The main object of the Ayurvedic medical profession is to render service to humanity. Whosoever chooses this profession, assumes the obligation to conduct himself in accordance with its ideals. A practitioner of Ayurvedic medicine shall be an upright man, instructed in the art and science of healing. He shall keep himself pure in character and be diligent in caring for the sick. He shall be modest, sober, patient, prompt to do his duty without anxiety and, pious in all the actions of his life.
In the light of the above, this Code of Ethics and Practitioner Conduct has been established and will be regularly reviewed and updated by CAAP to provide guidance for Ayurvedic Practitioners and protection for their patients. By becoming a Practitioner Level member of CAAP, the Ayurvedic Practitioner agrees to be bound by this code. The CAAP Practitioner Ethics Committee has been entrusted with the task of monitoring any ethically unacceptable behavior that breaches this code and reflects negatively upon the practice of Ayurveda or upon CAAP. Any allegations against CAAP Practitioner members will be examined by the CAAP Practitioner Ethics Committee, which will issue a recommended course of action to the CAAP Board for final disposition.
This Code of Ethics and Practitioner Conduct cannot list every possible situation that an Ayurvedic Practitioner may face in practice. It sets out the minimally accepted standards of ethical Practitioner conduct that should be applied in Practitioner practice to ensure public interest and that the needs of patients come first at all times. Beyond the well being of the patient and the public, this code promotes the well being of the Ayurvedic Practitioner, colleagues, and the profession itself. An Ayurvedic Practitioner’s ability to follow these principles will demonstrate their level of competence and fitness to practice.
For additional guidance or clarity, Practitioner members are advised to consult the CAAP Practitioner Ethics Committee.
General Duties and Responsibilities of Ayurvedic Practitioners
Patients expect that they can trust their well being to their Ayurvedic Practitioner. In order to justify that trust, Ayurvedic Practitioners have a duty to maintain high standards of practice and care and to show utmost respect for life in all its aspects.
Practitioner members of CAAP are therefore expected to:
- Always practice in compliance with the philosophy and principles of Ayurveda.
- Put the well-being of the patient before all other considerations.
- Cultivate and promote their own personal development, well-being and self-respect alongside the patients’ welfare.
- Be responsible for maintaining their own health and well being.
- Be honest and trustworthy and never abuse their Practitioner position.
- Cause no harm to patients and protect them from any risk of harm.
- Treat all patients equally; regardless of religion, nationality, race, culture, sex, politics, disability, sexual orientation or social standing.
- Respect the dignity, individuality and privacy of the patient.
- Listen attentively to the patient and respect his or her point of view.
- Take time to explain their findings and treatment approach to the patient and answer any questions that arise.
- Respect the right of patients to take part in decisions about their care and actively involve them in designing their Ayurvedic plan
- Respect the autonomy of the patient and encourage their freedom of choice
- Ensure that their personal beliefs do not interfere with the care of the patient
- Respect and protect confidential information
- Recognize and always work within the limits of their Practitioner competence
- Refer every patient whose condition is beyond their expertise to an appropriate health care practitioner or to a primary care doctor
- Be willing to consult and cooperate with colleagues both within Ayurveda and other health care professions
- Respond promptly and constructively to any criticism or complaint from any source
- Continue to update their Practitioner knowledge and skills in accordance with standards currently being developed
- Make no claim for the cure of any specific illness or disease
- Refrain from using any titles or descriptions suggesting medical, academic or educational qualifications that the Practitioner has not officially acquired
- Comply with all applicable state and federal laws that affect their practice.
- Ayurvedic Practitioners must be familiar with all laws or regulations relevant to the practice of Ayurveda in the locality of their practice and to remain aware of any legal changes that may affect their practice.
Relationship with Patients
The relationship between an Ayurvedic Practitioner and the patient is a Practitioner relationship based on trust. To establish and maintain that trust, the Ayurvedic Practitioner must be polite, considerate and honest. Good communication is paramount and involves listening attentively to patients, respecting their point of view, and never allowing one’s own beliefs and values to adversely influence the therapeutic relationship.
The Ayurvedic Practitioner must respect the right of patients to be fully involved in decisions about their care. It is their entitlement to accept or refuse advice or treatment. Before providing treatment or investigating a patient’s condition, it must be ensured, that the patient has understood what is proposed to be done and why.
