016). The thicalE Justification of Extending Holistic Care to Complementary and Alternative Medicine (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/295 This Immediate Access is brought to you for free and open access by Duquesne Scholarship Collection. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Duquesne Scholarship Collection. For more information, please contact [email protected]. THE ETHICAL JUSTIFICATION OF EXTENDING HOLISTIC CARE TO COMPLEMENTARY AND ALTERNATIVE MEDICINE A Doctoral Project McAnulty College and Graduate School of Liberal Arts Duquesne University In partial fulfillment of the requirements for the degree of Doctor of Health Care Ethics By Kaneen B Allen, MHA May 2016 Copyright by Kaneen B Allen, MHA 2016 THE ETHICAL JUSTIFICATION OF EXTENDING HOLISTIC CARE TO COMPLEMENTARY AND ALTERNATIVE MEDICINE By Kaneen B. Allen, MHA Approved April 7, 2016 ________________________________ ________________________________ Henk ten Have, MD, PhD Gerald Magill, PhD Director, Center for Healthcare Ethics Vernon F. Gallagher Chair for the Professor of Healthcare Ethics Integration of Science, Theology, (Committee Chair) Philosophy and Law Professor of Healthcare Ethics (Committee Member) ________________________________ ________________________________ Sr. Rosemary Donley, SC, PhD Henk ten Have, MD, PhD ANP-BC, FAAN Director, Center for Healthcare Ethics Professor of Nursing Professor of Healthcare Ethics Jacques Laval Endowed Chair for Justice (Committee Member) for Vulnerable Populations (Committee Member) ________________________________ James Swindal, PhD Dean, McAnulty College and Graduate School of Liberal Arts Professor and Dean of McAnulty College iii ABSTRACT THE ETHICAL JUSTIFICATION OF EXTENDING HOLISTIC CARE TO COMPLEMENTARY AND ALTERNATIVE MEDICINE By Kaneen B. Allen, MHA May 2016 Dissertation supervised by Henk ten Have, MD, PhD The doctoral project presents an argument for the inclusion of complementary and alternative medicine in the provision of holistic care. Over the course of history the practice of medicine has evolved with developments in science and technology and transitioned away from its holistic origins to a more fragmented practice. The project includes relevant literature on shortcomings of conventional medicine that are in part a catalyst for the trends of increasing complementary and alternative medicine utilization. The doctoral project concludes that the benefits of complementary and alternative medicine’s inclusion in care, and more specifically holistic care, is of value and further research will be of benefit to further the utilization of complementary and alternative medicine. iv DEDICATION This project is dedicated to my parents, my mom Dr. Carol Allen and dad Mr. Orvin Allen, whose constant love, prayers and support provide me sustenance. v ACKNOWLEDGEMENT I would first like to give all praise and honor to God in the completion of this doctoral project, for without Him, none of this would be possible. With the deepest gratitude I would like to acknowledge my committee. To Dr. Henk ten Have, department chair and advisor, thank you for your knowledge, patience and understanding throughout. To my committee, Dr. Gerard Magill and Sr. Rosemary Donley, thank you for your guidance and support. To Glory Smith, thank you for your words of encouragement and assistance through the years. To my family and friends who prayed for me fervently. To my mom and dad who always believed in me and knew I would not fail. To my friend Alexis, who pushed me to say the course. To Stacy who reminded me that God would not bring me this far and leave me. And to countless others who prayed for me through it all…THANK YOU. I am a testimony that, “I can do all things through Christ…” vi TABLE OF CONTENTS Page Abstract .............................................................................................................................. iv Dedication ............................................................................................................................v Acknowledgement ............................................................................................................. vi Chapter 1: Introduction ........................................................................................................1 Chapter 2: Development of Western Medicine ..................................................................5 Greek and Roman Origins of Medicine and Developments Modern Medicine Limitations of Western Medicine Chapter 3: Overview of Holistic Care ...............................................................................23 The Problem of Reductionism Concept of Holistic Care Smut’s Holism and Application to Complementary and Alternative Medicine Modes of Delivery Quality Chapter 4: Ethical Justification of Holistic Care ...............................................................44 Assessment of Risk Right to Health Care Duty to Treat Supererogation Vulnerability Chapter 5: Review of Existing Models of Holistic Care ...................................................65 vii Holistic Nursing The Veterans Affairs Model Elaboration and Practice of the Model Chapter 6: Care Coverage and the Utilization of Complementary and Alternative Medicine ............................................................................................................................88 Access to Care and Insurance (Patient Protection and Affordable Care Act) Role of the Provider Trends in Complementary and Alternative Medicine Increase Utilization Chapter 7: Conclusion......................................................................................................108 viii Chapter 1 – Introduction Western medicine, largely based on pure science, evolved through Grecian developments into the modern medicine of this century. Although, many landmark advancements have occurred in medicine across the world (specifically in Western society); Western society continues to see increases in mortality rates for many diseases and illnesses. As a result, health care is constantly changing and evolving due to advances in science and technology that improve the way illness and diseases, at a minimum, are addressed; however there are still opportunities for improvement. Significant gains can be achieved by incorporating holistic care (through complementary and alternative medicine) into the health care provided to all who seek care. Consideration also needs to be given to those who do not actively seek care, due to challenges with access. Access to health care is a large variable in the delivery of care and is largely influenced by cost, insurance, socioeconomic factors and culture. Governmental priorities and polices (such as the Patient Protection and Affordable Care Act which seeks to provide more Americans access to health care through quality affordable health insurance) that surround health care can have a large impact. Holistic care, simply defined, is care of a patient that acknowledges the connection between mind, body and spirit and addresses the health concerns of the patient as they pertain to the whole person.1 Science has shown linkages between emotions and chemicals in the body, and changes in either of these elements can, and do, impact health. As understanding of these linkages develops, it lends to the incorporation of the holistic piece into western medicine by changing the current approach of purely focusing on an individual with a disease, and providing them medication and treatment 1 for that particular disease. The singular approach may be successful in treating the disease, however falls short in the area of healing as the underlying causes of the disease are not addressed. As a result, patient perception of the shortcomings of Western medicine has led to the increased use of holistic care, as evidenced by the use of complementary and alternative therapies.2 Should the focus shift to the whole person and the underlying issues leading to disease, the benefits can go beyond just the individual. Benefits can be gained by shifting from, the way western medicine focuses on a singular approach (treatment of disease), and looking towards a more global approach, through holistic care that addresses the needs of the whole person. Addressing health care more holistically through complementary and alternative medicine will lead to improvements in health care quality.3 Health care quality is quite important to society and is evaluated by organizations such as the Joint Commission, the Office of the Inspector General, Health Departments, the Institute for Healthcare Improvement and the World Health Organization. Although, quality of care can improve by the appropriate implementation of holistic care, one must be cautious of what is incorporated and how, because the outcomes can lead to the converse, a decrease in quality. The implementation of holistic care goes beyond disease treatment to a true holistic system and approach that looks a health care prior to the onset of disease, during and post disease. According to the Center of Disease Control and Prevention there has been an increase in the number
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