Objects & Rules - Appendix A
A full member or practising associate member of the Society of Holistic Practitioners shall be expected to conduct himself and his practice in an ethical manner. While ethics in ordinary life may be a matter of personal interpretation, in a professional body an agreed code of ethics is necessary so that the public may know the standard of behaviour to be expected of a professional practitioner. For this reason, all practising members are expected to observe the following Code of Ethics. Any practising member who fails to do so may be subject to disciplinary action as laid down in Section 5 of the Code.
Sections 1 to 4 of the Code are concerned exclusively with ethics. They do not contain any rules or guidelines intended solely to promote a professional image for the Society or its members, since this is not an ethical consideration. There may be circumstances in which, in order to carry out the work he is called to do, a member may have to depart from the normal image of a professional person, and the Society does not regard itself as being entitled to place restrictions on him in this respect.
If a member has any doubt about the interpretation or applicability of the Code of Ethics in any situation, he should seek the advice of the Ethics Subcommittee.
It is possible for a patient, a member of the public or another practitioner to attempt to gain some personal advantage by imputing that a member has acted in breach of this Code when this is not the case. In such an event the member should immediately report the matter to the Ethics Subcommittee.
The code is divided into the following sections:
1) The member’s relation with his patients
2) The member’s relations with the public
3) The member’s relations with other practitioners
4) Advertising and other special applications
5) Disciplinary procedures and disputes between members.
SECTION 1 – THE MEMBER’S RELATIONS WITH HIS PATIENTS
1) A member shall accept for advice or treatment all who come to him, except in the following cases, where advice or treatment may be refused or discontinued at the discretion of the member:
a) If the member already has so many patients that by taking more he would be obliged to reduce the standard of care offered to existing patients to a level which he personally found unacceptable, in which case the member may refuse to accept any new patients.
b) If the member considers himself to lack the necessary competence to deal with the patient’s condition
c) If an existing or prospective patient is known personally to the member outside the professional relationship, or if a patient is directly involved in affairs connected with the member’s personal interests
Note: This is to enable a practitioner to refuse or discontinue treatment in situations where, because of personal involvement, he does not feel able to make an objective assessment of the patient’s condition.
d) If examination or questioning of the patient reveals contra-indications which would make treatment inappropriate, in which case no treatment should be given but advice may be given if desired
e) If a patient does not co-operate with the treatment or fails to follow reasonable instructions or advice
f) If a patient’s physical behaviour seems likely to cause injury to other patients or to the practitioner or his staff or assistants or to cause damage to clinic property or premises
g) If a patient fails to pay the prescribed fee for advice or treatment, provided that the patient was informed of the fee before the start of the treatment or consultation (see Rule 2(e)(ii) of this section). Members are urged to have consideration when non-payment is due to hardship
h) If the patient is simultaneously obtaining treatment from another practitioner without the member’s consent
i) If a prospective patient is actively engaged in a series of treatments given by another holistic practitioner and is seeking advice or treatment from the member without the other practitioner’s consent
j) If the patient if suffering from a specified disease or condition which endangers the welfare of the practitioner or his patients. Guidelines identifying such diseases and conditions will be issued from time to time by the Committee of the Society, who should also be contacted in any case of doubt. For any particular disease or condition the Committee may issue different guidelines according to the therapeutic disciplines being practised, and its ruling will be binding on members.
If the practitioner refuses or discontinues treatment, he must inform the patient of the fact and give the reasons for it if requested by the patient.
If the patient is seriously ill, the practitioner must not refuse or discontinue treatment unless the patient’s consent has been sought to transfer the case to another practitioner, and, subject to such consent, unless such a transfer has actually taken place. The other practitioner may be any person approved for the purpose by the patient, and may be the patient’s general practitioner.
In an emergency a patient may not be in a position to ask for treatment. In such a situation the member should render such assistance as he can, subject to the extent of his own training and qualifications and to any applicable exceptions in this Code, until the patient’s own practitioner or some other authority has taken full charge.
2) Examination and treatment shall only be carried out with the full consent of the patient.
The following should be observed:
a) In the case of a person under the age of 18, the consent of a parent or guardian should also be obtained if possible.
