Medical Ethics

Code of Ethics and Practice – The Society of Homeopaths

Last modified on April 25th, 2010

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Code of Ethics and Practice

Revised August 2004

Introduction

This Code and its Appendices call for careful observation by all members of
the Society of Homeopaths who are qualified and insured to practise, and by
those students following Society recognised courses. Those studying homeopathy
are recommended to become familiar with it as part of their preparation for
practice.

It also serves to guide and inform anyone interested in homeopathic treatment,
demonstrating the standards that are established and maintained for professional
homeopaths.

Professional homeopaths have a duty to their patients, the public, their colleagues
and their profession.

An independent individual who is not bound by a professional code of conduct
may behave (subject to criminal and civil law) as he or she pleases when dealing
with the public, regardless of the interests of patients or the reputation of
the profession as a whole.

A professional homeopath has, by becoming a member of the Society, agreed to
be bound by and to observe this Code of Ethics, and to supply the Society with
a signed statement to witness this agreement (which includes any future amendments);
to abide by and observe the Memorandum and Articles of Association, regulations
and pronouncements of the Society; to secure and maintain full medical malpractice
and liability insurance in accordance with the decisions of the Board of Directors
of the Society; to advise the Professional Conduct Department immediately in
the event of any police or governmental (including local government) inquiry
into their practice, and to submit to the jurisdiction of the Professional Conduct
Department.

Homeopathy is a unique medical system and therapeutic discipline which fulfils
an important role in health care; it serves to prevent ill health as well as
being of benefit to most patients in both acute and chronic disease.

A professional homeopath, as a result of education, training and clinical experience,
is competent to treat patients presenting with a wide variety of conditions.

Homeopathy may not always be the most appropriate form of treatment. No one
system can deal with all that an individual may need, nor serve the entire population.

Guiding Principles encourage integrity and responsibility in the practice of
homeopathy.

They exist for the benefit of patients, the development of understanding between
colleagues, and the reputation and advancement of our profession.

It is important to understand how each guiding principle applies to everyday
practice. They are expanded and explained in this Code. Whilst the Code cannot
resolve all ethical and practice- related issues, it aims to provide a framework
for establishing ethical practice as an integral aspect of the homeopath’s
role in encouraging optimum levels of practice.

They also form the basis for discussion when considering any complaint made
against a homeopath.

Central Principles

1 The homeopath’s highest and only calling is to make sick people healthy,
to heal, as it is termed (according to the founder of homeopathy, Dr. Samuel
Hahnemann).

2 Homeopaths practise their profession with integrity and dignity, being guided
by ethical principles which inform their conduct towards, and care of, patient
and colleague alike.

Respecting the Person – Respecting Autonomy – Maintaining Confidentiality

3 Homeopaths owe duty of care to patients and have regard for their wishes.

4 Homeopaths maintain the customary practice of keeping confidential all that
a patient says, and all that is written in case notes.

5 Homeopaths recognise and encourage patient responsibility for their own healing
and learning via, for example, discussion or educational dialogue. This process
forms an important part in establishing infor med consent.

6 It is important that patients are given information in a way they can fully
understand, and for all matters that concern them to be clearly explained and
agreed.

7 Homeopaths speak or write respectfully of fellow homeopaths to patients,
students or supervisees, or the general public.

Working to Clear Contracts – Avoiding Harm

8 Homeopaths practise with integrity and competence any skills other than
homeopathy as they may think appropriate, in a course of treatment. Pr ior to
the first appointment, they shall make it clear to the patient concerned the
nature of the treatment offered and indicate their relevant qualifications,
membership of register ing body and adherence to separate code of conduct for
the practice of such skills. See also 61.

9 Homeopaths are responsible for continuing their personal and professional
development by undertaking supervision, conferring with colleagues, and acquiring
knowledge of new theory and practice through further training and study, for
example participating in continuing professional development (CPD).

10 Failure to engage per iodically in a reasonable amount of CPD may be taken
into account when hearing allegations which call into question a member’s
professional competence.

11 Homeopaths report research findings and clinical experience methodically,
honestly and without distortion. All speculative theories will be stated as
such and clearly distinguished.

Avoiding Harm – Monitoring Competence

12 Homeopaths are responsible for monitoring their competence and becoming
aware of the necessity to consult with colleagues or to refer a patient to a
suitably qualified and experienced practitioner.

