Medical Ethics

ALLIANCE OF REGISTERED HOMEOPATHS

Last modified on January 9th, 2010

A useful article about ALLIANCE OF REGISTERED HOMEOPATHS .Full details about ALLIANCE OF REGISTERED HOMEOPATHS

http://www.a-r-h.org

CODE OF ETHICS AND PRACTICE

1. Introduction
Patients rely upon, and have a right to be able to place trust in, their healthcare
practitioners, who must therefore maintain high standards of care, competence and
conduct. Fellow healthcare practitioners also deserve respect and have a right to be
treated properly.

This Code of Ethics and Practice summarises the standards set by the Alliance of
Registered Homeopaths (ARH). All its registered members (referred to as members in
this document) agree to abide by the Code, which offers guidance on the observance of
the standards, indicates areas where particular challenges may arise, and forms the basis
for assessing the professional conduct of any member against whom a complaint has
been made – though it in no way restricts anyone’s legal rights in the event of a
complaint.

Such a code cannot be all inclusive, but it does set out the principles of ethical
professional conduct as a guide to all concerned.

Members should be aware that standards of good practice have been agreed throughout
the profession in the form of the National Occupational Standards for Homeopathy.
Ideally, members should be acquainted with the recommendations set out in these
Standards, copies of which are available from the Improvement and Development Agency
(tel. 020 7296 6600).

In healthcare, many decisions fall into areas where there is no absolute right or wrong
and where a series of conflicting obligations may have to be considered. The principles
laid out in this Code and in the National Occupational Standards for Homeopathy are
designed to enable members to act in a professional manner when faced with such
situations.

A member’s ability to follow these principles both in spirit and letter demonstrates their
competence and fitness to practice, and ensures their continued registration with the
ARH.

2. Basic Principles
The following are the basic principles all members should reflect on and adhere to:

2.1 Clarity of Contract

In order to ensure patients are able to make informed choices with regard to their
healthcare, members should give full and clear information about:

• duration and frequency of appointments

• charges

• availability for advice

• locum coverage

• emergency contact

• confidentiality and its breaching through disclosure

• security of records

• the place supervision plays in their practice.

Ideally, this information should be given in writing, before entering into the therapeutic
relationship. Often the best way to do this is to include it in a clinic leaflet, thus
establishing a clear contract with patients.

Practices other than homeopathy

If, during the course of treatment, it is considered appropriate to employ therapies other
than homeopathy, the member will practise these therapies with integrity and
competence. The nature of the treatment offered should be made clear to the patient.
members should indicate their relevant qualifications, membership of a registering body
and adherence to a separate Code of Conduct for the practice of such additional
therapies. It is necessary for the member to hold professional conduct insurance
applicable to every aspect of the patient’s treatment.

Referrals

Patients may refer themselves directly for homeopathic treatment. They should be
encouraged to inform their GP or healthcare practitioner that they are receiving
homeopathic treatment and, with the patient’s consent, the member may also inform
the GP of this in writing.

A GP who formally delegates the care of a patient within the NHS retains overall clinical
responsibility for that patient.

Details of all recommended referrals to other homeopaths or healthcare practitioners
are to be recorded in the patient’s notes at the time the recommendation is made.

In all these matters, if at any point the patient declines to give consent for the member
to make this contact, their wishes must be respected at all times and recorded in their
notes.
Hospital treatment

Where a patient or a patient’s representative requests homeopathic treatment to be
initiated or continued within a clinical setting (e.g. a hospital or hospice), both nursing
staff and the person with overall clinical responsibility are to be notified of this request
by the patient or their representative.

2.2 Informed Consent

In order to ensure the patient is able to give informed consent with regard to their
healthcare, the member should give full and clear information about the nature of
homeopathic treatment, both before that treatment begins, and as appropriate during
that treatment.

2.3 Accuracy of Records

All case notes will be clear, legible, and contain all the relevant information relating to
the progress of the case. They will enable a third party to have an understanding of the
patient’s state at the time of a consultation, and of whether the patient has improved,
maintained or deteriorated in their condition since they were last seen. This is
particularly important should the member at any time be involved in legal proceedings.

To ensure continuity of care, the treatment of a patient known to be under the care of
another homeopath should ideally not be undertaken without informing them and
requesting details of the patient’s treatment to date. However, this must be done with
the patient’s full knowledge and consent. If the patient does not agree to this, a note of
this fact should be recorded, indicating that continuity of care could not be achieved.

Where a patient requests the record of their treatment, or asks that it be forwarded to
another homeopath or other practitioner, it is important to send a copy of all
information from that patient’s case notes as quickly as possible. The full original notes
are to be retained by the member. A reasonable charge to the patient for this service
might be considered.

Patients should be notified in the event of the death or incapacitating illness of the
member treating them. The member will make prior arrangements for case notes to be
returned to patients, or destroyed.

