Kevin Smith is a bioethicist at Abertay University, Scotland. He has written widely on ethical issues arising from so-called ‘Complementary and Alternative Medicine’ (CAM). He is particularly interested in applying utilitarianism as a tool of bioethical analysis of pseudoscientific modalities. His conclusions from such analyses have been highly negative; he has identified a number of serious ethical concerns surrounding CAM, and asserts that these issues need to be articulated and acted upon by physicians and others in order to prevent patient harm and maximise support for scientific medicine. His bioethical research has received national and international attention beyond academia.
Abstract
How does the culture of self-management and spirituality harm public health?
In the realm of medicine and healthcare, the culture of self-management and spirituality, often lauded for empowering patients, conceals a myriad of problems when viewed through the bioethical lens of utilitarianism. Self-management, while promoting autonomy, often leads to suboptimal health outcomes due to misinformation and an over-reliance on personal judgment, which is particularly detrimental due to various cognitive biases that tend to lead patients astray.
The allure of spirituality and alternative healing practices, often romanticised, clashes with science-based and evidence-based medicine. This conflict is apparent in a range of cases including vaccine hesitancy, chronic disease management, and responses to public health advisories. Wherever personal beliefs impede public health efforts, we have an ethical problem.
The utilitarian perspective highlights a significant ethical dilemma: respecting individual choices while ensuring the well-being of the broader community. The inclination towards self-guided health practices and spiritual beliefs, under the guise of autonomy and personal empowerment, can lead to suboptimal or outright negative consequences for individuals, and may unwittingly undermine public health initiatives.
In essence, while self-management and spirituality in healthcare present an appealing veneer of empowerment and respect for individuality, they are fraught with bioethical problems that, upon closer scrutiny, reveal a potential for harm that outweighs their superficial benefits.