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Code of Ethics for Professional Conduct

Introduction – About the Code

This Code of Ethics is published by the European Traditional Chinese Medicine Association (ETCMA) as a foundation for codes of conduct in affiliated organizations and associations. It is based on the Professional Conduct Code of the British Acupuncture Council (BAcC).

Objectives of the Code:

To protect both patients and practitioners.
To emphasize the high standard of conduct maintained by practitioners who are members of the Association.
To serve as a foundation for the ethical codes of all professional organizations, with room for expansion as needed.

This code does not address every possible scenario. Member organizations of ETCMA are expected to:

Expand on the topics mentioned in the Code.
Provide examples of best clinical practices.
Update the Code as necessary.

Local law in each member country takes precedence over this ethical code.

*The Code is written in the masculine form for convenience only and applies equally to all genders.

Definitions

“Practitioner” – A person who is a member of one of the associations or organizations affiliated with ETCMA, unless otherwise defined by law.
“Patient” – An adult who voluntarily seeks advice or treatment from a certified practitioner (or a minor with parental/legal guardian consent).
Chinese Medicine Practitioner – A professional who has studied and received certification to assist individuals in improving and maintaining their health.

Fundamental Principles:

a. The practitioner must act with commitment to the patient’s wellbeing.

b. The practitioner must provide professional treatment within the scope of their training.

c. The practitioner must be aware of their ethical obligations toward patients, colleagues, and the profession.

Chapter 1 – Professional Conduct and Practitioners’ Duties

1. Maintaining Professional Standards
The practitioner is obligated to maintain the level of care and professional conduct as established by the Association.

2. Professional Relationship with the Patient
The relationship between the practitioner and patient must be strictly professional, with treatment sessions aimed at establishing trust.

Any breach of trust is strictly prohibited.

3. Basic Patient Rights
Every patient has the right to expect:

Objective and attentive care, prioritizing treatment of their condition.
Full attention and respect for their privacy.
A clear and comprehensive explanation of the diagnosis, treatment goals, and process.
Respect for their autonomy and encouragement of informed choice.
Complete contact information for the practitioner, including hours and availability.

4. Practitioner Responsibilities During Treatment:

- Perform thorough diagnosis and intake at the initial meeting using Chinese medicine tools.
- Acknowledge professional limitations and act accordingly.
- Share relevant information with other medical professionals with written patient consent.
- Consult and refer to other professionals as needed.
- Maintain an organized, updated patient file.
- Periodically assess treatment progress and need for continuation.
- Recommend alternative medical approaches when Chinese medicine is not appropriate.
- Report immediately and transparently to the professional organization/insurance provider in case of a treatment error, and await instructions.
- Respond promptly to any patient complaint, document it and the response.

Chapter 2 – Accepting a Patient

a. The practitioner must perform a thorough evaluation of the patient’s health status.
b. A comprehensive medical history must be taken.
c. The practitioner must explain the treatment plan, duration, and number of sessions.
d. Possible side effects must be explained.
e. It is recommended to obtain written informed consent from the patient.
f. The practitioner must comply with the Patient’s Rights Law and uphold patient confidentiality and safety, as well as the Prevention of Sexual Harassment Law (1998) and its regulations.
g. If the patient is already undergoing other treatments, it must be clarified whether Chinese medicine is appropriate.
h. Other treatment techniques (e.g., Shiatsu, Tui Na) may be used only with the patient’s consent.
i. The presence of another person in the room (e.g., trainee, student) requires the patient’s consent. Patients have the right to bring a companion of their choice.

Chapter 3 – Payment and Contractual Relations

All advice or treatment in Chinese medicine constitutes a contract between practitioner and patient.
Even when no payment is determined (e.g., first aid), all ethical rules still apply.
Patients must be provided with clear information about treatment costs and payment methods before and during treatment, including notice of any future changes.

Chapter 4 – Patient Files

The practitioner must maintain an organized, updated patient file that includes:

Personal details: name, address, phone number, date of birth.
Chief complaint and symptoms reported by the patient.
Relevant personal and family medical history, including contact with the primary physician.
Clinical findings and diagnosis according to Chinese medicine.
Documentation of treatments, progress, and changes in treatment plan.
Information and advice given to the patient, including referrals to other professionals.
Signed consent forms and documentation of communications with physicians.
Patient files must be maintained according to the laws of the country in which the practitioner works.
Files are the property of the practitioner. They may not be transferred to a third party without written consent from the patient.
In the case of a clinic sale, only copies may be transferred, and only with the patient’s informed consent.
Patient file information may not be used for personal or professional gain.
Files must be securely stored.
Destruction of files must follow legal procedures (e.g., shredding, burning).
If the file is in a foreign language, the practitioner must translate it upon request by the ethics committee or the patient.