2.4 Competence & Continuing Professional Development

Members should be aware of the extent and limits of their clinical skills, monitoring
them as necessary, using the tools of reflection and audit.members should be able to
refer patients appropriately to other practitioners when necessary. Members should
actively extend their knowledge base through continuing professional development
(CPD). CPD may include supervision, conferring with colleagues either personally or via
email, and acquiring knowledge of new theory and practice through further training and
study (e.g. attending appropriate seminars and post-graduate training courses or
contributing to an on-line homeopathic mailing list). CPD may also involve complying
with any statutory or ARH requirement that may be in force.

Failure to engage periodically in a reasonable amount of post-graduate education may be
taken into account when hearing allegations which call a member’s professional
competence into question.

2.5 Confidentiality & Disclosure

Members must ensure that patient information is kept secure and confidential, access
being restricted to the member and their assistants or agents, unless the patient agrees
otherwise in writing, or unless access is requested through due process of law.

Storage

Full and clear records of all treatments of patients should be made, kept, and stored for
at least seven years from the date of the last consultation, ensuring compliance with the
requirements of the Data Protection Act, whereupon they can be destroyed, with care
taken to preserve complete confidentiality.

Disclosure without consent

Disclosure without consent is a difficult issue, particularly if the member has promised
total confidentiality to the patient. For the most part, the question of confidentiality is
subject to the contract between each individual patient and their practitioner, but there
are instances where there is a conflict of interests between a member’s duty to society
and their duty to their patient. As members are subject to the law of the land in which
they practise, they must disclose records if ordered to do so by a Court. A member can
of course make every reasonable effort to persuade the patient to change their attitude
and to disclose information themselves.

It is important for members to clarify their policy on confidentiality before treatment
commences. It is recommended that this be clearly set out in the clinic leaflet. In the
event of a later dispute, this will constitute a written record of what has been
contracted between the patient and practitioner.

2.6 Clarity of Service

Members must establish and monitor clear boundaries between all parties to the
therapeutic relationship in order to maintain the impartial professional position that
needs to exist.
Thus, whilst it is not the object of these ethical guidelines to go into the realms of
morality, some points must be made.

On most occasions any form of emotional, intimate or sexual encounters between a
member and their patient, student or supervisor can be construed as an abuse of trust
and power. Such situations are therefore to be actively discouraged, particularly if the
relationship is clandestine.members should actively avoid placing themselves in such a
situation. Any complaint against a member resulting from such actions will be dealt with
severely by the ARH if there is evidence that there has been an abuse of power or trust.

3. Legal Obligations

Members have a duty to be aware of those ways in which the law of the country in which
they practise affects their practice. If these obligations are overlooked, members may
become involved in difficulties with state authorities, or with other professional or
institutional organisations.

Members are required:

• To comply with the law of the state, territory or country in which they practise.

• If a member of another professional register, to be aware of any statutory or
voluntary requirement imposed by its Code of Ethics.

• To inform patients about the nature of homeopathic treatment, before that
treatment begins.

• To tell patients the identity of the remedy prescribed, if asked.

• To provide clear instructions for each prescription made. For telephone
consultations, a written record of instructions given should be added to the
notes.

• Not to use the title ‘Doctor’ in connection with homeopathic practice, unless the
member holds a recognised medical qualification and is registered with the
appropriate state medical register. Whilst it is appreciated that members with a
PhD in other areas have the right to use the title ‘Doctor’, the ARH expressly
forbids its use when it might be misleading to the patient. There are Doctorates
in Homeopathy available in countries outside the UK, but the ARH can have no
way of checking the validity of the training involved in gaining such a
qualification. Therefore, unless an exception is granted to this rule by the Board
of Directors, no member other than a medical doctor registered in the UK may
use the title ‘Doctor’.

• Not to refer to assistants as ‘Nurse’, unless they are currently registered as such
with the United Kingdom Central Council for Nursing, Midwifery and Health Visiting, or the equivalent state medical register of the country in which they
practise.

• Not to conduct any intimate physical examination of a patient without the
presence of a third party acceptable to the patient, unless the patient gives
prior written consent.

• To conduct a physical examination of a child under 16 only in the presence of a
parent or legal guardian and with that child’s clear consent.

• To register under the Data Protection Act where this is required.If in doubt, the
member should call the information line of the Data Protection Commissioner on
01625 545745.

• To provide patients, on request, with access to their case notes. Statutory right
of access to any written health records exists under a number of pieces of
legislation including: Professions Supplementary to Medicine Act, Human Rights
Act,Data Protection Actea

• Not to draw up or sign any false or misleading documents, reports or
certificates.

• To obtain patients’ active consent to sensitive personal data being recorded in
their case notes.

• Not to record the patient on film or through digital imagery or sound recording
without their prior written consent.

• Not to claim or imply, orally or in writing, to be able to cure any named disease.