13 Homeopaths support and assist each other in their study and practice.

Maintaining Appropriate Boundaries

14 Homeopaths are responsible for avoiding exploitation of their patients
financially, emotionally, sexually, or in any other way.

Monitoring Standards, Invoking Society Procedures

15 Any homeopath who becomes aware through a patient that the patient has
an alleged complaint against a previous practitioner shall provide to the patient
a copy of the Society’s brochure Expressing Concerns, Making Complaints
.

16 Where good reason exists to believe a fellow homeopath has acted unwisely,
irresponsibly, or illegally, as a first step, and with full confidentiality,
attempt to discuss the matter with them.

Alternatively or subsequently contact the Professional Conduct Department of
the Society, asking for help to resolve the matter.

Guidelines for Clinical Practice support the previous section’s
Guiding Principles.

The essential elements of good practice lie in professional competence, responsible
relationships with patients and colleagues, and observance of ethical principles.

The following guidelines offer advice on what is widely regarded as good practice
in the therapeutic environment.

They have the additional function of helping to avoid misunderstandings or
conflicts with patients or other professionals. Where unwise conduct occurs,
it is possible for a homeopath to be regarded as having been careless, discourteous,
unprofessional or negligent – liable to a formal complaint being made
to the Society, or legal proceedings taken in a civil court.

Clinical Care

17 Patients are entitled to a professional standard of practice and care.
Essential elements of this are professional competence, good relationships with
patients and colleagues, and observance of professional ethical obligations.

18 Similarly, for any homeopathic proving, provers (who are volunteers) will
have signed a consent document indicating their understanding of the nature
of the proving process. They will be entitled to the same care and super vision
as patients.

19 Premises, equipment and medicines are to be kept in a serviceable, hygienic
and secure condition (see also 82).

Provision of Treatment

20 Homeopaths make all reasonable efforts to provide or continue treatment
of patients who request it. It may be necessary to decline to provide or terminate
existing treatment, where it is thought to be in the best interests of the patient,
for any reason.

21 Where an existing patient, by virtue of illness, is unable to give consent
for continuing treatment, the wishes of the immediate relatives should be respected.

This also applies when approached by the relative of someone who is not yet
a patient.

22 When dealing with cases of a serious and possibly terminal nature, ensure
that the patient is fully aware of the advisability of keeping their GP informed
of their condition. Where possible and appropriate, ask for the patient’s
permission to write to their GP concerning their progress.

23 The gravity of a patient’s condition is not to be exaggerated, nor
any promise be made as to the results of treatment, to the patient or anyone
else.

Medication

24 When a patient’s condition improves as a result of homeopathic treatment
and it seems possible to reduce dependence upon allopathic or any other medication,
responsibility for adjusting the dosage or ceasing to take prescribed drugs
lies with the patient and the prescribing practitioner.

25 Where such knowledge or consent cannot be obtained either by practitioner
or by patient, expert pharmaceutical advice may be sought from another competent
practitioner.

26 If a patient is considered to be suffering any adverse effects from currently
or previously prescribed medication, previous surger y or other medical intervention,
a homeopath may draw this to the patient’s attention. It may be appropriate,
with the patient’s consent, to refer them back to the person having clinical
responsibility for the patient at that time, with an explanatory letter.

Monitoring of Competence

27 A competent homeopath identifies those occasions when a patient’s
condition is:

• beyond the present limits of their clinical competence and expertise.

• likely to receive more immediate, effective benefit from another form
of treatment.

• showing signs and symptoms suggestive of an underlying condition which
requires referral for investigation and other medical diagnosis.

28 Where the examination, case-taking or treatment of a patient is beyond an
individual homeopath’s capacity, knowledge or skill, other options for
treatment are to be discussed and agreed.

29 In that case, the homeopath may provide the patient with sources of further
information in order to encourage informed choice, and/or refer the case formally
to another homeopath or other health care professional.

Liaison with Medical Colleagues

30 Patients may refer themselves directly for homeopathic treatment. They
may be encouraged to inform their GP or health care practitioner that they are
receiving homeopathic treatment, and when appropriate the practitioner may also
write to the GP informing them of this.

However, if the patient refuses to give consent for the practitioner to make
this contact, their wishes should be respected and recorded as such in their
notes.

31 Patients may also be formally delegated by their GP or other health care
practitioner. In such an event it is worth establishing the patient’s
needs and expectations, since they may envisage very definite and probably quite
limited treatment outcomes.

Where a patient has been so delegated it is recommended that the treatment
proposals be outlined to the referrer.

