Statement on the practice of Acupuncture

Foundation: Comisión Central de Deontología de la Organización Médica Colegial Española.
source : Spanish Medical Association.
language original: Spanish.
Approval: General Assembly of 4 October 2004.
Publication: Documentos Especiales OMC, December 2004.
Checked on 11 May 2005.

Statement of the WTO Central Commission of Deontology on the ethics of acupuncture practice

Introduction

1. Acupuncture is a particularly popular practice among non-conventional medical techniques. Originating in China, it is now used in at least 78 countries. In Belgium, 74% of Acupuncture treatment is administered by Western doctors. In Germany, 77% of pain clinics provide Acupuncture. In the UK, 46% of Western doctors recommend Acupuncture treatment to their patients or treat their patients with Acupuncture themselves.

2. In many developed countries, the increasing use of acupuncture indicates that there are factors other than tradition and cost that support it. Concerns about the adverse effects of chemical drugs, issues associated with Western medical approaches and assumptions, increased public access to health information, changing values and reduced tolerance of paternalism are some of these.

3. The World Health Organisation has issued guidelines to assist national health authorities in establishing regulations regarding the "knowledge of acupuncture and the expertise required of physicians and other health personnel who wish to include acupuncture in their professional work in the framework of modern Western medicine".

4. There are rulings of the European Court of Justice which refer to the fact that, in the absence of specific regulations for complementary therapeutic techniques, the law to be followed will remain within the limits of medical practice. The National Health Services of Germany, France, Belgium, the United Kingdom and Switzerland reimburse the costs of acupuncture treatment.

Reasons for the Declaration

5. The use of acupuncture in modern medical care involves taking it out of its traditional context and applying it as a therapeutic technique for a limited number of conditions for which it has proven efficacy, without the need to reconcile the theories on which modern medicine and traditional Chinese medicine are based.

6. In our country, the group of doctors who practise acupuncture is made up of practitioners who include acupuncture in their regular practice, both in the private and public systems, thus broadening the possibilities of applying a therapy appropriate to the patient's pathology.

7. Medicine is a science and an art, and therefore, without prejudice to the obligation of the physician to provide up-to-date, conscientious and attentive care and the right of patients to receive care that is safe and proven by medical science, one of the inalienable rights of the physician is the freedom to prescribe for the best treatment of his patients. In exercising this freedom to prescribe, the physician is accountable to society, to patients and to his or her colleagues in the profession, in accordance with the provisions of the law and professional ethics. agreement .

8. In recent years, a significant number of Medical Associations have established a Section, group or similar, for physicians practising acupuncture. The Colleges should provide the means to verify and guarantee an adequate training Degree for these practitioners so that they can be accredited until such time as national legislation is in place. Acupuncture has been a common practice in our country for many years; under the protection of Medical Associations, Medical Academies and Masters in Universities, it is being taught, without official regulation and control for practice and teaching.

9. In view of the above, the Central Commission on Deontology does not judge the efficacy of acupuncture as a therapeutic technique, but rather the Medical Association has to regulate the particular deontological aspects of its practice. Acupuncture has been recognised and accepted by the World Health Organisation as a useful method of medical activity and is supported by centuries of continuous practice.

Concepts and definitions

10. Acupuncture means not only the insertion of thin, solid, metallic needles through the skin at appropriate points for the prevention or treatment of disease, but may also include acupressure, electro-acupuncture, laser acupuncture, moxibustion (local and focused application of heat to acupuncture points using a pulverised and compressed combustible substance) and cupping, which are related therapeutic techniques of Traditional Chinese Medicine.

11. Acupuncture is a therapeutic method based on the following principles:

Diagnostic Principle: whereby, by applying the theory of subject medical theory in traditional Chinese medicine, with its specific terminology, a diagnosis is reached for the application of a therapeutic principle.

Therapeutic Principle: by which different therapeutic techniques are applied, setting in motion a series of systems aimed at healing and rebalancing them.

Preventive Principle: the diagnosis of traditional Chinese medicine financial aid through proper clinical analysis to provide a series of preventive measures, dietary recommendations, etc. in order to prevent the disease.