Note: A practitioner giving some forms of treatment to a minor without the consent of a parent or guardian may in law be committing an assault of the patient.
b) Consent is required, not only for the treatment as a whole, but for every part of it. A patient has the right to refuse to carry out instructions or to follow advice. (This does not imply that the patient has the right to insist on continued treatment under these circumstances.) A member, having given his professional advice about the treatments available, must not attempt to persuade the patient to accept any particular treatment.
Note: See also Section 2 Rule 1.
c) If an intended programme of treatment contains any element that must be unexpected to be fully effective, the member shall either:
i) obtain general permission from the patient before starting the programme of treatment for the inclusion of unexpected elements at the member’s discretion, or, if appropriate,
ii) ensure that the patient is aware of the discipline being practised and obtain general consent for the use of any techniques which are an accepted part of that discipline.
Usually (e.g. in osteopathy) a general description of how treatment is carried out can be given without impairing the unexpectedness of a particular action, and where possible this should be done.
Note: The object of this rule is to ensure that a patient who does not fully trust the practitioner should have an opportunity to refuse treatments which he cannot know in advance.
d) Specific consent is required for the presence of any third party at a consultation. The rules on confidentiality (see Rule 4 of this section) must also be observed by such a third party.
e) Consent cannot take place without adequate knowledge. This implies the following additional rules:
i) If the patient requests it, the practitioner shall provide any relevant medical information regarding the patient, in so far as this is reasonably possible.
ii) The practitioner shall inform the patient of his fees and other conditions before commencing treatment. A notice of fees and conditions posted on the clinic premises in a position where patients may read it before the commencement of treatment shall be regarded as fulfilling this requirement.
Note: The Society regards secrecy towards patients as undesirable and incompatible with the principle that the patient should take responsibility for his own health.
f) An exception to this rule and to the paragraphs above may arise in an emergency, when the patient may not be in a fit condition to give consent. In this case the member should follow the procedure for emergencies described in Rule 1 of this section, provided that consent has not been specifically withheld.
3) A member shall recognise an obligation towards his patient and shall at all times practise his skills to the best of his ability for the benefit of the patient.
The following should be observed:
a) The member must act towards the patient in accordance with the training he has received in the discipline being practised and must comply with any code of practice that may have been published by the Society with respect to that discipline.
b) All reasonable care must be taken in matters of hygiene, quality of medication and safety of equipment.
c) The welfare of the patient must always have priority over the requirements of research or administrative convenience.
d) The member shall take steps to ensure the continuity of any necessary treatments if he is absent from the practice for any length of time.
e) Professional duties shall be delegated only to persons qualified to carry them out.
f) If a patient is seriously ill and is not responding to treatment satisfactorily, the practitioner should seek the patient’s permission for a consultation with one or more other practitioners. The findings of such a consultation should be conveyed to the patient by the practitioner in charge of the case unless the patient has given specific instructions to the contrary.
g) The practitioner must keep adequate records of the patient’s progress. Any legal requirements with regard to keeping of such records and disclosure to the patient must be observed.
Note: See also Rule 2(e) of this section.
h) A member must ensure that his professional practice is fully covered by a professional indemnity insurance against public liability and malpractice.
Note: This rule will not be enforced until the Society can provide an insurance scheme for its members at a reasonable cost.
4) The confidences of the patient and diagnostic findings acquired during consultation or in the course of professional treatment must not be divulged to anyone without the patient’s consent.
Note: This rule arises from the fact that a patient may be unwilling to accept treatment or to describe fully the facts surrounding his condition unless confidentiality is assured.
a) The member must not only himself observe the requirements of confidentiality, but must also ensure that they are observed by colleagues, assistants, receptionists and any other persons who have access to confidential information.
b) Care must be taken for the security of written or computerised records, including appointment books. Even the fact of attendance for treatment should be regarded as confidential.
c) Those persons to who information must not be divulged without the patient’s consent include the members of the patient’s family.
d) The use of statistical data derived from patients’ records or the use for illustrative purposes of a patient’s case history with the name changed to prevent identification is only acceptable provided that either all the patients concerned have given their consent to such use or the identity of any of the patients concerned cannot under any circumstances be deduced or discovered by any person into whose hands the information may fall.
e) If a member receives an official request for disclosure of confidential information, the member should ask the Ethics Subcommittee for advice.
f) If a member is asked in a Court of Law to disclose confidential information, he should first ask the Court to take into consideration the fact that the information is a professional confidence. If the Court nevertheless overrules this contention and requires the member to disclose the information, the member may be in contempt of court if he refuses to do so. In these circumstances the Ethics Subcommittee will not consider the member to be in breach of this Code of Ethics by choosing to disclose the information demanded or by refusing to do so.
