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The Horizon Document

Last edited by Barak Gombosh on 1.9.2022

Recognition Document for Chinese Medicine Schools

The document will define basic requirements that will serve as a condition for a Chinese medicine school to be recognized by the Israeli Association of Chinese Medicine.

The recognition process is intended to provide the Association with information to determine whether the school’s traditional Chinese medicine curriculum meets the criteria set by the Israeli Association of Chinese Medicine. These criteria are derived from the accepted American standard in this field.

Granting official recognition is not intended to impose a uniform and rigid program of educational goals, clinical or theoretical content, or actions on the school. The Israeli Association of Chinese Medicine understands that different schools have different goals and emphases in their curricula. In light of this, each program is examined according to its declared goals, in accordance with the basic criteria set by the committee.

At this stage, the recognition process will apply in two tracks: a track for recognized schools and a track for schools in the recognition process. A recognized school will be defined as a school that has produced at least one graduating class according to the Association’s approved curriculum. A school in the recognition process will be defined as a school that does not have at least one graduating class according to the Association’s approved curriculum.

Recognition Process for a School Candidate for Full Recognition

  • The school has produced at least one graduating class
  • The school will meet the Association’s curriculum requirements, including 3050 hours as detailed in the extended recognition document.
  • The school will commit to meeting the requirements for teaching staff structure and school structure as defined in the extended recognition document within one year.
  • The school is obligated to recommend, support, and prepare its students for the Association’s certification exam.
  • All of the above is subject to the Association’s supervision. Therefore, recognition is conditional on verifying the above items anew each year.
  • The school will commit to the ethical code attached in the appendix

Recognition Process for a New School

The recognition process will be carried out in 4 stages:

  • Curriculum recognition process
    • Curriculum approval
  • Teaching staff recognition process
    • Approval of teaching staff structure
  • Structure recognition process
    • Approval of structure and services
  • Full recognition graduating class
    • First graduating class

Each program according to its declared goals, in accordance with the basic criteria set by the Association.