Chapter 5 – Disclosure Without Consent

Disclosure of patient information without consent may occur only when the patient poses a danger to themselves or others—violence, criminal activity, or a reportable disease.
In such cases, it is advisable to consult with the ethics committee and obtain legal advice.
In the case of a court order, only the required information should be disclosed, and advance consultation is recommended.

Chapter 6 – Delegation of Authority

If a patient is transferred to another practitioner (within Chinese medicine or another modality), the referring practitioner must ensure that:

The receiving practitioner is qualified and certified.
The receiving practitioner is a member of a recognized professional association.
The patient consents to the transfer.

Chapter 7 – Absence or Retirement from the Clinic

A practitioner who must be absent for an extended period is responsible for notifying patients and referring them to appropriate alternative care to ensure continuity.
A retiring practitioner must inform patients in advance, suggest suitable alternatives, and ensure patient files are transferred only with the patient’s consent.

Chapter 8 – Education and Continuing Professional Development

a. The practitioner must possess the appropriate education and experience to provide professional Chinese medical treatment.

b. The practitioner must limit their practice to areas in which they are trained and certified, according to the standards of licensing and certifying authorities.

c. The practitioner must remain updated in their field, through professional development activities recommended by professional bodies.
Practitioners lacking experience in a specific area must consult or refer to experienced practitioners or professionals in other fields to ensure the patient receives the best possible care
d.Practitioners lacking experience in a specific area must consult or refer to experienced practitioners or professionals in other fields to ensure the patient receives the best possible care. Practitioners must act in a manner that ensures the safety and health of their patients.
e. Practitioners must cease practicing if physical or mental limitations prevent them from treating safely and effectively.
f. If a practitioner is aware of another practitioner’s physical or mental impairment that may endanger treatment quality, they must encourage that colleague to seek guidance from a health/ethics committee and are obligated to report it to such a committee.
g. Knowledge must be regularly refreshed through courses, seminars, and training, including meeting all requirements set by the professional association.

Chapter 9 – Ethical Boundaries with Patients

a. Practitioners must avoid any intimate and/or romantic relationship with their patients.
If a practitioner senses that a patient is developing emotional involvement beyond the therapeutic setting, the practitioner must end the therapeutic relationship and recommend an alternative therapist.

b. If a practitioner detects inappropriate involvement by a patient, they must dissuade the patient. If professional and clean treatment sessions cannot be resumed, the relationship must be terminated. It is also recommended to report such incidents to the Ethics Committee for guidance while preserving the patient’s anonymity.

c. Practitioners must maintain a professional demeanor at all times, leaving no room for misunderstanding or misinterpretation. Any physical contact not required for treatment, romantic or intimate gestures, verbal suggestions, or sexual innuendo may be perceived as harassment or misconduct.

d. Practitioners must adhere to the Prevention of Sexual Harassment Law (1998) and its regulations, ensuring a safe and respectful clinical environment.

e. Practitioners must refrain from touching or inserting needles into patients in ways that deviate from accepted Chinese medicine standards in Israel.

f. Before inserting needles in intimate or nearby areas, practitioners must explain the purpose, benefits, and available alternatives.

g. Practitioners must provide suitable conditions and privacy if the treatment requires the patient to remove clothing.

h. Practitioners may not engage in romantic or sexual relationships with patients, their partners, or any relevant individuals for as long as the practitioner-patient relationship exists and for three months thereafter.

i. If treating a family member, friend, or acquaintance, the practitioner must uphold strict boundaries between personal and professional relations throughout the treatment.

j. Practitioners must ensure that any past, present, or potential future personal relationships do not interfere with professional obligations or the ability to deliver appropriate care.

Violation of these articles will result in:

An inquiry conducted by the Ethics Committee.
Exposure to potential legal claims under the Prevention of Sexual Harassment Law (1998) and its related regulations.

k. Signage – The practitioner must display a clearly visible sign at the clinic entrance or treatment room informing patients of their right to have a companion present during treatment.

l. Treatment of minors (under 18) requires written parental/legal guardian consent. During treatment, the presence or written consent of an adult is required. In cases of divorced parents, written consent from both is needed.

Minors have the legal right to refuse treatment even if the parent has consented. This right overrides parental approval.

Chapter 10 – Patient Consent

a. Practitioners must clearly explain all intended procedures and acknowledge the patient’s right to accept or refuse. Initiating treatment without consent or continuing treatment after consent is withdrawn may be considered assault.

b. Explicit consent can only be provided by a person legally recognized as competent and willing to undergo treatment.

Before beginning treatment, practitioners must ensure the patient understands and agrees to the treatment plan, especially if it involves exposing intimate body areas. All treatment stages must be documented in the patient file.

c. Practitioners must monitor treatment progression and obtain renewed consent if it continues beyond the initially agreed timeframe.

d.Practitioners lacking experience in a specific area must consult or refer to experienced practitioners or professionals in other fields to ensure the patient receives the best possible care. Practitioners must avoid delegating authority and must obtain the patient’s consent if involving reception staff or assistants.
Consent is valid only if the practitioner or a qualified colleague explains the procedures, answers questions, and ensures the patient’s understanding.