Note: The penalties for contempt of court can be severe. In serious cases a refusal to give information demanded by the Court may be construed as an attempt to obstruct the course of justice. If sensitive information is given to a member, especially regarding activities of a possibly criminal nature, or in any case where the member is in doubt regarding matters that may have legal implications, the member is advised to consult the Ethics Subcommittee.
g) In a situation where withholding information is likely to cause great danger to a third party or parties, members are advised to consult the Ethics Subcommittee of the Society. In cases of such urgency that this is impossible, members should use their own judgement, but will remain answerable to the Ethics Subcommittee.
h) Disclosure of confidential information without the patient’s consent is permissible in situation where the patient is not in a position to give such consent, provided that all the following conditions are met:
i) Disclosure is in the patient’s own interest.
ii) There is a genuine need for the information to be imparted, such as when a member wishes to refer a case to a colleague or to discuss it with an advisor.
iii) The patient has not specifically forbidden disclosure.
Even when all the above conditions are met, disclosure to any person who is not himself bound by rules of professional confidence should be undertaken only in cases of extreme necessity.
5) A member shall not use his position of trust with regard to the patient for any personal end or advantage.
The following should be observed:
a) A member shall not mislead a patient for personal gain. In particular, a member shall not encourage a patient to accept inappropriate or unjustified treatment.
b) A member must at all times maintain a strictly professional relationship with the patient. This is particularly important in view of the fact that some patients may be in a highly vulnerable or suggestible state. Such patients may not always be able to maintain the distinction between a personal and a professional relationship; consequently the practitioner will always be responsible for maintaining such a distinction.
c) Nevertheless it is possible that a genuine and mutual personal relationship may arise between two persons in the course of a professional relationship. In such a situation, the professional relationship must case forthwith, and both parties must be fully aware of the change in status of their relationship. The greatest care must be exercised during the transition from a professional to a personal relationship to ensure that there are no grounds to suspect exploitation of the patient by the practitioner, particularly if the personal relationship contains a sexual element, whether emotional or physical. It is suggested that both parties should sign an agreed statement that the professional relationship has ended, and that each party should keep a copy so that it can be produced if necessary.
Note: The problem here is that there is an element of exploitation in most relationships, irrespective of how they arose. If an apparently genuine personal relationship arises out of a professional relationship but then breaks down with one party accusing the other of exploitation, is this evidence of misconduct? The Society has to draw a dividing line where in reality there is a gradation. At the same time, it may have to use the most severe penalty available (i.e. expulsion) if the practitioner falls on the wrong side of that line.
d) While there can be no objection to the giving of advice and treatment to personal friends, it is strongly suggested that payment should not normally be accepted for such treatments or consultations, in order that a rigorous distinction between personal and professional relationships should be maintained. Practitioners are also reminded that proper diagnosis and treatment are often rendered more difficult by interaction on a non-professional level between practitioner and patient.
Note: See also Rule 1(c) of this section.
6) In his relations with his patients a member shall maintain a professional appearance and shall adopt a professional mode of dress appropriate to the discipline being practised.
Note: This helps to create a proper relationship with the patient and to uphold the distinction between professional and everyday activities in disciplines where this is appropriate.
SECTION 2 – THE MEMBER’S RELATIONS WITH THE PUBLIC
1) A member shall not attempt to persuade members of the public to become patients.
Note: See especially Section 4 concerning advertising.
2) A member shall not set himself up as an authority on matters beyond his sphere of competence.