Any physical examination requires the patient’s consent, or the consent of the person legally responsible for the interests of the patient. In case of treatment of a patient who is under the age of 16 or who is developmentally disabled, the informed consent of the parent or guardian or the person legally responsible is necessary. To attend to such a patient, a parent or the legally authorized guardian must be present throughout the whole of the examination and treatment. No other person may perform this role without the explicit written consent of the parent or the legally authorized guardian.
3.1. Maintaining Trust
Trust in a patient-practitioner relationship is an essential part of the healing process. To establish and maintain trust Ayurvedic Practitioner must:
- be courteous and truthful
- respect the privacy and dignity of your patients
- respect patients’ right to decline to take part in teaching or research, and ensure that their refusal should not adversely affect practitioner relationship with them
- respect the right of patients to a second opinion
- ensure that patients have clear information about your practice arrangements and how they can contact you.
- maintain trust confidentiality and good communication.
3.1.1. Ethical Boundaries
Practitioners must not allow their personal relationships to undermine the trust that patients place in them. They may find themselves called upon to treat Professionally someone who is a friend, or a client may become a friend. This is acceptable, provided both parties understand a clear distinction between the social and the Practitioner relationship.
In particular, Practitioners must never use their Practitioner position to establish or pursue a sexual or romantic relationship with a patient or someone close to the patient. If a Practitioner realizes that he/she is becoming romantically or sexually involved with a patient, the Practitioner relationship should be ended and the patient should be recommended to an alternative source of appropriate care.
Practitioners must ensure that their behavior in dealing with patients is Practitioner at all times and not open to misunderstanding or misinterpretation. Non-physical gestures, behavior, unnecessary physical contact, verbal suggestions or innuendo can easily be construed as abusive or harassing.
If a patient shows signs of becoming inappropriately involved with his/her Ayurvedic Practitioner, the Practitioner should discourage him or her and, if necessary, end the Practitioner relationship. In the Practitioner’s own interest, he/she may wish to report such matters to the CAAP Ethics Committee or seek advice from a colleague, whilst maintaining the anonymity of the patient.
Practitioners must allow their patients privacy if patients are required to undress for examination or treatments, and the Practitioner must also provide adequate clean gowns or blankets for every patient’s use.
The relationship of trust that underlies all health care requires that Practitioners observe the rules of confidentiality in their dealings with patients. Unless Practitioners do this, patients will be reluctant to give them the information needed to provide good care.
All information, medical or otherwise, concerning a patient is confidential. Such information may only be released with the explicit consent of the patient. Confidential information must not be revealed even to members of the patient’s family, except in the case of minors or the developmentally disabled, to parents or persons legally responsible for the patient’s interests. This duty of confidentiality, which survives a patient’s death, also extends to any one Practitioners’ employee in their practice.
Disclosures without consent may be necessary in the public interest, i.e. when Practitioner’s duty to society overrides their duty to patients. This will usually happen when a patient puts themselves or others at serious risk, for example by the possibility of a violent or criminal act. Even then, Practitioners must first make every reasonable effort to persuade the patient to change their behavior and to disclose the information themselves. If the Practitioner cannot persuade them to do this, they should disclose the information to the appropriate person or authority, taking legal advice first. The Practitioner must be able, if necessary, to justify their actions.
Ayurvedic Practitioners may disclose confidential information without consent, according to the reporting laws of their state, if for example:
Child abuse is involved, requiring notification of child protection services
Patient clearly presents a danger to themselves or others.
Limits of confidentiality, according to the reporting laws of the state should be included in a Practitioner’s patient consent form. In the case of a minor, limits of confidentiality should be explained to the minor in language accessible to them.
In case Practitioners are required or requested to give evidence or disclose information to a court or other tribunal, they should do so with care. Whatever evidence is given, they must be independent and impartial.
3.1.3. Good Communication
Good communication between Practitioners and patients is essential for effective care and relationships of trust. Good communication involves:
Listening attentively to patients and respecting their views and beliefs
Giving patients all possible information about their condition and their treatment plan in language they can understand and offering a summary of other options.
