Attitudes and practices of herbalists towards the informed consent process

Abstract

Introduction: Informed Consent (IC) is a major cornerstone in medical ethics that is expected to be implemented universally in healthcare. The growing use of herbal medicines in developing countries has aroused concerns, especially regarding how informed consent is implemented in this kind of medical practice. Aim: To explore the attitudes and practices of herbalists towards the informed consent process. Methods: This was a cross-sectional study that employed explorative qualitative methods of data collection. Data were transcribed verbatim and analyzed thematically using NVIVO version 12 software. Results: Three quarters (15/21) of the participants were females, with a median age of 54 years.14/21 of the herbalists had attained primary education, with ten having twenty years of experience working as herbalists. 16/21 participants reported having acquired their knowledge and skills about herbal medicine through an oral transition from relatives with a few of them reporting self-initiation into the practice through attending training institutions. Participants generally had a positive attitude towards obtaining informed consent, with adequate information disclosure considered the most essential element. The practices, processes, and elements that constitute informed consent in herbal medicine did not vary greatly from the normative medical practices. However, stark differences including the amount and type of information shared, decision-making processes that were communal other than the individual, and the requirements to document the consent, with implied consent being prominent were identified. Lack of intellectual property rights over herbal medicines and lack of knowledge, skills, and self-efficacy to practice informed consent were reported to be the key hindrances to practicing it. Key informants expressed an urgent need to have the Traditional and Complementary Medicines Bill assented to by the President of Uganda as this would enhance the implementation of informed consent embedded within. A majority of the participants shared similar sentiments however they feared losing the market for their herbs once this mandate was approved. Conclusion: Informed consent processes and practices are generally acceptable to herbalists as in health practice with limitations around disclosure of herbal medicine formulations, alternatives, and documentation. To this consideration, verbal and implied consent is highly recommended. The proposed regulation of IC among herbalists should take a communitarianism approach rather than ethical individualism. Additionally, there is a need for extensive training in the informed consent processes, the establishment of intellectual property rights over herbal medicines, and the standardization of herbal medicines through research.