The following should be observed:
a) Since this rule applies with particular force to a member’s relations with his patient, his patients must for the purposes of this rule be regarded as members of the public.
b) A member should not present as facts matters on which there is legitimate difference of opinion.
c) Since the scope of any training is necessarily limited, a newly trained member should not consider himself an authority even on matters in which he has been trained. Even a member with many years of experience is advised to consider how little he knows and how much there is to learn. In general, when writing or talking about any matter connected with holistic medicine, members are recommended to restrict themselves to describing how they were trained, any relevant experience, and their present understanding of the matter.
3) A member shall not misrepresent his qualifications.
The following should be observed:
a) No member may use the title “Doctor” or allow it to be used of him without connection in such a way as to imply that he is a registered medical practitioner, or in any other way to represent himself as a registered medical practitioner, unless this is the case. Outside the United Kingdom members should follow the customs of professions of similar status to their own.
b) While the Society does not forbid its members to practise forms of holistic medicine in which they have not been formally trained, a member shall not described himself as an acupuncturist, herbalist, homeopath, masseur or masseuse, osteopath, chiropractor, naturopath or psychotherapist unless he has either successfully completed a course of an appropriate duration and standard in the discipline concerned or has been admitted as a full member of the Society by virtue of his experience in that discipline. In cases of doubt the Ethics Subcommittee should be consulted.
Note: The Society considers the use of the phrase “Registered Holistic Practitioner” to be an accurate description of its members and not in any way in breach of this Code. However, members are warned that it may be dangerous to use the phrase, as others may take the view that it could be confused with the phrase “Registered Medical Practitioner”, which is legally protected. This could lead to prosecution.
4) A member shall endeavour to conduct his practice and maintain its premises in such a manner as not to give offence to his neighbours or to his patients.
SECTION 3 – THE MEMBER’S RELATIONS WITH OTHER PRACTITIONERS
1) Members shall at all times conduct themselves in an honourable manner towards other practitioners.
The following should be observed:
a) To avoid misunderstandings and disputes, it is recommended that all agreements between practitioners should be in writing. Examples are: agreements regarding the sale of a practice, agreements with locums or between a principal and an assistant, or agreements between a member and a colleague about the use of shared premises. If appropriate, the assistance of a solicitor should be obtained. In the case of agreements between a principal and an assistant, the agreement should contain all matters required by statute, should give details of any professional indemnity or other insurance provided by the principal, and may include reasonable restrictions on future practice by the assistant.
b) Any dispute between members of the Society must be referred to the Ethics Subcommittee for adjudication as described in Section 5 of this code.
c) This paragraph applies also to conduct towards the Society, its officers and Committee members, and towards other teaching and professional bodies.
2) A member shall not, whether by implication or by default, allow the public to believe that practitioners sharing premises or advertising jointly with him have the same qualifications as himself unless this is the case.
3) A member shall not undertake the care of a person who to his knowledge is actively engaged in a series of treatments given by another holistic practitioner without the consent of that practitioner, except in an emergency, nor shall he endeavour by any means to entice a particular patient or patients in general to leave any other practitioner to become his own patient or patients.
Note: See also the rule not to attempt to persuade a member of the public to become a patient (Section 2 Rule 1).
4) If a member treats the patient of another practitioner, whether due to referral, holidays, sickness, emergency or for any other reason, he shall render the same care and attention as he would for his own patients and shall encourage the patient to return to his original practitioner at the earliest opportunity, unless the original practitioner expresses a wish to the contrary.
The following should be observed:
a) If the patient decides not to return to the original practitioner, the second practitioner should ask the patient to inform the original practitioner in writing. If the patient is unwilling to do so, the second practitioner should do so himself.
b) In all cases the decision whether or not to return to the original practitioner rests solely with the patient, and not attempt must be made by either practitioner to persuade the patient to remain with him.
Note: See also Rule 3 in this section.
5) If the care of a patient is transferred, whether temporarily or permanently, from one practitioner to another, and irrespective of the reason for the transfer,
a) steps must be taken to ensure that all parties concerned understand the procedure being adopted
b) the original practitioner should, on request, afford all possible help to the second practitioner and pass on to him any relevant information, subject to the patient’s consent.