Sharing information with a patient’s partner, close relatives or caregivers if the patient has given the Practitioner consent. When a patient cannot give consent, Practitioners should share the information with those close to the patient that need or want to know, except when Practitioners have reason to believe that the patient would object if able to do so.
If a person under the Practitioner’s care has suffered harm as a result of their actions or recommendations, they should act immediately to take responsibility and provide an explanation.
If the patient is an adult who lacks understanding capacity, the explanation should be given to a person with responsibility for the patient, unless Practitioner has reason to believe the patient would have objected to the disclosure. In the case of children, the situation should be explained honestly to those with parental responsibility and to the child, to the extent that the child has the maturity to understand the issues.
Relationship with Colleagues
4.1. Communication with Other Health Care Practitioners
Practitioners should work in cooperation with other health care Practitioners such as the primary care physician, specialists and psychotherapists to obtain best results for each individual patient. At times this may simply be a matter of communication in the mutual care of the patient, or if the patient’s condition is outside the Practitioner’s competence they may want to transfer the patient to another Practitioner.
Although Ayurvedic treatment may at times reduce the requirement for conventional medication or its dosage, the prescriptions issued by medical doctors must never be changed without the patient consulting his or her provider.
When communication with another healthcare Practitioner is indicated, Practitioners should inform their patient of the reasons for this and discuss the matter. Whatever the type of communication with other healthcare Practitioners (e.g. telephone, fax, letter etc.), a copy of all communication should be made and kept in the patient’s file or a file dedicated to Practitioner case correspondence. A copy of such correspondence should be made available to the patient on request.
If a patient decides to transfer from one Practitioner to another, the first Practitioner must share all records and details of treatment including herbs used with the Practitioner taking over care, after the patient has given consent.
Practitioners must never attempt to persuade the patient of another Practitioner to seek treatment with them. If Practitioners treat the patient of another Practitioner because of holiday, illness, referral for specific treatment, or any other reason, they must not attempt to solicit the patient, either directly or by default, to continue treatment with them.
4.2. Honorable Conduct
Practitioners must at all times conduct themselves in an honorable manner in their relations with other colleagues and health care practitioners. It is inappropriate to openly criticize treatment prescribed or administered by another health care Practitioner. Differences of opinion are to be expected, and opinions should always be presented in an unambiguous and tactful manner.
Practitioners must not undermine a patient’s trust in the care or treatment they receive, or in the judgment of those treating them, by making malicious or unfounded criticism of colleagues. If Practitioners hear such criticism voiced by patients or colleagues, they must act with the utmost discretion and Practitionerism and be extremely cautious about voicing any critical opinion, even if you hold such views.
If Practitioners have evidence or are reliably informed that another practitioner’s conduct, health or Practitioner work pose a threat to patients, they have a responsibility to act to protect the patients’ safety. Practitioners are advised to report concerns to the CAAP Practitioner Ethics Committee or, if necessary, to a relevant legal authority.
Relationship with the Public
5.1. Honorable Conduct
Practitioners must conduct themselves at all times in an honorable manner in their relationship with the public. Public communication may include advertising, contact through media (newspapers and other publications, television, radio, world-wide-web), talks to the public and discussions with enquirers. In all these instances Practitioners are required to conduct themselves in a manner congruent with this Code of Ethics and Practitioner Conduct and to avoid making misleading claims about curing disease or in any way implying abilities beyond their competence.
Practitioners should provide patients, colleagues and other Practitioners with good quality, factual information about their Practitioner qualifications, the services they provide and their practice arrangements. Practitioners should do this in a way that puts patients first and preserves their trust.
Practitioners must not mislead a patient into believing that they are medical doctors, unless they are legally recognized as such within the country in which they practice. If Practitioners possess doctorates in other subjects, they must make it clear that, while being able to use the doctor title, they are not medical doctors.
Problems with Your Health
The interests and safety of clients must come first at all times. If Practitioners know that they have a serious condition, which they could be transmitted to patients, or that their judgment or performance could be significantly affected by a condition or illness, or its treatment, then they must take and follow advice from a consultant in occupational health or another suitably qualified colleague on whether, and in what ways, they should modify their clinical practice. Practitioners should not rely on their own assessment of the risk they pose to patients.
The above paragraph also applies, if Practitioners have become dependent on alcohol or any other drug, prescribed or otherwise, to an extent that may affect their practice.
