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AMERICAN CHIROPRACTIC ASSOCIATION CODE OF ETHICS
This Code of Ethics is based upon the acknowledgement that the social contracts dictates the profession’s responsibilities to the patient, to the public, and to the profession; and upholds the fundamental principle that the paramount purpose of the chiropractor's professional services shall be to benefit the patient.
I. Doctors of chiropractic should adhere to a commitment to the highest standards of excellence and professionalism and should attend to their patients in accordance with established best practices.
II. Doctors of chiropractic should maintain the highest standards of professional and personal conduct, and should comply with all governmental jurisdictional rules and regulations.
III. Doctor/patient relationships should be built on mutual respect, trust, and cooperation. In keeping with these principles, doctors of chiropractic should demonstrate absolute honesty with regard to the patient’s condition when communicating with the patient and/or representatives of the patient.
Doctors of chiropractic shall not mislead patients into false or unjustified expectations of favorable results. In their communications, doctors of chiropractic should never misrepresent their education, credentials, professional qualification, or scope of clinical ability.
IV. Doctors of chiropractic should preserve and protect the patient's confidential information, except as the patient directs or consents, or the law requires otherwise.
V. Doctors of chiropractic should employ their best good faith efforts provide information and facilitate understanding to enable the patient to make an informed choice in regard to proposed chiropractic treatment. The patient should make his or her own determination on such treatment.
VI. The doctor-patient relationship requires the doctor of chiropractic to exercise utmost care that he or she will do nothing to exploit the trust and dependency of the patient. Sexual misconduct is a form of behavior that adversely affects the public welfare and harms patients individually and collectively.
Physician sexual misconduct exploits the doctor-patient relationship and is a violation of the public trust.
VII. Doctors of chiropractic should willingly consult and seek the talents of other health care professionals when such consultation would benefit their patients or when their patients express a desire for such consultation.
VIII. Doctors of chiropractic should never neglect or abandon a patient. Due notice should be afforded to the patient and/or representatives of the patient when care will be withdrawn so that appropriate alternatives for continuity of care may be arranged.
IX. With the exception of emergencies, doctors of chiropractic are free to choose the patients they will serve, just as patients are free to choose who will provide healthcare services for them. However, decisions as to who will be served should not be based on race, religion, ethnicity, nationality, creed, gender, handicap or sexual preference.
X. Doctors of chiropractic should conduct themselves as members of a learned profession and as members of the greater healthcare community dedicated to the promotion of health, the prevention of illness and the alleviation of suffering. As such, doctors of chiropractic should collaborate and cooperate with other health care professionals to protect and enhance the health of the public with
the goals of reducing morbidity, increasing functional capacity, increasing the longevity of the U.S. population, and reducing health care costs.
XI. Doctors of chiropractic should exercise utmost care that advertising is truthful, and accurate in representing the doctor’s professional qualifications and competence. Advertising should not exploit the vulnerability of the patient should not be misleading, and should conform to all governmental jurisdictional rules and regulations in connection with professional advertising.
XII. As professions are self-regulating bodies, doctors of chiropractic shall protect the public and the profession by reporting incidences of unprofessional, illegal, incompetent and unethical acts to appropriate authorities and organizations and should stand ready to testify in courts of law and in administrative hearings.
XIII. Doctors of chiropractic have an obligation to the profession to endeavor to assure that their behavior does not give the appearance of professional impropriety. Any actions that may benefit the practitioner to the detriment of the profession must be avoided so as to not erode the public trust.
XIV. Doctors of chiropractic should recognize their obligation to help others acquire knowledge and skill in the practice of the profession. They should maintain the highest standards of scholarship, education, and training in the accurate and full dissemination of information and ideas.
For more information on how to file a complaint or obtain an advisory opinion, please request a copy of the “Administrative Procedures for the Code of Ethics” or click here
ACA ETHICS COMMITTEE
RENTAL ARRANGEMENTS and CLINIC or LABORATORY REFERRALS
It is unethical for a doctor of chiropractic to receive a fee, rebate, rental payment or any other form of remuneration for the referral of a patient to a clinic, laboratory or other health service entity.
The ACA Code of Ethics mandates, as primary obligation of the doctor of chiropractic, the exercise of clinical judgment and practice "solely for the patient's benefit." In the view of this association, the receipt of any form of remuneration for a patient referral runs directly counter to this primary obligation and tends to adversely impact upon the relationship between chiropractor and patient.
Arrangements in which "rental fees,” “rebates," or free gifts are received in return for patient referrals are, in the ACA's view, unethical and unacceptable in the professional practice of chiropractic.
The ACA recognizes that there are some forms of rental agreements for space or equipment, which are legitimate arm-length business transactions not conditioned on patient referrals. However, some forms of rental agreements may be designed to conceal the real nature of the payment, that is, to induce referrals.
The ACA also recognizes that the federal government has developed guidelines, which outline those circumstances in which space or equipment rentals would not constitute an illegal or improper form of remuneration in return for Medicare or Medicaid referrals.
The ACA feels these federal guidelines provide an excellent basis by which a doctor of chiropractic can ethically evaluate and engage in space or equipment rental agreements. These guidelines appear in Title 40 of the Code of Federal Regulations, Part 1001 and may be summarized and adapted for the purposes of our ethical standards as follows:
A lease agreement for space or equipment in which a doctor of chiropractic refers a patient to an entity which either leases to or from the doctor space or equipment, will not constitute an unethical practice where:
1. The lease agreement is in writing and signed by the parties.
2. The lease specifies the space or equipment covered by the lease.
3. If the lease is intended to provide the lessee with access to the premises or equipment for periodic intervals of time, rather than on a full-time basis for the term of the lease, the lease specifies exactly the schedule of such intervals, their precise length, their periodicity, and the exact rent for such intervals.
4. The term of the lease is for not less than one year.
5. The rental charge is consistent with fair market value in arms-length transactions and is not determined in a manner that takes into account the volume or value of any referrals of business between the parties.
Doctors of chiropractic are advised to consult with their local examining board or other regulatory agencies for specific requirements, which may relate to clinic or laboratory referrals. (Approved 1989)
SEXUAL INTIMACIES WITH A PATIENT
The ACA Ethics Committee ("Committee") has received numerous requests for clarification relative to the ethical implications of sexual intimacies between a doctor of chiropractic and a patient he or she is treating.
This advisory opinion is intended to resolve any misunderstanding and to state that it is the opinion of the Committee that sexual intimacies with a patient is unprofessional and unethical based on the existing ethical provisions in the ACA Code of Ethics: A(6), A(7), A(10) and C(2).
The physician/patient relationship requires the doctor of chiropractic to exercise utmost care that he or she will do nothing to "exploit the trust and dependency of the patient." Doctors of chiropractic should make every effort to avoid dual relationships that could impair their professional judgment or risk the possibility of exploiting the confidence placed in them by the patient. (Approved 1991)