6) A member shall not imply criticism of another member either in writing or orally before patients or the public at large. Any serious misgivings as to the conduct of or course of treatment given by another practitioner should be directed to the Committee of the Society. A member to whom criticisms of another practitioner are communicated should act with discretion and express no opinion.
Note: In law such criticism may be construed as libel or slander. See also the rule against setting oneself up as an authority (Section 2 Rule 2).
7) A member’s obligations to other practitioners apply regardless of whether the practitioners involved are members of the Society of Holistic Practitioners.
SECTION 4 – ADVERTISING AND OTHER SPECIAL APPLICATIONS
The Society is aware that many of the leading professional bodies in the field of holistic medicine forbid their members to advertise or place severe restrictions on where, when and how advertising may take place. The Society feels that this policy is mistaken. Rules which may be appropriate for members of an organisation like the BMA may be quite inappropriate for members of other organisations, who lack the legal status, social infrastructure, regular supply of patients and virtually guaranteed livelihood available to BMA members. Moreover, proper advertising carried out by reputable holistic practitioners will provide the public with information about holistic medicine generally; consequently responsible advertising is fundamentally in the interest of the holistic medical professions.
Nevertheless, the ethical rules already described in relation to patients, the public and other practitioners must still be applied. In particular, the rule against persuading members of the public to become patients and the rule against enticing the patients of other practitioners must be borne in mind. These rules give rise to the following subsidiary rules:
1) The objective of advertising must always be to inform the public of the services available to it, not to persuade the public to use the services of a particular practitioner.
2) In his advertising a member shall not state or imply a preference for the treatment of particular groups within society, nor shall he suggest that particular categories of patient are discourage or excluded from treatment.
Note: This is an extension of Section 1 Rule 1.
3) When advertising is undertaken it must be regarded as part of the member’s professional activities, and must maintain an appropriate standard and style of presentation. In particular, care must be taken to avoid commercialising this field of medicine, whose principal aim should always be one of service.
Note: Care must also be taken over the proper wording of any publicity, since any lack of competence in the publicity will be taken by the public to reflect a lack of professional competence in the practitioner. This rule is related to the rule about maintaining a professional appearance (Section 1 Rule 6), insofar as a member’s advertising is the way in which he appears before the public in his professional capacity.
The following should be observed:
a) Stationery, Business Cards, Informational Leaflets, etc.
When printing stationery etc. a member may include his name, designatory letters, appropriate professional activities, practice name if any, logo if any, address, telephone number and practice hours, together with any explanatory phrases or descriptions he may think fit. He must not include, whether directly or by implication, any comparisons with other practitioners or with holistic disciplines or forms of training other than his own, and he must not claim that he gives superior care, has special healing prowess or has cured or is able to cure specific ailments.
Notes:
i)
The claim to cure is always unacceptable. It is basic to the holistic concept of
medicine that it is the patient’s own healing energy that cures; the
practitioner can only help this process.
Thus there is no objection to the claim, where appropriate, that a particular
medical discipline is helpful in the treatment of a particular complaint.
ii)
Partnerships are legally required to show all the
partners’ names on all business stationery and on the premises of the
practice. Changes in partnership should
be accompanies by appropriate amendments as soon as they occur.
b)
Advertising in Local Papers, Periodicals etc., also
in British Telecom Directories, Yellow Pages, Thompson’s Local Directories and
other directories
The same fundamental considerations apply as for informational leaflets. However, practitioners should not that many of the leading professional bodies in the field of holistic medicine insist that, when advertising takes place at all, it should be in light type, using single column lineage format, not display or semi-display. When members of such bodies are advertising in the same medium, members are recommended to follow a similar practice in order to avoid competitive advertising and the accusation that they are trying to persuade the public to use their services rather than simply giving information.
c) Broadcasts, Lectures, Newspaper Articles etc.
Contributions to newspapers, periodicals, professional journals and other published works may appear over a member’s name and qualifications when he is writing in the capacity of a holistic practitioner. The same applies to broadcasts and lectures. Such activities must not include any attempt to persuade members of the public to use the practitioner’s services.