If Practitioners work alone in their own home or other premises, they should be aware of the need for caution, particularly when seeing a patient for the first time. It may be necessary to take sensible precautions, such as asking another person to be on the premises during a session.
Practitioners must ensure that their staff are capable of performing the tasks for which they are employed. Practitioners are responsible for the actions of their staff, including students or colleagues. Staff should be aware of the relevant parts of this Code of Ethics and Practitioner Conduct that relate to their activity within the practice.
At the outset of consultation Practitioners need to be clear about the cost of consultation and the possible cost and duration of treatments.
All herbal remedies should have clear instructions for the patient as to how remedies are to be used and when they should be taken. Herbs should be clearly labeled with the content, the patient’s name, and the Practitioner’s name and contact details.
Practitioners must keep accurate, comprehensive, easily understood and legible case notes including the following details:
Patient’s name, address, date of birth and telephone number
Date of each consultation
Relevant medical and family history
Record of the patient’s consent to treatment
Treatments and advice given on initial and subsequent visits
Details of patient’s progress.
Practitioners serve as custodian of their patients’ records. In practices where they work with other colleagues, they should enter into an agreement on the ownership and hence the responsibility for these records. On no account should records be transferred to another practice without the authorization of the patient. A request for such transfer should be dealt with promptly.
Patient records must be kept secure and confidential at all times. If Practitioners retire or otherwise cease practice at any particular address, appropriate arrangements must be made for the safe custody of records.
Financial and Commercial Dealings
8.1. Financial Dealings
When a patient consults a Practitioner, this involves entering into a contractual relationship. Practitioners must be honest and open in any financial arrangements with patients. In particular, they should charge fees responsibly and in a way, that avoids bringing themselves or the profession into disrepute. Their fee structure must be clearly defined and available to review if requested and should be available to the patient prior to the appointment.
If a patient does not pay a fee, the Practitioner still has a duty to apply the standard of care expected of an Ayurvedic Practitioner.
Practitioners must not exploit patients’ vulnerability or lack of medical knowledge when billing for treatment or services. Practitioners must not encourage their patients to give, lend or bequeath money or gifts that will directly or indirectly benefit them.
Practitioners must not put pressure on patients or their families to make donations to other people or organizations.
Practitioners must be honest in financial and commercial dealings with employers, insurers and other organizations or individuals. They must keep sound financial records and comply with all relevant legislation.
Practitioners may not engage in fee splitting or kickbacks for referrals.
8.2. Commercial Activities
Practitioners must make a clear distinction between their practice and any commercial activity in which they may be involved. Practitioners must ensure that none of their business affairs influence the care of their patients.
To promote a product to patients for no good reason other than profit is highly unethical. If Practitioners sell or recommend any product or service to a patient, they must be satisfied that this will be of benefit to the patient and that they are appropriately qualified to offer such products or advice.
Before selling or recommending such a product or service, Practitioners must declare to the patient that they have such an interest. Practitioners must ensure that patients can differentiate between the prescribing of a product and the marketing of a product.
Infringement of the Code of Ethics and Practitioner Conduct
Infringement of this Code of Conduct may render Practitioners liable to disciplinary action with subsequent loss of the privileges and benefits of CAAP Practitioner membership. Ultimately, we will therefore require a Code of Discipline.
Persons applying for registration with CAAP shall forward along with his application form the following declaration duly signed by him,
- I solemnly pledge myself to consecrate my life to the service of humanity.
- Even, under threat, I shall not use my knowledge contrary to the laws of humanity.
- I shall maintain the utmost respect for human life from the time of conception.
- I shall not permit consideration of religion, nationality, race, party politics or social standing to intervene between my duty and my patient.
- I shall practise my profession with conscience and dignity.
- The health of my patient shall be my first consideration.
- I shall respect the secrets which are confined in me.
- I shall give to my teachers the respect and gratitude which is their due.
- I shall maintain by all means in my power, the honour and noble tradition of medical profession.
- I shall treat my colleagues as my brothers.
- I shall maintain the standards of professional conduct and etiquette and observe the code of ethics, laid down in these regulations.
I make this declaration solemnly, freely and upon my honour and agree to abide by the same.