In their discussion of informed consent for CAM, Ernst and Cohen1 neglected the issue of spiritual informed consent. By the standard of "what a reasonable patient would find material to a treatment decision," many patients are not adequately informed about the "spiritual risks" of alternative treatments.
Complementary and alternative medicine is often presented in a sterile, medical context without recognizing the rich, spiritual roots of many techniques that cannot be separated from their clinical practice. Ayurvedic medicine is intimately associated with Hinduism and transcendental meditation. Reiki uses "spiritual energy with innate intelligence" and can involve contact with "spirit guides."2 Therapeutic touch is built on the Hindu concept of prana, despite its adoption of more clinical language. Qigong and Tai Chi carry with them spiritual suppositions consistent with centuries of Chinese religious tradition. Practitioners may use a technique not inherently spiritual (such as chiropractic, acupuncture, or yoga) but apply it using an Eastern religious worldview. Likewise, herbs can be given, not as medicine but to allow "nature spirits" or "life energy" to impact on a patient's health.