In Montana, the penetration rate is even higher: 59 percent of Montanans use some form of alternative medicine, according to a study conducted in September by the Bureau of Business and Economic Research at the University of Montana. This survey was done in conjunction with a conference held in October in Missoula, sponsored by the university’s Asia-focused Mansfield Center and titled The Healing Arts in American and Asian Cultures: A Conference on Living and Dying Well.
The conference focused primarily on Asian and other alternative healing practices and their relevance for the American health care system. But a secondary emphasis—prompted by conference co-sponsor, the Missoula Demonstration Project, a community-wide dialogue on dying well—explored the applications of alternative therapies to care at the end of life.
Keynote speaker Arthur Kleinman, M.D., professor of medical anthropology and psychiatry at Harvard Medical School, examined the bridge between East and West. Kleinman discussed whether Chinese medicine offers a model for the American health care system at a time when Western medicine, and Western social medical complaints such as alcoholism and stress-related illnesses, are both on the rise in China.
With some exceptions, the conference was less about integrating Eastern and Western philosophies of healing than about studying the differences and boundaries between them. Sessions highlighted art therapy, acupuncture, healing and therapeutic touch, herbal therapy, homeopathy and Ayurvedic and naturopathic medicine.
The relevance of complementary therapies to end-of-life care, observed speaker Nancy Dunne Boggs, a naturopathic physician in Missoula, derives from a fundamental belief system that holds patients responsible for their own well-being and self-healing. Naturopathy is a form of primary health care that emphasizes "natural" therapies and the healing power of nature.
"When one is committed to such a philosophy of self-responsibility, a person would enter the final stage of life demanding not to be left alone, not to be isolated, not to be in pain," Boggs observed in a recent phone interview. At the same time, complementary therapies such as nutrition, acupuncture and herbal treatments might contribute to palliative goals of pain relief, sedation or relaxation, without the side effects that pharmaceuticals often carry, she added.
Walt Hollow, M.D., of the University of Washington School of Medicine, and a family practitioner with an HMO medical panel serving an urban Native American population in Seattle, offered another perspective. The use of traditional Indian medicine has been growing in recent years, following the 1978 passage of legislation lifting a century-old federal ban on its practice.
"Indians use dual systems for their health care, which has consequences, both positive and negative," Hollow observed. The more Western medical practitioners are aware of—and can talk to patients and traditional healers—about this interface, the better. Hollow reported that he has attended many ritual ceremonies performed for his patients by traditional Indian healers. "The next time they come to my office, they are much more likely to listen to my recommendations."
Traditional Indian medicine treats the person’s physical, mental and spiritual realms, and attempts to restore the balance between them. It also pays explicit attention to terminal issues and the patient’s care preferences and spiritual needs at the end of life. Traditional Indian healers frequently counsel terminally ill patients, with the aim of helping them feel as comfortable as possible with their dying, Hollow said.
Most end-of-life health professionals have been trained and acculturated in conventional Western medicine. Yet they frequently confront medicine’s failings, in the way it sacrifices the terminally ill person’s quality of life to a mechanistic battle with disease. Much from the philosophies of other medical traditions—such as the interconnection of mind, body and spirit; the recognition of spiritual as well as physical needs; the idea that one can be "well" while dying; and the use of non-pharmacological pain management modalities—would seem to resonate with the observations of hospice and other end-of-life providers.
Yet bringing alternative healing traditions into end-of-life care, when it happens, most often comes from individual professionals who have studied healing touch or other complementary methods and incorporated them into their own practice. One end-of-life provider that has tried in a more systematic way to incorporate—and study—complementary modalities is Franciscan Health System Hospice in Tacoma, WA. Three years ago this hospice launched a program called Comfort Therapy, offering up to eight free sessions of massage, music, art or hypnosis/relaxation therapy to enrolled hospice patients, while studying their effects on pain intensity, analgesic use and quality of life.
The pilot research was largely inconclusive, but suggests that massage therapy can have a positive impact on patients’ quality of life, reports Susan Cutshall, M.Div., a spiritual caregiver with the hospice. Integration of Eastern and Western modalities happens "in the lives and spirits of hospice practitioners," who have studied Reiki, healing touch or energy work, Cutshall says. "Those people bring that perspective through their presence."
Cutshall adds that hospice professionals trying to realize such an integration of Western and complementary approaches to end-of-life healing are true pioneers. "We don’t yet know what it’s going to look like. Are we working with our patients’ emotions, or their energy? Are we addressing their physical pain, or something a whole lot larger?"
Definitions of Complementary and Alternative Medicine Differ
Keynote speaker Marc S. Micozzi, M.D., Ph.D., executive director of the Medical College of Philadelphia and editor of the 1997 medical textbook, Fundamentals of Complementary and Alternative Medicine, suggested that these methods are better described as complementary, not alternative. "What we call ‘alternative’ medicine, much of it is primary care for 80 percent of the world’s people."
Micozzi highlighted two major challenges posed by the meeting of East and West. One is to distinguish complementary therapies with deep empirical roots in other cultures from what he called "unusual" therapies, often based on the work of a single individual. "We need to be much more discriminating about what we lump together. The medical system itself needs to rise to the challenge, embrace and sort out the wheat from the chaff, because no one else can," he said. The other challenge lies in finding ways to integrate complementary and conventional medicine without doing serious damage to the philosophical underpinnings of either.
Conference presenter Mary Stranahan, D.O., is an osteopathic general practitioner at the Medicine Tree Medical Center in St. Ignatius, MT, where she practices "integrative medicine"—taking the tools from both worlds and combining them in a mutually agreed-upon package that best addresses the patient’s needs. "Providers need to be open to other ways—all of us. We have to park our egos at the door, and conduct research outcomes," she asserted.
Larry Beresford, a San Francisco-based writer, frequently covers end-of-life issues.