Running Head: LEGAL & ETHICAL IMPLICATIONS OF NATUROPATHY 1

Legal and ethical implications of naturopathy

Miquella Young

Arizona State University

LEGAL & ETHICAL IMPLICATIONS OF NATUROPATHY 2

Legal & Ethical Implications of Naturopathy

Naturopathic medicine is not just natural medicine. Licensed naturopathic physicians in

today’s era engage in four or more years of education before beginning their practice. Otherwise

known as general physicians with a specialty in preventative and natural medicine, this

population of medical professionals has potential to be a great asset in collaborative medical

spaces. Integrative medicine is all about transcending the great debate between traditional and

conventional care: bringing the strengths of each into clinical practice. Naturopathic medicine

seeks to do just that, despite current legal and ethical barriers to providing care.

Licensing & Regulation

To practice naturopathy as a licensed physician, students must undergo four-year post-

graduate education at one of seven accredited universities in the country. The Southwest College

for Naturopathic Medicine requires similar education to traditional medical practice, with the last

two years of study focused on immersive clinical practice. Contrastingly, students are not

required to take the MCAT, an exam which determines a student's readiness for medical school.

Instead, N.D.s take the NPLEX, or Naturopathic Physician's Licensing Exam upon meeting

educational eligibility requirements to partake. It is a two-part exam by the North American

Board of Naturopathic Examiners. Once passed, practitioners receive their license in the same

state as the accredited school they attended.

There are not specific national requirements for NDs to follow, which causes confusion

and inconsistency among the community of practitioners. However, there are only seven

different universities that provide accredited licensure to naturopathic physicians, so practitioners

are at least unified by institution. The universities vary in their admissions requirements, but each

of these programs is looking for students who possess the qualities that will matriculate into
LEGAL & ETHICAL IMPLICATIONS OF NATUROPATHY 3

successful naturopathic physicians: "concern for others, integrity, appropriate observational and

communication skills, motor function, intellectual-conceptual abilities, integrative and

quantitative abilities, and behavioral and social maturity" (AANM, n.d.). Since NDs typically

charge less for their services, application and attendance to these universities is cost-effective for

students seeking integrative medical education.

Some regulatory issues that arise among these institutions are the varying scopes of

practice. The Southwest College of Naturopathic Medicine has one of the widest scopes of

practice, including everything that an M.D. or D.O. would do except major surgery

and administration of prescription drugs. Currently there are only 17 states who permit NDs to

practice legally; although, there are two states that specifically deny N.D.s to practice

(Jesson & Tovino, 2010). Restrictions on practice are regulated by the state. NDs can only

practice in their state of licensure since standards of care vary under statuary jurisdiction

(Jesson & Tovino, 2010, p. 79-80).

Legal Implications

Malpractice suits come into play for the naturopath when attempting to interpret the

broad definition of medicine: "diagnosing, prescribing, treating or operating for any human

disease, pain, injury, deformity, or physical condition" (Jesson & Tovino, 2010). Examples may

be the fine line between a ND educating a patient on an herbal remedy and prescribing it. It is

important to note that integrative health practitioners like NDs experience fewer malpractice

suits than allopathic physicians since their remedies are often less potent and invasive (Augusta,

2018).

On the contrary, there is currently a division between CAM practitioners, like the

naturopath, and doctors of strictly western medicine (MDs and DOs). This problem has
LEGAL & ETHICAL IMPLICATIONS OF NATUROPATHY 4

reasonable grounds in history since "quackery" was a prominent issue following the rise of CAM

(Baer, 2016). However, with heightened government and institutional regulation for CAM

physicians, there is less reason for physicians to believe that naturopaths are not qualified to "do

good" for their patients. Current research, like that of nutraceutical research as a supplement to

standard cancer therapies, may help bridge this gap and reduce legal implications for both fields

of medicine (Ahmand, et al., 2015).

Disputes between western and CAM practitioners may result in both parties resisting

cross-discipline collaboration and recommendation. A simple solution is to put bias aside and

realize the value in each team member, turning to documents like, Competencies for Optimal

Care in Integrated Environments as a frame of reference. These competencies may be part of the

solution to this physician rivalry, bringing an end to distrust and a beautiful new beginning to

interprofessional collaboration.

Ethical Implications

In naturopathic medicine, there are CAM practices like homeopathy, Ayurveda, and

herbal medicines that are prescribed to patients without quantitative research to support the

claims. There are practices that are safe but not yet proven effective and safe practices only

proven effective for certain conditions or populations. One ethical issue that arises with these

exploratory therapies is beneficence; is it ethical to provide treatments that may not be doing

anything more than a placebo? Is the naturopath doing any good by prescribing these therapies to

their patient? NDs are providing a service for a fee. To charge patrons for a service that may or

may not do anything to biologically heal their body may seem like "quackery" to some.

Western medicine strays away from naturopathy’s out of fear that their CAM modalities

will prove to be inefficacious. MDs may see that herbal medicines cannot be standardized or
LEGAL & ETHICAL IMPLICATIONS OF NATUROPATHY 5

regulated to the extent of pharmaceuticals and label it as unpredictable. However, naturopaths

see this inconsistency as the consequence of natural variation in body and plant composition.

NDs may not be doing good if an herbal treatment is contraindicated with another medication.

This scales the problem to the side of nonmaleficence. In the end, the naturopath is meeting the

demand for quality holistic care with their supply of CAM therapies. By simply engaging in the

act of care and meeting patient expectations there is good being done.

