Ask a lawyer: Complementary therapies

Question: 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?

Answer: Complementary therapies are therapies that are employed in conjunction with mainstream health-care practices.1 Examples of complementary therapies may include massage, herbal products, homeopathy and visual imagery.2

A nurse’s legal and professional obligation to provide reasonable and prudent care would generally extend to administering a complementary therapy. Before administering a complementary therapy, such as an herbal substance, the nurse has a professional and legal obligation to confirm that the administration of the herbal substance falls within their scope of practice and ensure that they possess the necessary knowledge, skill and judgment to administer it safely.3 The nurse should also ensure the necessary informed consent to administer the therapy has been obtained.

Generally, it is not within a nurse’s scope of practice to independently initiate a treatment.4 A nurse must be aware of relevant legislation, regulations, professional standards and guidelines and health-care institution policies concerning administering complementary therapies.5 For example, Ontario’s Hospital Management Regulation specifies that every order for treatment must be made by a physician, dentist, midwife or nurse practitioner.6 Nurses who are asked by patients to administer a complementary therapy will therefore want to determine whether the patient would require a medical order and if its use is supported by the health-care institution’s policies. Regarding the patient’s complementary therapy, the nurse should also ensure that they have consulted with the health-care team, that it is appropriately incorporated in the patient’s plan of care; and that they document the patient’s participation in accordance with their professional standards and the health-care institution’s policies.

If, however, a nurse is asked to administer complementary therapy where there is unknown risk to the patient, they may refuse to administer the substance if they believe that administering it would pose a risk to patient safety.7 If a nurse refuses, their concerns must be clearly documented in the patient record and they should communicate their concerns to the patient, the health-care team and nursing management as appropriate.

In College of Nurses of Ontario (CNO) v Manning,8 a community care nurse administered by mouth a purported alternative cancer treatment, composed of fruit and vegetable, to an end-stage patient who was at risk of aspiration. The CNO panel found 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 CNO 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 CNO panel also found that the nurse failed to document that written consent was obtained. The patient passed away the following afternoon after the liquid was administered. The nurse received a 6-month suspension in addition to terms, conditions and limitations on his nursing registration.

A nurse must be careful to practise in accordance with their legislated authority, professional standards, employer’s policies, employer’s Code of Conduct and the Canadian Nurses Association Code of Ethics for Registered Nurses when administering complementary therapies.

To discuss complimentary therapies with a legal advisor, who is a lawyer, on a confidential basis, please contact CNPS at 1-800-267-3390.

1. “Complementary and Alternative Health Care”, College of Registered Nurses of British Columbia.

2. “Complementary and/or Alternative Therapy and Natural Health Products: Standards for Registered Nurses” (January 2011),  College & Association of Registered Nurses of Alberta, [CARNA Standard].

3. “Practice Guideline: Complementary Therapies”, College of Nurses of Ontario, [CNO Guideline]; “Complementary & Alternative Health Care: A Guideline for Registered Nurses and Nurse Practitioners”, College of Registered Nurses of Nova Scotia, p 3; CARNA Standard, supra note 2 at p 4.

4. Note: Nurse Practitioners must confirm whether ordering a form of an alternative therapy falls within their scope of practice.

5. For example, the CARNA Standard specifies on page 5 that RNs are only to administer Natural Health Products that are legal in Canada.

6. Hospital Management, RRO 1990, Reg 965, s 24(1) enabled by the Public Hospitals Act, RSO 1990, c P 40. This regulation applies to Ontario Hospitals.

7. CNO Guideline, supra note 3.

8. 2008 CanLII 89799 (ON CNO).


Published November 2016



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