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

32 The Society recognises that the optimum situation for the patient is one
where the homeopath and the patient’s GP establish a sound, open, co-operative
and professional relationship, each recognising the health care benefits the
other has to offer the patient within the bounds of their legal and ethical
responsibilities and competencies.

33 Where a patient requests homeopathic treatment be initiated or continued
within a clinical setting (i.e. hospital, hospice) both nursing staff and the
individual (practitioner, doctor, consultant) with overall clinical responsibility
should be notified of this request.

Liaison with Colleagues

34 To ensure continuity of care, with access to previous notes and prescriptions,
the treatment of a patient known to be under the care of a fellow homeopath
is not to be undertaken without informing them. If the patient does not agree
to this, a note of this fact (and that continuity of care cannot be achieved)
is to be recorded.

Patient Records

35 All case notes shall be clear and legible, and contain all the relevant
infor mation relating to the progress of the case. They shall enable a third
party to have an understanding of the patient’s state at the time of a
consultation; whether the patient has improved, maintained or deteriorated in
their condition since they were last seen. This is particularly important where
the homeopath recognises the possibility of legal proceedings for, e.g., child
protection, medical neglect or malpractice issues.

36 Consent

In all instances where a patient has given a written consent for a particular
course of action, this is to be kept on file; so too any verbal agreement is
to be recorded in the notes. Notes are to be completed at or near the time of
a consultation; they should not be written or amended later. Copies are to be
kept of all correspondence.

37 Referrals

Details of all recommended referrals to other homeopaths or health practitioners
are recorded at the time of the recommendation being made.

38 Maintenance

The basic requirements of case notes are as follows:-

Name, address, telephone number and date of birth.

Essential details of medical history.

Dates and details of all treatments given, homeopathic or otherwise.

A record of medication of any kind taken by the patient, including the names
and addresses of the prescriber if available; also any diagnosis the patient
has received from a competent medical authority, together with such information
as peak flow recordings, blood pressure readings, other medical data such as
weight loss, unusual bleeding or other information provided by the patient.

A record of symptoms divulged by the patient which suggest a serious physical
or mental disorder may be present.

Advice given to the patient in a clinical or telephone consultation important
for improving the known condition.

Decisions that the homeopath makes in the management of a patient’s case,
such as referrals, disclosure of information or request for medical tests and
examinations.

39 Storage

Full and clear records of all treatments of patients shall be taken, kept and
stored for at least seven years from the date of the last appointment, whereupon
they can be destroyed, with care taken to preserve complete confidentiality.

40 Access

Patient records shall be kept secure and confidential at all times, access being
restricted to the homeopath and their assistants or agents, unless the patient
agrees otherwise in writing, or unless requested through due process of law.

Whilst patient records are the property of the homeopath consulted, patients
do have right of access to their notes (see section 66 below).

Where a patient requests the record of their treatment, or asks that they 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 notes are retained by the originating homeopath.

Where the executor or relatives of a patient now deceased request access to
records, section 40 applies.

Practitioner Cover – Availability

Weekends and Bank Holidays

41 Patients are to be clearly informed about weekend and bank holidays availability
and accessibility, and given guidelines on what to do if an emergency were to
arise during these times.

42 Illness or Holiday cover

Clear arrangements are made for patient care when a homeopath is on holiday
or ill for a long time. Practitioners either provide locum cover and provide
patients with clear guidelines about this cover, or they explain that there
is no cover provided during their absence and advise patients of what to do
in the event of any emergency, ensuring that patients know the date of their
return.

43 The practitioner is responsible for ensuring that any locum attending is
suitably qualified and experienced.

Assistants: Where a homeopath employs another practitioner (or works with a
student, or apprentice who has responsibility for elements of patient care,
the senior homeopath is responsible for providing easy access to advice and
supervision).

Establishing or Retiring from a Practice

44 When setting up a practice for the first time or moving into a new area
or clinic, practitioners inform colleagues of their arrival.

45 Practitioners proposing to operate under a business name will ensure its
uniqueness in order to avoid local confusion.

46 Upon deciding to move or retire from practice, a homeopath informs all current
patients of this intention, together with any arrangements being made for the
transfer of the practice. This may be in the form of a local newspaper advertisement.

47 Practitioner illness or death: in the event of the death or incapacitating
illness of their homeopath, arrangements are required to ensure that patients
are notified.