Cultural Implications

There are high barriers to naturopathy that exist for immigrant populations. For starters,

immigrants are less likely to have access to CAM practices since they often fall into job fields

with lower socioeconomic status and are therefore less likely to have access to health insurance

(Elewonibi & BeLue, 2016). Many immigrant, minority, and culture-specific groups already

have an affinity towards herbal remedies and holistic healers. Without access to naturopathic

doctors, who provide many of the services they are familiar with, these populations will be at

higher risk for using herbs of questionable quality and in unregulated dosages. The perceived

dangers and instances of mortality continue to rise for CAM practices without access to quality

care providers like NDs.

Insurance plans may be tipping preference towards western medicine and away from

CAM therapies. One cross-sectional analysis of insurance enrollees in Washington found that

insurance plans that patients enrolled in preferred provider organizations and point-of-service

products were more likely to use CAM services and receive coverage, but the majority of plans

offer little to no coverage of CAM (Lafferty, et al., 2006). By lumping all the CAM practitioners

together, it is easy for health insurance companies and government health agencies to make

generalizations about its efficacy. Naturopathic practitioners are one group of CAM practitioners
LEGAL & ETHICAL IMPLICATIONS OF NATUROPATHY 6

that stand out within the culture of natural medicine for their regulated educational and licensure

requirements. However, they are not treated as unique medical specialists. Consequently, their

ability to treat those populations who have an affinity towards traditional medicine is highly

limited. The licensed naturopath has respect for persons of all cultural backgrounds but does not

have the support of public and private financial programs to provide their services to those who

need it most.

The Future of Naturopathy

In response to skyrocketing healthcare costs, our country is undergoing a necessary

paradigm shift towards patient-centered medicine. With the increase in quality education,

naturopathy can rise to help meet this need. Arenzt discusses the future of naturopathic medicine,

proposing that evidence-based practice can give the profession a guiding framework for patient-

centered care (2017). Citizens are demanding options for treatment that are less expensive and

more sustainable. Integrative medicines like naturopathy can provide that, along with evidence-

based care and improved patient outcomes. It is vital that CAM’s legal history is recognized as

outdated, naturopathy recovers its community standing, and insurance policies cover natural

remedies provided by licensed physicians.

If these goals are not realized, then there is danger for naturopathy to be dissolved and some

of its principles to be partially adopted into allopathic medicine (Baer, 2016). National

healthcare costs may continue to rise as western medicine desperately tries to externally cure

chronic disease in an aging population who, in one study, favored naturopathy for its alignment

with their beliefs, the quality of attention, self-empowerment tools, and the educational benefits

(Oberg, et al., 2015). Without distinguishing naturopathy from CAM, the field may continue to
LEGAL & ETHICAL IMPLICATIONS OF NATUROPATHY 7

be discredited. Medical doctors may not seek to collaborate in research and collaborative care;

the field will remain divided and research will remain one-sided.

Even though licensed naturopathic physicians undergo a rigorous 4-year clinical training

program and must pass the nationally recognized licensing exam, N.D.s are still widely limited

in their scope of practice. They can only practice in 17 states, their services are not covered by

most insurance companies, there is less federal regulation of products, and they are often shut out

of medical collaborations. By seeing beyond these limitations, naturopathic medicine may be

America’s bridge to healthcare reformation by tying science and tradition together.

LEGAL & ETHICAL IMPLICATIONS OF NATUROPATHY 8

References

Ahmad, A., Ginnebaugh, K. R., Li, Y., Padhye, S. B., & Sarkar, F. H. (2015). Molecular targets

of naturopathy in cancer research: Bridge to modern medicine. Nutrients, 7(1), 321-334.

10.3390/nu7010321.

Arentz, S. (2017). Bursting the bubble of 'no evidence' by reframing the foundations of

naturopathy. Australian Journal of Herbal Medicine, 29(2), 63-74.

Association of Accredited Naturopathic Medicine Colleges. (n.d.). Naturopathic doctor licensure

list of states and provinces. Retrieved February 19, 2018, from https://aanmc.org/resources/

licensure/

Association of Accredited Naturopathic Medical Colleges, AANMC. (n.d.). Naturopathic

Medical School Academic Prerequisites. Retrieved January 16, 2018,

from https://aanmc.org/naturopathic-schools/academic-prerequisites/

Augusta, D. (2018, January 16). HCR 441 Week 2. Retrieved from https://myasucourses.asu.edu/

webapps/blackboard/content/listContent.jsp?

course_id=_375345_1&content_id=_17666315_1&mode=reset

Baer, H. A. (2016). The sociopolitical status of U.S. naturopathy at the dawn of the 21st

century.  Medical Anthropology Quarterly,  15(3), 329-346. 10.1525/maq.2001.15.3.329.

Elewonibi, B.R. & BeLue (2016). Prevelance of complementary and alternative medicine in

immigrants. Journal of Immigrant and Minority Health, 18(3), 600-607.

Jesson, L. E., & Tovino, S. A. (2010). Complementary and alternative medicine and the law.

Durham, NC: Carolina Academic Press.

Macdonald, C., & Gavura, S. (2016). Alternative medicine and the ethics of commerce.

Bioethics, 30(2), 77-84. 10.1111/bioe.12226

LEGAL & ETHICAL IMPLICATIONS OF NATUROPATHY 9

Oberg, E. B., Thomas, M. S., McCarty, M., Berg, J., Burlingham, B., & Bradley, R. (2014).

Older adults' perspectives on naturopathic medicine's impact on healthy aging. Explore

(New York, N.Y.), 10(1), 34-43. 10.1016/j.explore.2013.10.003.