How unethical is chiropractic?

Medical ethics rests on 4 core principles: autonomy, beneficence, non-maleficence, and justice, along with the crucial rule of veracity (truth-telling). In the realm of chiropractic, the most significant ethical issues/problems generally fall into the following ethical categories:

1. Compromised Informed Consent & Veracity

Informed consent requires that a patient fully understands the nature, risks, benefits, and scientific backing of a treatment before proceeding.

1.1.The “Subluxation” Theory: A sizable segment of the chiropractic community still adheres to the erroneous belief that spinal “vertebral subluxations” cause a disruption in the body’s “innate intelligence,” leading to systemic disease. From an ethical standpoint, promoting an unproven, pseudo-scientific premise as medical fact violates veracity and compromises patient autonomy, as patients cannot give truly informed consent based on erroneous concepts.

1.2. Over-claiming Scope of Efficacy: While evidence might support spinal manipulation for acute lower back pain (if one were to interpret the dtat optimistically), most chiropractors claim they can treat many other illnesses, including non-musculoskeletal conditions such as asthma, allergies, infantile colic, ADHD, and high blood pressure. Marketing these services without robust clinical trial backing misleads vulnerable populations.

2. Violations of Non-Maleficence

The principle of non-maleficence requires practitioners to avoid inflicting unnecessary harm or exposing patients to disproportionate risks.

2.1. Cervical Manipulation and Stroke Risk: One of the most severe ethical concerns involves high-velocity, low-amplitude (HVLA) thrusts to the upper neck, the hallmark modality of chiropractors. This procedure has been linked to vertebral artery dissection (VAD), which can cause strokes and deaths. The ethical failure is most obvious when chiropractors perform these adjustments without warning the patient of this and other adverse outcomes.

2.2. Paediatric Chiropractic: Performing spinal adjustments on infants and toddlers (whose spines are primarily cartilage and still developing) poses distinct physical risks. Because infants cannot consent and the evidence of benefit for childhood ailments is practically non-existent, this behaviour violates non-maleficence.

3. Secondary Harm: Delay of Standard Medical Care

Harm does not only come from physical injury; it also comes from omitting or delaying necessary medical treatment.

3.1. Anti-Vaccine and Anti-Medicine Sentiments: A large proportion of the chiropractic profession advise patients against conventional medicine, pharmaceuticals, and vaccination. When a chiropractor discourages a patient from seeking standard medical care, they are actively contributing to potentially life-threatening delays in care.

4. Violations of Beneficence and Justice

Beneficence means acting in the patient’s best interest, while justice involves the fair and equitable distribution of healthcare resources.

4.1. The “Maintenance Care” Business Model: A common predatory practice of chiropractors involves convincing patients that they require lifelong, regular spinal adjustments to “stay aligned” and prevent disease, often locked into expensive upfront contracts. Recommending continuous, costly treatments that lack clinical evidence of long-term benefit shifts the focus from patient welfare (beneficence) to practitioner financial gain.

4.2.Over-Utilization of X-rays: Some chiropractic clinics mandate full-spine X-rays for every new patient, regardless of symptoms, and repeat them frequently to “prove” alignment changes. Exposing patients to unnecessary ionizing radiation for marketing or diagnostic justification is a direct violation of both non-maleficence and the ethical use of healthcare resources.

For a more detailed account of the ethical problems in so-called alternative medicine, please see our book on this very subject.