Basic Requirements

  1. The school will present a goals program that defines its future activity outline. The goals program will include an official statement defining the training objectives of practitioners in the field of health– traditional Chinese medicine.
    • The goals program must include a brief description of its objectives.
    • The school must demonstrate that its current and planned future resources, programs, services, and activities are consistent with the goals program. Additionally, the institution will be required to continuously present the degree of success in achieving its goals and objectives.
    • The goals program and educational objectives should be periodically presented to the target audience and stakeholders (management, teaching staff, students).
  2. The educational institution will be required to be organized and anchored in law and authorized to conduct its activities according to the laws of the State of Israel.
  3. The curriculum will have an administrative director, with appropriate qualifications, who will dedicate most of their time or main occupation to management.Additionally, a qualified administrative team will be required, whose size and organizational structure will be appropriate to the scope and purpose of the curriculum.
    • The chief administrative director (who can be the school principal) will be responsible for operating the institution or program in its entirety, in accordance with policies and procedures.
    • Department heads: Will have appropriate qualifications including: recruitment and organization of teaching staff, defining roles and areas of responsibility.
    • Teaching staff: Will be detailed later.
  4. The school will have accurate and complete systems for managing records.
    • The school must maintain and secure academic and administrative records. While maintaining and establishing the right to privacy.
    • Clinical records: The school is obligated to maintain clinical records of patients whom students get to treat. These records will be accurate, secure, and complete, and will be kept confidential in relation to accepted standards of medical confidentiality. Documentation of clinical records will be conducted at each practitioner-patient encounter.
    • The school will have the ability to produce documents and the ability to store student lists.
    • The school will evaluate the effectiveness of the training as well as the extent to which its declared goals are achieved, by measuring and documenting student achievements in verifiable ways.
    • Maintaining a feedback system for evaluating students regarding courses and teaching staff.
  5. The school will consider the Association’s request to submit records throughout the entire curriculum in the field of Chinese medicine, and will allow access if necessary and with the school’s consent.
    • Measuring student achievements: Assessment of student achievements will be systematically implemented throughout the entire curriculum. A variety of measures will be used to assess acquired knowledge, basic skills, competence, as well as appropriate behavior as a practitioner in traditional Chinese medicine.
    • Tests, quizzes, oral exams, assignments, and instructor evaluations will be tools for monitoring and tracking student progress.
    • Student assessment will also include knowledge, skills, understandings, approaches, characteristics, achievements, personal and professional behavior, practitioner-patient relationship, equipment, and environment required for good professional practice in traditional Chinese medicine.
    • Academic policies and procedures: Policies and procedures regarding students’ academic progress and grades given to them must be fair and consistent, and also published and delivered to students in an accessible manner.
    • The program and teaching staff should have an effective and efficient system for monitoring students as they progress through clinical training. Students with particularly weak academic achievements will be identified at an early stage, their weaknesses will be documented and communicated to the student and relevant officials (department head/school principal.) If necessary, a decision will be made to terminate the student’s studies accordingly.
  6. The school will include a teaching staff appropriate to the proposed curriculum.
    • Size and qualifications of teaching staff: The recommended maximum ratio between lecturer and students is 1:15 in a practical course, and 1:50 in a theoretical course. The school will employ teaching staff with teaching qualifications and clinical experience.
    • Lecturer Skills: The faculty will be required to have the following abilities: General education at least at the high school diploma level according to the regulations of the State of Israel and academization, except for the “grandfather generation”, professional education, English proficiency, and teaching experience and practical professional clinical experience. The lecturer must demonstrate basic knowledge of proper didactic teaching.
    • Seniority: A lecturer will be hired as a faculty member according to one of the following definitions:
      • “Senior Teacher” – after demonstrating at least 10 years of experience from the date of receiving the certification from the school where they studied, provided that their training process is recognized by the association and according to the discretion and decision of the college. They will also prove practical experience in their field and be up-to-date with developments in their area.
      • “Teacher” after demonstrating at least 5 years of experience since completing their studies. They will also prove practical experience in their field and be up-to-date with developments in their area.
      • “Beginning Teacher” – after demonstrating at least 3 years of experience, as well as proving practical experience in their field.
    • Proper Conduct of a Lecturer:
      • The lecturer will teach the course according to the published syllabus and curriculum. The lecturer must provide the syllabus to students at the beginning of the course. The syllabus should detail content, course objectives, teaching methods, bibliographic list, assessment methods, and criteria for receiving grades.
      • The lecturer must adhere to the schedule and teach all required material.
      • The lecturer should use supplementary learning aids to enrich the student experience.
      • The lecturer should be attentive to students’ needs, answer questions, and provide appropriate, patient, and professional responses.
      • The lecturer should create a positive learning atmosphere to promote and build student self-confidence. All of the above in subsection 6d. is the sole responsibility of the schools.
  7. Conduct regarding rights, obligations and areas of responsibility.
    • The school will operate with transparency regarding the rights, obligations, and areas of responsibility of the students. This will be done through the study regulations or other appropriate means that will be published in advance.
    • The Israeli Association of Chinese Medicine recommends that schools maintain and manage a system of counseling, guidance, career development, and placement in relevant workplaces to realize personal potential and personal and professional growth for students.
  8. The school will have learning resources and equipment including a professional library, appropriate and sufficient for the offered study programs.
    • The library should be accessible within the school premises and include well-known professional books that form the basis for Chinese medicine studies worldwide, and at least one basic book from each field taught at the school.
  9. The school will provide safe facilities ,accessible, functional, properly maintained on the institution’s grounds. The facilities will include classrooms,clinic/clinic, appropriate media and learning equipment suitable and sufficient to support the offered educational programs.
    • The school must provide properly equipped classroom spaces appropriate for the curriculum and its scope.
    • The school building will meet standards subject to Israeli building laws.
  10. The school will have a solid and appropriate financial basis to fulfill all its commitments to students and lecturers. The school will provide a document attesting to financial stability signed by an accountant. These conditions are intended to enable the student to complete their course and support the school’s study programs and activities now and in the future.
    • The school will provide a document through an external accountant attesting to “financial strength” allowing for 4 years of study regardless of the number of enrollees.
  11. The school will publish and provide students with, a catalog or similar official publication that details in a fair and accurate manner the following:
    • Current educational goals and objectives.
    • Admission requirements and relevant procedures.
    • Policies regarding student admission based on the scope of study hours and/or credit points as accepted by the school, in cases of student transfer from school to school.
    • Rules and regulations regarding behavior and attendance in classes.
    • Procedures for dismissal from the institution, whether for academic or other reasons.
    • Grading policy.
    • Tuition and refund policies.
    • Administrative staff at the institution.
    • Education and professional qualifications of faculty members.
    • Detailed curriculum at the course level
    • Academic calendar.
    • Details of the entire academic program and all courses of study.
  • Study programs, courses, services, administrators, and faculty members will be available throughout the academic year.