When asked for comment by a newspaper, especially a national newspaper, members should realise that they have little or not control over the published form and content, nor is there any certainty that their words will be published in full or in the context they intended. Similar dangers exist in edited (as distinct from live) television or radio programmes. Members should also be careful not to attempt to answer questions outside their field of competence. (See the rule on not setting oneself up as an authority, Section 2 Rule 2.)
d) Course of Instruction
Members shall not give formal courses of instruction in any branch of holistic medicine whether under their own auspices or under the auspices of any other body without written permission from the Committee of the Society.
Note: This is because a member of the public who attends such a course is liable to regard membership of this Society and the qualification in respect of which the member was admitted to the Society as part of the member’s qualification to teach. This is not the Society’s intention.
This rule does not preclude the giving of general talks about holistic medicine or particular holistic disciplines, nor, in the case of massage, does it preclude informal or introductory courses without specific therapeutic content; however, such talks or courses must not be construed or promoted as professional training in the therapeutic disciplines concerned, nor should they contain any attempt to persuade the public to become the member’s patients. In case of doubt the Ethics Subcommittee should be consulted.
e) Group Practices, Group Advertising etc.
In the case of a group practise or advertisement, a member of the Society must ensure that the same rules are carried out by the group as would be applicable to the member himself.
SECTION 5 – DISCIPLINARY PROCEDURES AND DISPUTES BETWEEN MEMBERS
See also the Objects and Rules of the Society, section 8.
1) In the event of a dispute between members, or if a complaint is made about a member by a patient, a member of the public or another practitioner, a preliminary investigation shall be carried out under the direction of the Registrar to ascertain the facts of the matter insofar as this is possible, and the Registrar shall have the power as part of this investigation to demand further information, explanations or other evidence from the member or members concerned. The Registrar shall then present the findings of the investigation to the Ethics Subcommittee for adjudication.
2) Both parties to the complaint or dispute shall have the right to appear in person before the Ethics Subcommittee, accompanied or represented if desired by a friend, to present any relevant evidence and to answer any questions which members of the Ethics Subcommittee may wish to ask.
3) Having heard the case, the Ethics Subcommittee shall
a) in the case of a dispute between members, deliver its decision to the parties involved, and/or
b) in all cases where the implementation of its decision requires further action by the Society, make a recommendation to the Committee of the Society regarding the action to be taken.
4) In the event of a dispute between members, the Ethics Subcommittee may consider either or both parties to be in breach of the Code of Ethics if any part of the Code has been directed contravened or if the guidelines in Section 3 concerning agreements between members have not been followed or if a party has refused to accept the decision of the Society. The Ethics Subcommittee may also recommend to the Committee that either or both parties should be required to pay the Society’s costs in hearing the case or that either party should be required to pay the costs of the other party, irrespective of whether a breach in the Code has occurred.
5) If the Ethics Subcommittee finds a member guilty of a breach of the Code of Ethics, it shall have the power to recommend the imposition by the Committee of the following penalties:
a) in a case of misinterpretation or inadvertent transgression of the Code, that the member should be instructed not to repeat the offence and, at the discretion of the Ethics Subcommittee,
i) to offer any reparation which the Ethics Subcommittee may consider appropriate for any suffering, damage or other consequence of the transgression to any person affected by it, including any expenses incurred in bringing the case, and/or
ii) to pay the Society’s costs in hearing the case.
b) if the offence is a result of negligence or a wilful disregard of the Code, that the above recommended action should be accompanied by a reprimand, and/or a fine and/or suspension of membership for a period not exceeding 2 years.
c) in the event of gross misconduct, that the member be expelled from the Society.
A recommendation for expulsion must be unanimous; otherwise a majority verdict will suffice if a unanimous verdict cannot be obtained.
6) If either party feels aggrieved as a result of the procedure described, or by any consequent decision by the Committee, he may appeal to the Society at an Extraordinary General Meeting called for that purpose. Written evidence may be presented, but neither party shall have the right to appear in person or be represented at the meeting unless the Society requests it. Notice of appeal must be made within 28 days of the Committee’s decision. If the Society considers that an appeal by a member is frivolous it may impose a new or increased penalty.
7) The above procedures do not affect the legal rights of the parties involved.
August 1991