Metal Chelation Following Inappropriate Testing: Approach to Non-Medically Indicated Therapy Requests : Ethics in Practice.

Requests for chelation therapy following inappropriate or scientifically unsound testing in medical toxicology practice raise important ethical tensions between patient autonomy, professional integrity, and the therapeutic relationship. The central tension is how medical toxicologists should respond when patients strongly request non-medically indicated therapies that lack evidence of benefit and carry potential risk. We argue that while respect for patient autonomy requires earnest engagement with patient concerns, it does not obligate physicians to provide therapies they believe are scientifically unsupported or potentially harmful. Ethical care in these situations requires balancing patient autonomy with nonmaleficence and responsibilities to preserve professional integrity and public trust. Patients pursuing alternative therapies are sometimes motivated by prior experiences of dismissal, unresolved symptoms, and distrust of conventional medicine. Reflexive refusal or adversarial communication may further erode trust and increase the likelihood of patients pursuing unsafe therapies elsewhere. We propose that medical toxicologists should approach these encounters with transparent communication, acknowledgment of medical uncertainty and patient suffering, and continued therapeutic engagement even when declining requested treatment. Maintaining a therapeutic alliance while avoiding non-indicated interventions is challenging in practice but promotes long-term patient health and preserves trust, both between physician and patient and between the public and profession of medical toxicology.