Association Requirements for Study Programs:

The curriculum is detailed in the“Certification Exam Specification“ (hereinafter “the Specification“) and will be updated according to what is stated in the specification and in coordination with the schools. The program must include the following minimum core subjects:

  1. History of Chinese Medicine and Philosophy:
    • Discussion of the different schools and traditions in Chinese medicine, as well as how these relate to the development of Chinese medicine.
  2. Basic Theory:
    • The Dao.
    • Yin-Yang.
    • 4 Levels
    • 5 Elements, and their laws and cycles.
    • 6 Layers
    • 8 Principles.
    • Yin organs – Yang organs, (Zang-Fu).
    • The theory of the meridian system (Jing Luo).
    • The extraordinary meridians.
    • Internal and external disease factors, such as: 6 external pathogens, 7 emotions, etc.
    • Pathology in Chinese medicine.
    • Perception and importance of disease, symptoms, signs in Chinese medicine.
    • Body substances such as: Qi, Blood, Jing, Body fluids.
  3. Acupuncture Points and Meridian Theory:
    • Location systems: anatomical location, proportional location, location by palpation, Chinese measurements (cun).
    • Functions and indications of classical acupuncture points. As well as point combinations.
    • Functions, indications, and locations of extra points.
    • Classification of points by groups.
    • Contraindications for acupuncture points.
    • Other categories and types of acupuncture points (scalp, ear, etc.).
    • The network of main meridians and special meridians.
  4. Diagnostic skills:
    • Identifying “red flags” emergency situations for urgent referral to a medical institution.
    • Taking medical history/questioning
    • Classical diagnostic methods: observation, palpation, smelling, listening.
    • Pulse / tongue diagnosis
    • Differential diagnosis.
    • Western medicine skills: measuring vital signs (blood pressure, pulse, respiratory rate and temperature.)
  5. Treatment planning:
    • Building a treatment strategy.
    • Ability to choose the appropriate strategy, plan and manage treatment, execute, and evaluate treatment results.
    • Prognosis.
    • Contraindications, in relation to treatment.
    • Making appropriate referrals.
    • Taking into account special factors or symptoms indicating potential risk to the patient, for example: patients with immune deficiency, diabetic patients, mental health patients, etc.
    • Identifying the need to modify the standard treatment approach in special cases, such as: infants and children, pregnancy, etc.
  6. Acupuncture treatment techniques:
    • Needle insertion: depth, angle, duration, manual manipulation and needle removal.
    • Moxibustion: safety rules, application method, direct/indirect, etc.
    • Additional techniques: bleeding, cupping, gua sha, star, seven, electro, etc.
    • Basic acupuncture techniques: tonification/sedation, moving, etc.
    • First aid and emergency situations in treatment.
    • Safety issues.
  7. Equipment and safety:
    • Selection and maintenance of acupuncture equipment: types of needles, needle disposal, medical waste, sterility, etc.
    • Selection and maintenance of additional equipment: cupping glasses, moxibustion, electro, heat lamp, etc.
    • Patient and practitioner safety.
    • Sterile work techniques.
    • Avoiding damage due to negligence from: improper use of needles, moxibustion, cupping, bloodletting, electro, etc.
    • Personal cleanliness and hygiene, and clinic cleanliness.
    • Resuscitation.
  8. Practitioner-patient relationships, clinic management and professional ethics:
    • Communication skills: listening, counseling, containment, guidance.
    • Dealing with reactions that may arise during treatment, as well as the ability to make appropriate referrals.
    • Medical confidentiality.
    • Informed consent.
    • Record management: legal requirement, data sharing.
    • Ethical and legal aspects of referring patients to other healthcare professionals (ethical code appendix.)
    • Professional behavior and appropriate interpersonal conduct.
    • Understanding laws and regulations governing the practice of Chinese medicine
    • Recognizing and clarifying patient expectations.
    • Professional liability insurance and legal requirements.
    • Establishing and managing a private clinic, including all aspects related to self-employment.
  9. Western medicine:
    • Identifying “red flags” emergency situations for urgent referral to a medical institution.
    • Anatomy and physiology.
    • Western medicine concepts and terminology.
    • Relevant basic sciences.
    • Pathology and disease model in Western medicine.
    • Nature of the clinical process, including: taking medical history, diagnosis, treatment, and follow-up.
    • Relevant laboratory tests, as well as relevant diagnostic procedures.
    • Infectious diseases, infectious disease agents, and sterilization methods relevant to the Chinese medicine practitioner.
    • Basic pharmacology including: contraindications and side effects, methods of searching for drug information, and interactions between drugs and herbs/dietary supplements.
    • Referral and/or consultation with a qualified medical professional, and the need for it.
  10. Chinese herbal medicine:
    • It is mandatory to teach at least a leading group of herbs in each herb category defined in the professional literature
    • Introduction to herbal medicine.
    • Development of herbal medicine methods in China.
    • Terminology of plant parts and its importance in relation to use.
    • Properties of herbs, for example: category, taste, temperature, meridian entry, etc.
    • Preparation methods.
    • Methods of taking/using.
    • Treatment strategies: sweating, clearing, harmonizing, etc.
    • Laws regarding synergistics, including common contraindications, prohibitions, precautions.
    • 6 layers, 4 levels.
    • Introduction to herbal names.
    • Modern indications according to research.
    • Dosages and timing of administration.
    • Unavailable/unused/illegal herbs – and their substitutes.
  11. Formulas:
    • It is mandatory to teach at least leading formulas in each category defined in the professional literature.
    • Categories, functions and roles of classical formulas.
    • Meanings of formula names.
    • Modern functions and actions according to research.
    • Specific contraindications for each formula.
    • Composition and proportion of herbs in each formula.
    • Main modifications for each formula.
    • Explanation to patients regarding administration, potential side effects, preparation and storage of formulas.
    • Patent formulas: main companies, common modifications and delivery format.
    • The Israeli Association of Chinese Medicine strongly recommends practical experience in a Chinese pharmacy/compounding formulas by the student as practice.
    • Herb-drug interactions.
  12. Chinese nutrition:
    • Categorization of foods in terms of temperature, taste, and function in the body.
    • Nutritional counseling in relation to various diseases and health conditions.
    • Preparation of main recipes according to Chinese nutrition tradition.
  13. Manual therapy/ touch:
    • Methods that can be chosen from: Shiatsu, Tui Na, (Tai Chi, Qi Gong.)
    • Jin Shin – (after receiving a written request and discussion in the association committee – not final)