• To be aware of those diseases which are notifiable,and to refer patients
immediately to their GP if such a disease is suspected.

• Not to treat animals and charge a fee. Only a vet may do this. However, it is
perfectly proper for a vet to ask a member to treat an animal under their care.

Premises

Members are also required:

• To comply with Local Council Regulations and the advice of their local
Environmental Health Officer regarding adequate facilities such as heating,
lighting, ventilation, toilets, electrical installations, smoke alarms and fire
extinguishers.

• To protect the safety of the public and those people working on the premises by
establishing suitable working conditions.

• To make a first aid kit available at all times (Shops and Offices Act).

• To regularly review facilities and working practices in order to ensure they
comply with current standards. Members should be aware of their
responsibilities under Health and Safety legislation (Health & Safety Act)
whether as employer, employee or self-employed practitioner.
• To hold suitable third party liability insurance covering their premises.

4. Advertising & Media

All advertising must be decent, legal, honest and truthful, and must conform to relevant
guidance such as the British Code of Advertising Practice.

Professional advertising may indicate special interests, but must not make claims of
superiority or disparage professional colleagues or other professionals.

It must not be designed to mislead or deceive, or make unrealistic or extravagant claims.

5. Where Things Go Wrong

5.1 Problems with health

The interests of patients must come first at all times, and must not be compromised. If,
therefore, a member’s mental, emotional or physical health becomes impaired to such
an extent that they are unable to give their patients an optimum level of care,they
should swiftly seek and follow appropriate professional advice.

Similarly, if the mental, emotional or physical health of a colleague becomes impaired to
such an extent that they are unable to give their patients an optimum level of care, a
member should swiftly bring their concern to the attention of another colleague,
supervisor or the ARH Ethics and Welfare Director.

5.2 Where trust breaks down

If, for whatever reason, the trust between a patient and member breaks down to such an
extent that the member can no longer offer an appropriate standard of care or service,
either the member or the patient may end the relationship. If this happens, the member
should try to make sure the patient has an alternative source of homeopathic care if
they want or need it. With the patient’s permission, the member should provide the new
practitioner with sufficient information to allow responsibility for care to be handed over
without delay.

6. Complaints and disciplinary procedures

6.1 Complaints

Practitioners trained as homeopaths to ARH standards following the guidance in this
Code, are able to practise homeopathy safely, competently and ethically. However, from
time to time something may go wrong.

Patients, members of the public, other professionals and members of ARH have the right
to complain if they perceive that a member of ARH has not provided treatment or
conducted themselves in accordance with this Code. Members should ensure that their patients have clear information about how to express any concern they may have about
their treatment.

If a patient or other interested party brings an apparent failure in care to the member’s
attention, they should act promptly and constructively, giving the matter proper
consideration. The needs of the patient must come first. The member should give a
sensitive explanation of what has occurred, and take the initiative to put things right. If
appropriate, the member should offer a suitable apology and an assurance that steps will
be taken to prevent a recurrence.

Because questions of compensation may arise, the member should also notify the ARH
Ethics and Welfare Director and the professional indemnity provider of any steps taken in
response to a complaint brought against them. If a complaint against a member is taken
to ARH, the member will co-operate fully with ARH’s efforts to resolve it. If their
conciliation attempts fail, the member must co-operate fully with the subsequent
Professional Conduct Committee (PCC) proceedings. If a PCC disciplinary hearing proves
necessary and the member fails to attend, the hearing will proceed in their absence,
unless sufficient grounds for the hearing to be adjourned have been provided.

Members have the right to expect support from ARH in the event of any unwarranted and
unsubstantiated allegations made against them while carrying out their professional
duties. ARH regards the support of members who have complied with their ethical duties
as being equally as important as its regulatory function.

6.2 Receiving a Complaint

Ethics and Welfare Director

A complaint received against a member will be passed on to ARH’s elected Ethics and
Welfare Director (EWD).

The EWD will then contact the complainant in writing to confirm the allegation received
and to clarify any points that are not clear.

If the EWD feels that the allegation warrants investigation, then they will contact the
member involved.

If the complaint cannot be effectively conciliated by the EWD liaising with both parties,
then they will take steps to set up a Professional Conduct Committee (PCC).

Professional Conduct Committee

The PCC is made up of two Directors of ARH and three members, and will be constituted
by the EWD. Having appointed the PCC, the EWD will then assume a role of support for
the member, leaving the PCC to fulfil the function of adjudication.

One of these five people will be nominated as the Chairperson, who will co-ordinate the
proceedings.

The PCC will:

• establish if there is a complaint to answer

• listen to the evidence available

• decide on an outcome on the balance of probabilities, and do so on the day of
the hearing, notifying both parties there and then of their decision.

If the complaint is proven, the PCC may impose as a penalty any of the following:

• Admonishment

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