Ethical Practice in Vulnerable Populations

Course overview

Acupuncturists who treat adult outpatients generally rely on a set of assumptions about our patients that make us equal partners in a business transaction, exchanging our expertise for their money. We assume they are hiring us on their own initiative because they want to, can stop if they change their minds, can recognize and articulate their own likes and dislikes, and can evaluate and reject anything we tell them that doesn’t fit with their values or preferences. A number of these assumptions are simply not valid for some patients with infertility, chronic pain or terminal illness, as well as inpatients, children, and the elderly or cognitively impaired, all of whom may be emotionally, cognitively or socially limited in their ability to choose what they accept from us. This class clarifies legal and ethical definitions of autonomy and consent, using case studies from practice to illustrate gray areas that may arise, along with how to recognize and manage them. Transference, countertransference and the ‘bodhisattva complex’ are discussed. Advice is given for drawing the important but elusive line between hope and magical thinking, in the context of current research which shows that acupuncture has measureable and meaningful ‘non-specific’ effects of context and patient interaction, (aka ‘just placebo’).   Straightforward practices for are presented for consciously monitoring the patient’s emotional engagement with the diagnosis and treatment process. As a form of mindfulness these approaches can enhance any patient relationship. They are particularly useful for practicing with vulnerable patients, and charting to minimize malpractice exposure in emotionally difficult cases.