Curriculum Hour Requirements:

  1. The minimum duration of the curriculum must be at least eight academic semesters and at least 3050 academic hours. (An academic hour is defined as a “clock“ hour * 1.33)
  2. The programme outline must include at minimum:
    • 750 hours– in the theory of traditional Chinese medicine, pathology in Chinese medicine (syndromes), differential diagnosis, various diagnostic techniques.
    • 450 hours– learning point locations, point functions, needle techniques, moxibustion, cupping, electro-acupuncture and other treatment techniques. Extra meridians, extra points.
    • 300 hours– individual Chinese herbs, Chinese formulas.
    • 50 hours and Chinese nutrition.
    • 250 hours– manual therapies.
    • 500 hours– Western medicine and exact sciences.
    • 100 hours– clinic management, practitioner-patient relationships, professional ethics and elective courses.
    • 650 clinical hours consisting of:
      • 390 hours– practical work. Of which 200 hours of acupuncture and herbal practice are mandatory over at least 100 treatments, as a practicing therapist in a clinic under clinical supervision. At this stage, the therapist is required to perform all stages of treatment: inquiry, diagnosis, and acupuncture treatment. Treatments combining herbs should constitute at least 50% of acupuncture treatments. The remaining practical hours can be divided between acupuncture, herbal medicine (including practical experience in a Chinese pharmacy), nutrition, or manual therapies from accepted methods.
    • 130 hours– clinical discussion.
    • 130 hours– clinical observation.
  3. The school must prepare a curriculum for each course (syllabus) or main teaching unit. This must be distributed to every student in the course and must be kept in the course program files as part of the curriculum. The course program must contain at least the following details:
    • Course objective.
    • Course goals in operational terms.
    • Course prerequisites.
    • Course content outline.
    • Course requirements.
    • Important dates (submission deadlines for assignments and projects, exams, etc.)
    • Grading method.
    • Required and recommended reading materials.
    • The details must be sufficient to allow the student to see the full scope of the course and understand the school’s requirements of them.
  4. The program must demonstrate achievement of professional competence.
  5. The program must have an appropriate clinical component.

(*) At the time of writing this document, Chinese medicine study programmes are not officially recognised as academic programmes in Israel. However, this document has been prepared with future academic recognition of the field in mind.
(**) Any changes to the recognition document will be made in agreement and collaboration with the schools accredited by the Israeli Association of Chinese Medicine.

The European Traditional Chinese Medicine Association – Ethical Code – for Professional Conduct (Version 1 – 2.09)

This code of professional conduct will be translated into the language of each of the member organizations (translated from English).

About the Code

The Code of Professional Conduct is published by the European Traditional Chinese Medicine Association (ETCMA) as a basis for codes of conduct in member organizations and associations. It is based on the British Acupuncture Council (BAcC) Code of Professional Conduct. The code is designed to protect patients. It also serves to explain to people outside the field the high standards by which members operate.

The code represents the minimum standard and should only serve as a basis for the codes of each individual organization. It does not address every possible scenario that practitioners will encounter. To help maintain a particularly high level of professional conduct, each organization and association member of ETCMA is expected to expand on the central issues described in the code with examples of best clinical practice. Members will also regularly update the code to keep organization members as up-to-date as possible regarding changes and developments related to the professional conduct expected of members of organizations and associations that are members of ETCMA.

The law in each of the countries of the organizations that are members of ETCMA takes precedence over this code.

In this code, “practitioner” refers, unless otherwise defined, to an individual who is a member of one of the organizations or associations that are members of ETCMA. Moreover, the reference in this code to “patient,” unless otherwise stated, is to an adult person who voluntarily seeks advice or treatment from a practitioner.