Publicity and advertising

48 Advertisements, stationery and name plates maintain a high standard of
propriety and integrity to enhance the reputation of homeopathy.

•Advertising shall not contain claims of superiority.

• No advertising may be used which expressly or implicitly claims to cure
named diseases.

• Advertising shall not be false, fraudulent, misleading, deceptive, extravagant
or sensational.

• Where fees are quoted in an advertisement all costs shall be clearly
shown.

•No member may use their Society membership in the commercialisation of
any product or remedy.

• When advertising jointly with practitioners of other therapies, all
reasonable steps are taken to ensure that those practitioners are members of
recognised professional bodies.

• All advertisements shall conform to the British Code of Advertising
Practice.

• Qualifications originating from bona fide academic organisations, also
statutory designations or qualifications, awarded by established and generally
recognised professional organisations, may be shown.

•Group advertisements under the heading ‘The Society of Homeopaths’
may only include the initials RSHom, denoting registration with the Society,
and FSHom denoting a fellowship of the Society.

Boundary Issues and Professional Conduct

49 Clear boundaries are to be observed by all parties to a therapeutic, educational
or supervisory relationship. Any form of emotional, intimate or sexual encounter
(however the participants may regard it) is abusive: of the person, of power,
and of trust. It is improper, unprofessional conduct not to be undertaken in
any circumstances. It is never appropriate to enter into these categories of
relationship with patient, student or super visee.

50 It is a professional duty to avoid putting oneself in such a situation,
and to avoid any form of behaviour which might be adversely misconstrued.

51 Where an intimate relationship pre-exists a proposed practitioner-patient,
tutor-student or supervisor-supervisee relationship, our professional duty is
to consider whether the change being contemplated is appropriate, giving primacy
to the needs of the prospective patient, student or supervisee.

52 Where a patient, student or supervisee is expressing feelings towards the
homeopath, tutor or supervisor which cause problems for the maintenance of professional
boundaries and when the professional – for whatever reason – is
unable to resolve the situation in an acceptable manner, the professional relationship
is to be ended.

53 The homeopath is reminded that the onus is on them to consider the boundaries
to be observed. Appropriate action to uphold the Code of Ethics and Practice
is by taking concerns to colleagues, to supervision, or to the Society’s
Professional Conduct Department.

54 Where a professional relationship has come to its natural end and both parties
at some later time consider entering into a new relationship, part of that process
involves the homeopath bringing the matter to supervision.

Legal Obligations

The Society has a duty to bring to the attention of its members those ways
in which the law of the country affects their practice. If these requirements
are overlooked, practitioners may become involved in difficulties with the general
law, or with other professional or institutional organisations.

A homeopath is required:-

55 To comply with the law of the state, territory or countr y where the homeopath
practises.

56 To take all reasonable steps to be aware of current law as it applies to
their homeopathic practice.

57 To be aware, if a member of another professional Register, of any statutory
requirement imposed by its Code of Ethics.

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

59 To offer patients the identity of the remedy prescribed.

60 To provide written instructions for each prescription made. For telephone
consultations, a written record of instructions given is added to the notes.

61 To avoid the use of the title ‘Doctor’ in order not to create
a false impression (by referring to oneself or having others address one as
such) of being a registered medical practitioner, when this is not the case.

62 To avoid referring to assistants as ‘Nurse’, unless they hold
a nursing qualification recognised by the Nursing and Midwifery Council.

63 To conduct any intimate physical examination of a patient only in the presence
of a chaperone, having placed the patient’s written consent in their notes.

64 To avoid making a physical examination of a child under 16 unless in the
presence of a parent or legal guardian, and with that child’s clear consent.

65 To act responsibly, where not under statutory legal obligation, when there
is clear evidence of a child being at risk, of sexual abuse or other harm, whether
that evidence is obtained from the child, the perpetrator, or other adult or
child; and to contact the Child Protection Officer at the local Social Ser vices
Department or NSPCC so that action may be considered under the Children’s
Act (1989)

Each local authority produces its own handbook of child protection procedures,
which should be consulted along with experienced professional advice.

66 To provide patients, on request, access to their casenotes. Statutory right
of access to any written health records exists under a number of pieces of legislation
– Professions Supplementary to Medicine Act (1960), Human Rights Act (1998),
Data Protection Act (1998).

67 To register under the Data Protection Act (1984) where any patient records
are stored electronically. Registration is a legal obligation even if this information
consists solely of names and addresses, unless the latter are used only for
mailing newsletters, practice information etc.