Chapter 11 – Commercial Commitments and Advertising

Practitioners may advertise their Chinese medicine services honestly, including accurate details about qualifications, training, and experience.

Registration / Licensing

a. When registering or applying for a license, practitioners must provide accurate information about education, experience, other degrees, and relevant data.
b. Practitioners are required to report any changes, including criminal records or malpractice claims, to licensing authorities.

Placement and Distribution of Advertising

a. All published information must be legal, respectful, decent, and accurate in accordance with professional guidelines.

b. Advertising may mention unrelated qualifications or interests but must not claim superiority or disparage other practitioners.

c. Misleading, pressuring, or exaggerated statements regarding treatment length, type, or effectiveness are prohibited.

Chapter 12 – Selling Products

The practitioner must clearly separate their role as a Chinese medicine practitioner from any commercial activity they are involved in.

Practitioners are prohibited from advertising information that could raise suspicion of a commercial interest influencing the care they provide to patients.

Selling a product to a patient for financial gain without therapeutic justification constitutes an ethical violation. Recommending or selling a product or service must only be done if the practitioner genuinely believes it will benefit the patient’s condition and provided the practitioner has appropriate training and credentials to make such a recommendation. It must be ensured that no financial interest influences the quality of care.
The patient must be informed in advance if the sale is promotional or a part of the treatment.
Practitioners must not encourage gifts, inheritances, or donations from patients. They must avoid placing pressure on the patient or their family members to donate money or property to any individual or organization.

Chapter 13 – Membership in Other Organizations

If a practitioner is also a member of another organization with a different ethical standard, they remain obligated to adhere to this Code of Ethics.

Use of Additional Methods

Practitioners using additional treatment methods outside of Chinese medicine must acquire appropriate training in these methods. Using an additional method without training is considered a breach of this Code.

Techniques, Supplements, or Equipment Outside of Chinese Medicine

Practitioners using techniques, supplements, or equipment not integral to Chinese medicine must disclose this to their patients. It is recommended that the practitioner obtain proper training, insurance, and patient consent when using these tools

Chapter 14 – Use of Titles and Professional Identity

A Chinese medicine practitioner must not use a title or designation implying a professional status or qualification other than those stated in their certification. However, a practitioner may use the title “Certified Chinese Medicine Practitioner.”
A person must not use titles such as “Doctor,” “Dr.,” “Expert,” or “Medical Practitioner,” or any similar term suggesting they are a physician, unless they are licensed as a Medical Doctor (MD).
If a practitioner holds an honorary or academic title unrelated to medicine or Chinese medicine, they may include it along with the specific field.

Chapter 15 – Relationships with Fellow Practitioners

In this section, the term “practitioner” refers to anyone practicing in health-related professions, including Chinese medicine practitioners who are not members of the association.

a. Practitioners must refrain from persuading a patient currently under the care of another practitioner to switch to their care.

b. If a practitioner treats a patient already under the care of another Chinese medicine practitioner due to vacation, illness, or other reasons, they must encourage the patient to return to their original practitioner once available. The substitute practitioner must not directly or indirectly solicit the patient to continue care with them.

Criticism of other Therapists

Professional opinions may be expressed, but only in a respectful and cautious manner. Criticism of treatment methods or other practitioners, whether direct or implied, must be avoided unless absolutely necessary.
If there is solid evidence that a practitioner’s personal or professional competence is compromised in a way that endangers the public, there is a duty to report this to the appropriate organizations and institutions.
Confidential patient information must not be shared with any party without the patient’s consent, except in extreme cases where public safety takes precedence.

Collaboration with Western Doctors

When appropriate and possible, Chinese medicine practitioners should maintain open and stable communication with the patient’s primary physician, particularly if the physician referred the patient to them. This must be done with the patient’s consent.

Chapter 16 – Teaching and Observation

Lectures delivered to healthcare professionals, para-medical professionals, or the general public about Chinese medicine and practitioners’ work are fully acceptable. It should be clarified that such lectures are for general knowledge only and do not constitute formal professional training.

Assistants and Observers

A Chinese medicine practitioner may allow Chinese medicine students, potential students, or other individuals to observe in their clinic. Observation during treatment sessions is only permitted with the patient’s explicit consent. The practitioner must ensure that the patient does not feel pressured to agree to such observation.

Chapter 17 – Research

Practitioners involved in research must receive approval from an ethics committee and obtain patient consent.
The practitioner must ensure that participation in research does not compromise the quality of care.
Patient privacy must be preserved in any publication of research results, and only with the patient’s approval.

Chapter 18 – Salary

Chinese medicine practitioners must inform patients of treatment costs and any associated services before beginning treatment, as well as the method of payment. Any changes in fees during a course of treatment must be communicated in advance with reasonable notice.

Chapter 19 – Insurance

Practitioners must not treat patients without valid professional liability insurance.