The Code of Professional Conduct

Commitment to Patients

The Duty to Treat

  1. Practitioners have an obligation to their patients to maintain a high standard of care, competence, and conduct.
  2. The relationship between practitioners and the patient is one between a professional and a client entitled to place absolute trust in the practitioner as a professional. It is the duty of every practitioner not to breach this trust in any way.
  3. Every patient consulting a professional has the right to expect:
    • That their concerns will be treated with top priority.
    • To be listened to fully and have their privacy respected.
    • A full and clear explanation from the practitioner, until the patient fully understands, regarding the diagnosis reached by the practitioner.
    • A clear and full description of the nature and purpose of the proposed treatment.
    • Respect for the patient’s sovereignty and encouragement of their freedom of choice.
    • To ensure that the patient knows how and when the practitioner can be reached.
  4. In providing treatment, the practitioner has the duty:
    • To perform a thorough diagnosis of each condition using appropriate diagnostic tools and questioning.
    • To recognize the limitations of the practitioner’s professional ability and to act within the boundaries of that ability.
    • To provide, in appropriate cases and with the patient’s consent, relevant information to other medical professionals involved in the patient’s care.
    • To consult with others and refer for diagnosis and treatment to another source as needed.
    • To maintain comprehensive and up-to-date patient records.
    • For each patient – to check, at predetermined intervals, the status and progress of the treatment and evaluate the appropriateness of continuing acupuncture treatment.
    • To encourage the patient to seek different medical help if it becomes clear that acupuncture and Chinese medicine are not the most effective means of treating the patient’s problems.
    • To report to the professional organization properly and immediately if the practitioner discovers that they have made a mistake in treatment, and to await instructions from the organization.
    • To respond immediately to a patient’s complaint regarding any aspect of the practitioner’s professional conduct and to maintain a record of the complaint and the measures taken as a result of it.

Payment

5. When a patient consults with a practitioner, it constitutes entering into a contractual relationship. Usually, the patient will pay for the treatment. Even if the patient does not pay or if there is no clear contractual relationship (for example, treatment in an emergency case), the practitioner is still bound by the rules of care expected from a professional practitioner of Chinese medicine and acupuncture.

6. Patients should be given clear information regarding the amount and structure of payments both before the start of treatments and during the course of treatment.

Patient Records

7. Practitioners should maintain accurate, comprehensive, legible, and up-to-date patient records that include:

  • Personal details of the patient (name, address, phone number, and date of birth).
  • The main complaint and symptoms reported by the patient.
  • Relevant medical and family history (including details of the treating physician).
  • Clinical findings and diagnosis according to Chinese medicine.
  • Documentation of treatments given, details of treatment progress, including re-examination of the treatment plan.
  • Any information and advice given to the patient, especially referral to a doctor or other practitioner.
  • Any decision made together with the patient.
  • Consent forms from the patient or a first-degree relative for treatment and the patient’s authorization for the practitioner to contact the family doctor or any other relevant doctor.

8. Practitioners are required, by law, to keep patient records for the duration required by the law of each country.

9. Patient records are the property of the practitioner and he or she must retain these records. However, if the patient requests a copy of their file, the practitioner should act according to the laws of the country in which they work.

10. The requirement to maintain original patient records specifically refers to the purchase and sale of a clinic; even with the patient’s consent, the practitioner transferring the clinic may only transfer copies of records and not the originals. Practitioners should ensure that patients are fully informed about the change and are given the option regarding the continuation of treatment and the nature of keeping their original records.

11. The practitioner is not allowed to use information obtained from the patient or their file in any other context for personal or professional gain.

12. Patient records should be stored in a secure and locked place at all times. The country’s laws should be observed in this regard, including compliance with electronic information laws.

13. Patient records should be destroyed according to the law practiced in the country where the clinic operates. If the law does not specify the method of record destruction, shredding and burning will be the most appropriate means. Practitioners should make appropriate arrangements for proper storage and transfer of records in case of the practitioner’s death or severe injury.

14. If patient records are written in a language other than the official language of the country, it will be the practitioner’s responsibility to provide a full translation of the records if required by the ethics committee of the professional organization or similar authority, in case a complaint is filed against the practitioner or if the treatment file is required for official purposes, or at the patient’s request.

Delegation of Treatment Authority

15. Practitioners have an obligation to ensure that treatment is conducted professionally in cases where there is a need to delegate authority to another Chinese medicine practitioner or other therapy. The transferring practitioner should ensure that the receiving practitioner’s professional level is sufficient and that they are a member of a recognized professional body. The practitioner should also ensure that any treatment given by another practitioner is done with the patient’s consent.