68 To be careful not to draw up or sign any false or misleading documents,
reports or certificates.

69 To obtain the patient’s active consent to sensitive personal data
being recorded in their casenotes.

70 To avoid recording on film or through digital imagery any material concerning
a patient which might be regarded as explicit, indecent or pornographic.

71 To avoid showing on film or through digital imagery any material concerning
a patient without that patient’s clear written consent to the precise
material to be shown, and where and to whom it will be shown.

72 To avoid making claims (whether explicit or implied; orally or in writing)
implying cure of any named disease.

73 To be aware of those diseases which are notifiable and to take appropriate
action in these cases (see Appendix A).

74 To avoid giving any treatment with the intention of terminating a pregnancy.

75 To be aware that responsibility for adjusting or withdrawing prescribed
medication lies with the patient and the prescriber of that medication.

76 To be aware that a patient formally delegated by a General Practitioner
or Consultant under the NHS remains under the overall clinical care of that
person.

77 To avoid releasing any documents or information concerning a patient to
a third party without that patient’s wr itten consent.

78 To avoid disclosing any information about patients acquired professionally,
and to preserve confidentiality at all times, unless clear ethical or legal
concerns overrule this, or unless the patient has consented in writing to its
use in the teaching situation (see below).

79 Confidentiality implies good faith existing between two or more people who
have a commitment to supporting each other in what they are doing on behalf
of each other.

80 Apart from the patient giving consent to the nature and extent of a disclosure,
the following legal and moral exceptions may justify information being given
to third parties in their professional capacities:

a) by rule of law when required to do so by rule of law.

b) under the Prevention of Terrorism Act (1989).

c) by virtue of employment in an organisation operating local protocols which
have a legal requirement to provide information, e.g. under the Children’s
Act (1989) and Public Health Act (Control of Disease) Act (1984).

d) in an emergency or other dangerous situation where in the opinion of a homeopath
the information may assist in the prevention of possible injury to the patient
or to another person.

81 Where contact is initiated by a member of a patient’s family, or a
friend or other person, to listen carefully to their concerns in an unprejudiced
manner and act appropriately, without breaching confidentiality or contradicting
the wishes of the patient.

Premises the following applies to all places of practice:

82 to comply with local council regulations and advice of the 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 (reference Shops and
Offices Act 1963)

• 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 1974) whether employer,
employee or self-employed.

Patient Consent for Educational Purposes this section expands provisions 70
and 71 above.

83 Written consent shall be obtained in advance of making a video or other recording
of a patient in consultation, or before producing in printed form any material
from casenotes, or likewise sending a communication electronically which may
become printed matter.

• When obtaining consents, how material is to be used and with whom shall
be made clear to the patient in order to define and restrict publication.

• The patient signs to agree a clearly defined use of material, and to
acknowledge their anonymity being preserved at all times. Identifying factors
(names, locations, employments) shall not be revealed in a recording, nor in
the labelling of cassettes, nor in any other oral or printed form.

• The written consent(s) are to be kept with the patient’s notes.

•Once it is given, the patient may withdraw consent during a recording
of their case or at any time afterwards, without needing to justify a decision.
In this event, the recording is erased at once, teaching material withdrawn
from circulation where possible, and confirmation of all actions sent to the
patient concerned.

•If consent has been obtained for a specific purpose which the homeopath
wishes to extend, e.g. to use further material, to show to a different audience
or to publish more widely, a supplementary written consent shall be obtained
in a form identical with the original.

• All recordings are to be kept secure by the college or teacher, and
shall not be lent, sold or viewed outside the jurisdiction of the college or
teacher.

•Colleges, teachers and students need to be fully aware of the confidential
nature of material used for teaching purposes.

•Written consent must be obtained that students will keep confidential
all the information contained in the recording and any ensuing discussion, which
may only take place in the seminar room (this is only necessary if not mentioned
within the code of ethics of the homeopathic college concerned).

• When a recording is used at a seminar arranged by the Society of Homeopaths
or one of its members, the audience must be reminded of the above statement
of confidentiality.

Licensed and Registered members sign to agree to abide by the Code of Ethics
and Practice on acceptance as members of the Society, and this covers confidentiality.
Where an audience is not entirely made up of members of the Society so bound
by this code, then a written signed statement shall be obtained from all participants
to preserve the confidentiality of the information they receive from video films,
case histories, discussions etc, all of which shall be kept within the teaching
room.

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