12. From the three previous principles it is clear that acupuncture is a medical practice, as it requires a diagnosis prior to the establishment of the therapeutic principle that will determine the technique to be used, the prescription of points and the method of manipulation, or the techniques necessary to prevent the illness in each specific patient. As indicated in article 6.2.a of Law 44/2003, of 21 November, on the organisation of the health professions, it is the responsibility of graduates in medicine to indicate and carry out activities aimed at the promotion and maintenance of health, the prevention of illnesses and the diagnosis, treatment, therapy and rehabilitation of patients, as well as the judgement and prognosis of the processes that are the object of attention.

13. In other words, a medical act is understood to be any lawful activity, carried out by a legitimately qualified medical professional, leading to the cure of a disease, the alleviation of an ailment or the overall promotion of health, including, therefore, diagnostic, curative, pain-relieving and health-preserving acts, by direct or indirect means. We understand that the acts on which the practice of acupuncture is based are medical and therefore reserved for medical practitioners, regardless of whether other health personnel are authorised to apply the prescriptions of the acupuncture practitioner with regard to acupressure, moxibustion, cupping or auriculotherapy.

14. It is clear that the legal interests at stake, both public and private, require control of practice and regulation of training by the State, taking into account the criteria of the committee General General Association of Medical Associations.

Deontological and Professional Aspects

15. The physician practising acupuncture is subject in all respects to the provisions of the Code of Medical Ethics and Deontology. Given the peculiarity of this therapeutic technique and of current teaching systems, it is necessary to qualify and determine some particular aspects that require special attention.

16. The 1999 Code of Medical Ethics and Deontology makes clear in Art. 21.2 the obligation of the acupuncture practitioner to inform patients of the need not to abandon fundamental treatment if any. They must also keep their knowledge of the mechanisms of action of acupuncture as they are discovered up to date in order to integrate them with those of conventional Western medicine (article 18 of the CEDM).

17. The doctor will not use any of the techniques of traditional Chinese medicine in which he is not sufficiently trained. The patient who submits himself to this treatment modality must be sure that he is being treated by a person who knows the medical pathology, who will apply these techniques based on a precise differential diagnosis; furthermore, he must have the guarantee that the person who applies them knows them and has undergone the same control required for conventional medical practice.

18. When a patient requires another clear therapeutic indication, he/she should be informed and referred to the corresponding specialist. Giving false hope, prolonging a treatment without justification or indicating the withdrawal of other useful treatments for the patient are ethically reprehensible actions.

19. Informed consent should be obtained from the patient, preferably in writing, before starting treatment. In particular, the patient should be clearly informed of the peculiarities of the technique or techniques to be used, the number of sessions planned, the expected benefits and the probable evolution. The adverse effects that may occur according to the patient's own characteristics and the possibility that the treatment may exacerbate some symptoms at the start of the treatment should also be discussed.

20. With the best interests of the patient in mind, the acupuncture practitioner should always cooperate as much as possible with the primary care physician or specialist who is the patient's usual health care provider. Some patients may not wish their GP to know that they are being treated with non-conventional medical techniques; their wish for confidentiality should be respected, although it is prudent to encourage them to tell their GP, as treatment with acupuncture may reduce or change drug requirements.

21. The advertising of a medical practitioner practising acupuncture shall be governed by the general deontological rules governing acupuncture; it must be objective, prudent and truthful, without any intention of comparison with other health professionals, especially in view of the fact that acupuncture is currently the subject of intense intrusiveness, using a misleading advertising .

Conclusions

22. Acupuncture, as previously defined, is an invasive therapeutic technique that requires a prior diagnosis, preferably in writing, according to the postulates of traditional Chinese medicine, which can only be carried out by a doctor who, with an integrative vision with Western medicine, judges it to be the most appropriate or complementary treatment for a specific patient.

23. Following the proposals of the World Health Organisation, it is the responsibility of the National Government to regulate the practice and teaching of acupuncture, with the prior advice of the Collegiate Medical Organisation.