Absence from the Clinic

16. If a practitioner is absent from the clinic for any period of time, they should ensure that patients know where they can receive appropriate alternative treatment during the absence, or arrange for a substitute. If the practitioner retires from the profession, they should inform patients of their retirement, other practitioners in the area, and the storage location of patient records.

Continuing Education

17. Practitioners should refresh their knowledge and techniques by, for example, participating in seminars and advanced studies or by taking recognized professional courses. This definition includes completing all professional requirements of the professional organization.

Ethical Boundaries in Relationships with Patients

Inappropriate Relationships

18. Practitioners should avoid sexual relationships with a patient. They should be alert to the danger inherent in emotional involvement with a patient. If a practitioner realizes that they are developing emotional or sexual involvement with a patient, they should terminate the professional relationship and recommend alternative treatment for the patient.

19. If a patient shows signs of inappropriate involvement with the practitioner, the practitioner should discourage their intentions and, if necessary, terminate the professional relationship. It is advisable to report such incidents to the ethics committee of the professional organization or similar authority, or to consult a colleague while maintaining patient anonymity.

20. Practitioners should maintain professional behavior with patients at all times, which does not leave room for misunderstanding or misinterpretation. Even non-physical behavior, gestures, unnecessary physical contact, verbal suggestion, or innuendo can easily be interpreted as rudeness or harassment.

21. Practitioners should allow for patient privacy if the patient is required to remove their clothes for treatment. Practitioners are also required to provide appropriate and clean covering for the patient’s use.

22. Practitioners may sometimes find themselves called upon to treat a family member or someone they consider a friend. There is nothing wrong with this as long as clear boundaries are maintained between therapeutic and social relationships.

23. Practitioners are required to ensure that relationships of any kind in the past, present, or anticipated in the future do not constitute an obstacle to fulfilling their professional duties. They should also avoid any behavior that could be interpreted as such.

Legal Obligation

Patient Consent

24. Practitioners should clearly explain the procedures and treatments they intend to perform and recognize the patient’s right to choose or avoid treatment or recommendation. Examination and preparation for treatment without the patient’s consent or continuation of treatment after the patient has withdrawn consent may be interpreted as assault.

25. Consent should be given by someone defined as competent by law, of the patient’s own free will, and be reported. Even if a patient appears to consent to treatment by arriving and lying on the treatment table, explicit consent is required before starting treatment. A practitioner should obtain explicit consent, in writing if necessary, and ensure that the patient understands the planned treatment. This is especially important in cases where treatment involves sensitive body areas. It is recommended to document all relevant information in the patient’s file.

26. Practitioners are required to document follow-up to explanation and patient consent in cases where treatment continues beyond the initially planned, allocated, or agreed time. The patient’s consent should also be documented if there is a significant change in treatment in the choice of points, techniques, or duration of treatment.

27. Practitioners should avoid delegating the authority to obtain patient consent to reception staff or assistants. Consent is considered valid only when the practitioner themselves (or a qualified colleague) explains the procedures, answers the patient’s questions, and ensures that the patient understands the explanations.

Minor’s Consent

28. If the patient is defined as a minor according to the laws of the country, the consent of the parent or guardian for treatment must be obtained. In the absence of such consent, treatment of a minor should be avoided.

29. Therapists should be aware that a minor’s right to refuse treatment, even if consent has been given by a responsible adult, has legal validity that supersedes that of the responsible adult. If the therapist encounters such a dilemma, they should consult with the organization’s ethics committee and seek legal advice before providing any treatment.

30. When treating a minor, one must adhere to the professional organization’s guidelines regarding the presence of a parent or legal guardian in the treatment room throughout the examination and treatment.

Confidentiality

31. Therapists are obligated to maintain the confidentiality of medical and other information concerning their patients, and to release this information only with the explicit consent of the patients. This obligation also applies to the therapist’s opinion regarding the patient even after the patient’s death. This obligation also applies to all other staff members of the practice.

32. The fact that a person is a patient in the clinic should be kept confidential. It should not be assumed that it is permissible to discuss details of a patient’s treatment with their spouse or other family members, unless explicit consent has been given by the patient.

Disclosure without Consent

33. Disclosure without consent may be necessary in cases where public interest outweighs the commitment to the patient. This would be the case where the patient may pose a danger to themselves or others through, for example, potential violent or criminal behavior, or failure to report a notifiable disease. In any such case, therapists are advised to consult with the ethics committee or a similar committee, or seek legal advice before deciding to release information about the patient without their consent.

34. A court may order a therapist to disclose information about a patient. In such a case, only information relevant to the legal proceedings should be disclosed. If the therapist receives such an order, it is recommended to consult with the ethics committee or a similar committee regarding the best course of action in the matter.

Commercial Obligations

Advertising

35. All advertising should be legal, respectable, honest, and truthful in accordance with the professional organization’s guidelines. Advertising may contain information about the therapist’s qualifications and additional areas of interest (unrelated to acupuncture), but should in no way include claims of professional superiority or disparagement of other therapists.

