Code of Ethics and Professional Conduct
1. Introduction
The California Association of Ayurvedic Medicine (CAAM) believes that all clients are entitled to expect high standards of practice and ethical conduct from their Ayurvedic Professional(s). Essential elements of these standards are professional competence, good relationships with clients and colleagues, and observance of professional and ethical obligations.
This Code of Ethics and Professional Conduct (the “Code”) serves to communicate the high standards under which the Ayurvedic Professional (the “Professional”) is expected to operate and is intended to provide guidance for the Professional, and protection for the clients of the Professional based in California. The Code will be reviewed on a regular basis and updated from time to time. By becoming a Professional Member of CAAM, the Ayurveda Professional agrees to be bound by this Code, as it exists now, and as it may be changed in the future.
CAAM recognizes that this Code cannot list every situation that the Professional may face during the course of practice. However, this Code provides guidelines for acceptable minimum standards of ethical and professional conduct that should be applied in an Ayurveda-based professional practice in California, thus ensuring that the public interest along with the needs and safety of the client come first at all times. In addition, this Code promotes the well-being of the Professional and the Profession itself. Adherence to the guidelines and principles of this Code demonstrates an adequate level of competence and fitness to practice on the part of the Professional. For additional guidance or clarity regarding a particular matter involving the Professional’s practice, the Professional may contact the CAAM Professional Ethics Committee. Beyond the wellbeing of the client and the public, this Code promotes the wellbeing of the Professional, colleagues, and the profession itself.
This Code is not intended to substitute for or serve as professional legal advice or guidance. The Professional is encouraged to seek the advice of an attorney for any matter or question related to the Professional’s particular practice, such as the requirements for practicing in California, the allowable scope of practice, and the documentation, policies and procedures advisable or necessary to practice in California.
2. General Duties and Responsibilities
The Ayurveda Professional has an obligation to honor the trust a client places in them as a healthcare provider with full disclosure of their education, philosophy and recommendations according to the guidelines set in Senate Bill 577 in the state of California. The Professional has a duty to maintain a high level of integrity and the utmost respect in the care for their clients’ health and wellbeing.
Ayurvedic Professional Members are expected to:
Always practice in compliance with the philosophy and principles of Ayurveda
Put the well-being of the client before all other considerations
Cultivate and promote professional development, well-being and self-respect
Be responsible for maintaining their own health and well-being
Be honest and trustworthy and never abuse their professional position
Cause no harm to clients and protect them from any risk of harm
Treat all clients equally, regardless of religion, nationality, race, culture, gender, politics, disability, sexual orientation or social standing
Respect the dignity, individuality and privacy of the client
Listen attentively to the client and respect their point of view
Take time to explain their findings and treatment approach to the client and answer any questions that arise.
Respect the right of client to take part in decisions about their care and actively involve them in designing their Ayurvedic plan
Respect the autonomy of the client and encourage their freedom of choice
Ensure that their personal beliefs do not interfere with the care of the client
Respect and protect confidential information
Recognize and always work within the limits of their professional competence
Refer every client whose condition is beyond their scope of practice and or expertise to an appropriate healthcare practitioner or to a primary care doctor
Be willing to consult and cooperate with colleagues both within Ayurveda and other healthcare professions
Respond promptly and constructively to any criticism or complaint from any source
Continue to update their professional 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 educational qualifications that the professional has not officially acquired
Comply with all applicable state and federal laws that affect their practice
The Professionals 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
3. Relationship with Clients
The relationship between the Professional and the client is a professional relationship based on trust. To establish and maintain that trust, the Professional must be polite, considerate and honest. Good communication is paramount and involves listening attentively to clients, respecting their point of view, and never allowing personal beliefs and values to adversely influence the therapeutic relationship.
3.1 Consent
The Professional must respect the right of clients 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 client’s condition, it must be ensured that the client has understood what is proposed to be done and why. Any physical examination requires the client’s consent, or the consent of the person legally responsible for the interests of the client. For any examination of genitalia there must be an offer for the presence of a third party as a chaperone, no matter the gender of the client or the Professional. In case of treatment of a client 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 client, a parent or the legally authorized guardian must be present throughout the entire examination and treatment. No other person may perform this role without the explicit written consent of the parent or the legally authorized guardian.
