My patient has asked me to administer a complementary therapy in the form of a liquid herbal substance, which I do not know much about. What are my legal obligations? Am I able to refuse?
Complementary therapies are therapies that are employed in conjunction with mainstream health-care practices.1 Examples of complementary therapies may include herbal products, visual imagery, and traditional medicines like Ayurvedic and Aboriginal medicines.
A nurse’s legal and professional obligation to provide reasonable and prudent care can extend to administering a complementary therapy. Before administering a complementary therapy, such as an herbal substance, it would be important to confirm that the administration of the herbal substance falls within a nurse’s scope of practice and that they possess the necessary knowledge, skill and judgment to administer it safely.2 It would also be prudent to verify that the necessary informed consent to administer the therapy has been obtained.
It is often not within the nursing scope of practice to independently initiate a treatment.3 It is important to be aware of legislation, regulations, professional standards and guidelines as well as the health-care institution’s bylaws and policies relevant to the administration of complementary therapies.4 Ontario’s Hospital Management Regulation specifies that every order for treatment must be made by a physician, dentist, midwife or nurse practitioner.5 Therefore, nurses who are asked by patients to administer a complementary therapy will generally be expected to determine whether the therapy would require a medical order, whether it can be appropriately incorporated into the patient’s plan of care (in consultation with other care team members as appropriate), and whether its use is supported by the health-care institution’s policies. The nurse would, in the normal course, document the request, the response, the administration or use by the patient in accordance with their professional standards and the health-care institution’s policies.
A nurse who, despite these measures, believes that administering the proposed complementary therapy would pose a risk to the patient’s safety, should bring their concerns to the attention of the team member who endorsed the treatment, the most responsible professional and if necessary, nursing management.
In College of Nurses of Ontario v Manning,6 a community care nurse administered a liquid by mouth as a purported alternative cancer treatment, composed of fruit and vegetable, to an end-stage patient who was at risk of aspiration. The panel determined that the nurse committed professional misconduct by administering the treatment without a medical order, without consulting the health-care team and without obtaining the appropriate consent from the substitute decision maker. The panel found that since the nurse led a family member to believe that the fruit and vegetable liquid was a treatment for cancer, it followed that consent was required for the treatment. The panel also found that the nurse failed to show evidence (in the form of a documented consent or testimony) that he obtained consent from a substitute decision maker, as it was deemed that the patient was not able to consent to treatment at their stage of illness. The patient died the day after the liquid was administered. The nurse received a six-month suspension in addition to terms, conditions and limitations on his nursing registration.
When administering complementary therapies, it is important to follow the relevant legislated authority and professional standards, and to be familiar with any relevant employer’s policies, employer’s code of conduct and Code of Ethics.
CNPS beneficiaries can contact CNPS at 1-800-267-3390 to speak with a member of CNPS legal counsel. All calls are confidential.
1.“Complementary & alternative therapies,” British Columbia College of Nursing and Midwives, https://www.bccnm.ca/Documents/standards_practice/rm/RM_Policy_Statement_on_Complementary_and_Alternative_Therapies.pdf
2.“Complementary Therapies,” College of Nurses of Ontario, last modified December 2018, accessed October 2, 2019, http://www.cno.org/en/learn-about-standards-guidelines/educational-tools/ask-practice/complementary-therapies/; “Complementary and Alternative Health Care and Natural Health Products Standards,” College & Association of Registered Nurses of Alberta , last updated on December 2018, accessed October 1, 2019, https://cnps.ca/wp-content/uploads/2020/03/complementary-and-alternative-health-care-and-natural-health-products-1.pdf
3.Nurse practitioners must confirm whether ordering a form of an alternative therapy falls within their scope of practice.
4.For example, the CARNA Standard specifies on page 8 that nurses are only to administer or recommend Natural Health Products that are approved by Health Canada.
5.Hospital Management, RRO 1990, Reg 965, s 24(1) under the Public Hospitals Act, RSO 1990, c P 40. This regulation applies to Ontario hospitals.
6.College of Nurses of Ontario v Manning, 2008 CanLII 89799 (ON CNO), CanLII, accessed October 1, 2019.
Revised October 2019
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