36. Advertising must not be misleading or deceptive. It must not be scandalous or include unrealistic claims, self-praise, or exaggerations. Neither the content nor the form of distribution should be such that it would put pressure on potential patients. The advertising must not create unjustified expectations regarding the duration, type, or effectiveness of treatment. A therapist must not claim to have the ability to cure or alleviate conditions.

Placement and Distribution of Advertising

37. Therapists should ensure that advertising appears in an appropriate place that does not harm the image of the profession, and that the distribution of advertising is done in a professional manner.

Financial and Commercial Activities

38. Therapists should maintain a clear separation between their practice as Chinese medicine therapists and any other commercial activity in which they are involved. There should be no suspicion of any additional commercial interest influencing the Chinese medicine treatment.

39. Selling a product to a patient without justification other than financial gain constitutes an ethical violation. Selling or recommending a product or service to a patient should only be done if the therapists are convinced it will benefit the patient and provided that the therapists have appropriate training to offer the product or advice. It must be ensured that no financial interest of the therapists influences the treatment.

40. Before selling or recommending a product or service, therapists should declare to the patient their intention to do so. Therapists should ensure that the patient distinguishes between a product that is part of the treatment (prescribing of a product) and a marketing product (marketing of a product).

41. Therapists should avoid encouraging patients to give, lend, or bequeath money or gifts for which they would be direct or indirect beneficiaries. Therapists should refrain from pressuring patients or their family members to donate to other individuals or organizations.

Obligations of a Multi-Disciplinary Clinic

Membership in Additional Organizations

42. If therapists are members of additional professional organizations whose ethical standards differ from those presented below, they should know that they are still bound by this code in all matters relating to their professional conduct.

Additional Treatment Methods

43. Therapists who also use treatment methods other than Chinese medicine will acquire appropriate training. The use of an additional treatment method without proper training will be considered a violation of the ethical code.

Use of Additional Techniques, Supplements, and Equipment as Complementary Treatment to Acupuncture and Chinese Medicine

44. Therapists who use techniques, supplements, or equipment that are not an integral part of Chinese medicine must inform patients of this. It is recommended that therapists ensure appropriate training and insurance for the use of other techniques, supplements, or equipment, as well as obtain patient consent for the additional treatment.

Use of the Title “Doctor”

45. Association members should avoid using the title “doctor,” whether as a title in advertising or in referring to themselves or allowing others to call them so in reference to their status as Chinese medicine practitioners, as the use of this title implies a medical doctorate.

46. Honorary degrees, doctorates in any other field, or a master’s degree in Chinese medicine do not justify the use of the title “doctor” in reference to Chinese medicine and acupuncture.

Treatment of Animals

47. Animals should not be treated without appropriate training in veterinary acupuncture and Chinese medicine, and always taking care not to treat cases beyond the professional capability of the therapists. In any case, state laws must be obeyed.

Relationships with Professional Colleagues

Relationships with other Therapists

48. In this section, the definition of “therapist” refers to all healthcare professionals, including Chinese medicine practitioners who are not members of the association.

49. Therapists should avoid persuading a patient who is under the care of another therapist to switch to receiving treatment from them.

50. Treatment of another therapist’s patient due to vacation, illness, or other reason should end with encouraging the patient to return to treatment with their original therapist as soon as they are available again. The patient should not be solicited, directly or indirectly, to remain with the substitute therapist.

51. In any case, the patient’s wish is decisive. If a patient decides to change therapists, courtesy and the patient’s best interest require communication between the therapists regarding the transfer of the patient and the provision of essential information to the new therapist, with the patient’s consent.

Contact with Western Doctors

52. It is appropriate and desirable to maintain contact with the patients’ Western doctors, especially if they are the ones referring a patient to a specific therapist. With the patient’s consent, it is preferable to maintain open communication with the family doctor even if the patient came for treatment on their own initiative.

Criticism of other Therapists

53. Occasionally, therapists encounter criticism, from patients or colleagues, regarding the skills or professional abilities of other therapists. Whether these therapists are members of the association or not, one should act with discretion and professionalism, avoiding expressing an opinion as much as possible. This instruction also applies in cases where therapists themselves have criticism of colleagues, in the field of Chinese medicine or another health field.

54. Patients are expected to act with honesty, discretion, and respect for others’ opinions. They are allowed to express their personal views regarding the correct treatment method in publications, seminars, etc. However, they should refrain from criticizing treatment methods or therapists, whether directly or by implication, beyond what is expected in conversation.

Dealing with Concerns about another Therapist’s Behavior

55. If there is evidence or solid information that another therapist’s ability, personal or professional, has been compromised in a way that poses a threat to patients – therapists have an obligation to act to protect patient safety. If necessary, the concern should be reported to the appropriate organizations and institutions.

56. Therapists must obtain the patient’s consent before repeating information given to them confidentially. Only in extreme cases where public interest takes precedence can the information be shared without consent.

Teacher’s Obligations

Public Lectures

57. Public lectures for healthcare professionals, paramedical professions, and the general public, intended to deepen understanding of the work of Chinese medicine practitioners and the range of areas it covers, are entirely acceptable. The lectures are for general knowledge only and cannot be considered as part of any professional training.

Assistants and Observers

58. Therapists may accept Chinese medicine students, potential Chinese medicine students, or other individuals as observers in the clinic. An observer can be present in the treatment room only with the explicit consent of the patient. Therapists should ensure that the patient does not feel pressured to agree to this presence.

Research

59. A therapist participating in research involving their patients should obtain approval from the research ethics committee. Patient consent to be part of the research must also be obtained. Therapists must ensure that the research does not compromise optimal patient care.

60. Therapists must also ensure that patient privacy remains protected. Patient details remain confidential when publishing research findings. However, the patient’s explicit and detailed consent must be obtained for the publication of research results. If a patient refuses to give consent for publication – the refusal must be respected.

Appendix to the Recognition Document – Procedures for Chinese Medicine Educational Institutions for Prevention of Sexual Harassment 3/2019–

In recent years, and in light of various reports occasionally heard in the Chinese medicine community, we at the Israeli Association of Chinese Medicine are making efforts to reduce the phenomenon of sexual harassment in clinics and schools. As part of these efforts, we ask you to implement the following regulations in schools, which are required by the Sexual Harassment Law, regarding adult education institutions.

  1. Schools will conduct training and awareness activities on preventing sexual harassment and victimization in each academic year. The training will be given to the teaching staff and all students in the classes (in each year and cohort) according to the following guidelines:
    • Student training – will take place once a year, for each class separately, in face-to-face training or through technological means such as a dedicated computerized learning module (minimum of 90 minutes). The learning module should be submitted to the Ethics Committee of the Israeli Association of Chinese Medicine. Face-to-face training will be given by an external body, qualified to deliver the topic, funded and responsibility of the school, and/or by the person responsible for sexual harassment issues at the college.
    • Training for the permanent teaching staff at the school – will take place once a year, in face-to-face training (minimum of 3 hours) or through technological means such as a dedicated computerized learning module. The learning module should be submitted to the Ethics Committee of the Israeli Association of Chinese Medicine. Face-to-face training will be given by an external body, qualified to deliver the topic, funded and responsibility of the school, and/or by the person responsible for sexual harassment issues at the college. It is recommended that even in colleges where computerized learning modules are used, the use of the module be combined with face-to-face training from time to time.
    • For training topics, it is recommended to use the guidance of the Center for Sexual Assault Victims Assistance
  2. The school will bring to the attention of every new student and employee the provisions of the law, regulations, and rules for the prevention of sexual harassment.
  3. The school will publish in a visible and prominent place, permanently, and on every campus, the main points of the law, regulations, and rules for the prevention of sexual harassment and victimization, information regarding how to file a complaint of sexual harassment or victimization, as well as the contact details of the person responsible for this issue at the school.
  4. A person responsible for sexual harassment and victimization issues will be appointed at the school, for each of the school’s campuses. The school management will appoint, as far as possible, a person suitable for fulfilling the responsibilities of the position, in terms of their skills, experience and professional standing, in terms of their interpersonal relations, and in terms of their familiarity with the law, these regulations, and the disciplinary provisions applicable to them.
  5. The person appointed according to the guidelines in section 4 – must undergo, shortly after their appointment, training of not less than 18 hours, which will deal, among other things, with the nature of the role, familiarity with the law for the prevention of sexual harassment, prevention methods, and how to handle complaints.
  6. The school will add to its regulations a prohibition on intimate relationships within the framework of authority relationships, including between faculty members and school students.
  7. We recommend adding to the school’s regulations a procedure regarding sexual harassment and victimization within the school framework – An example of Tel Aviv University’s regulations is attached here.
  8. The school will submit annually to the Authority for the Advancement of Women’s Status and to the Committee for the Advancement of Women’s Status and Gender Equality in the Knesset, with a copy to the Ethics Committee of the Israeli Association of Chinese Medicine, a report detailing the various actions taken by the institution to prevent sexual harassment within its domain, as well as the number of complaints submitted to the person responsible at the institution and how they were handled; this report will not include details that would allow the identification of the complainant, the accused, and other persons involved in the complaint. (Appropriate forms are available on the Knesset website.)
  9. In addition to the training and awareness outlined in sections 1-3 – it is recommended that the school conduct additional activities to provide information and prevent incidents of sexual harassment and victimization at the school.