3.2 Maintaining Trust
Trust in a client-practitioner relationship is an essential part of the healing process.
To establish and maintain trust you must:
Be courteous and truthful
Respect the privacy and dignity of your clients
Respect your clients’ right to decline to take part in teaching or research, and ensure that their refusal does not adversely affect your relationship with them
Respect the right of clients to a second opinion
Ensure that clients have clear information about your practice arrangements and how they can contact you
Other important aspects of establishing and maintaining trust are ethical boundaries, confidentiality and good communication.
3.3 Ethical Boundaries
Professionals must not allow their personal relationships to undermine the trust that clients 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 professional relationship.
In particular, Professionals must never use their professional position to establish or pursue a sexual or romantic relationship with a client or someone close to the client. If a Professional realizes that they are becoming romantically or sexually involved with a client, the professional relationship should be ended and the client should be recommended to an alternative source of appropriate care.
Professionals must ensure that their behavior in dealing with a client is professional 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 client shows signs of becoming inappropriately involved with their Professional, the Professional should discourage them and, if necessary, end the professional relationship.
Professionals must allow their clients privacy if clients are required to undress for examination or treatments and the Professional must also provide adequate clean gowns or blankets for every client’s use.
3.4 Confidentiality
The relationship of trust, that underlies all health care, requires that Professionals observe the rules of confidentiality in their dealings with clients. Unless Professionals do this, clients will be reluctant to give them the information needed to provide good care.
All information, medical or otherwise, concerning a client is confidential. Such information
may only be released with the explicit consent of the client. Confidential information must not be revealed even to members of the client’s family, except in the case of minors or the developmentally disabled, to parents or persons legally responsible for the client’s interests.
This duty of confidentiality, which survives a client’s death, also extends to any other professionals’ employed in their practice.
Disclosures without consent may be necessary for the concern of public interest, i.e. when the Professional’s duty to society overrides their duty to clients. This will usually happen when a client puts themselves or others at serious risk, for example by the possibility of a violent or criminal act.
Even then, Professionals must first make every reasonable effort to persuade the client to change their behavior. If the Professional cannot persuade them to do this, they should first get legal advice when appropriate and then disclose the information to the appropriate person or authority. The Professional must be able, if necessary, to justify their actions.
The Professional 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
The client clearly presents a danger to themselves or others.
Limits of confidentiality, according to the reporting laws of the state should be included in the Professional’s client consent form. In the case of a minor, limits of confidentiality should be explained to the minor in language accessible to them. If the Professional is required or requested to give evidence or disclose information to a court or other tribunal, they should do so with independent and impartial care.
3.5 Good Communication
Good communication between Professionals and clients is essential in a trusting relationship to provide effective care.
Good communication involves:
Listening attentively to clients and respecting their views and beliefs.
Giving clients all possible information about their condition and their treatment plan in language they can understand and offer a summary of other options.
Sharing Client Information
With a client’s partner, close relatives or caregivers after the client has given the Professional their consent.
When a client cannot give consent:
If an adult lacks understanding capacity, the explanation should be given to the person responsible for the client first. If there is no designated responsible person, then the Professionals should share the information with those close to the client that need or want to know unless the Professional has reason to believe the client 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.
If a person under the Professional’s care has suffered harm as a result of their actions or recommendations, they should act immediately to take responsibility and provide an explanation.
3.6 Client Care and Protocols
The Professional must keep accurate, comprehensive, easily understood and legible case notes including the following details:
Client’s name, address, date of birth and telephone number
Date of each consultation
Presenting symptoms
Past medical history
Relevant medical and family history
Clinical findings
Protocols and advice recommended on initial and subsequent visits
Details of client’s progress
The Professional serves as custodian of the client’s records. In communal practice with other colleagues, if the AP works for another business, that business may “own” the records. It is wise to contract for ownership of the records and to specify whether the client is considered a client of the AP or the company employing the AP. On no account should records be transferred to another practice or professional without the written authorization of the client.
If a client has suffered an adverse reaction as a result of a protocol or recommendation, the Professional should act immediately to take responsibility, provide an explanation, and do everything necessary to safeguard the well-being of the client and avert a crisis.
As explained in Section 3.4 above, The Professional shall maintain client privacy and confidentiality, in full compliance with the healthcare privacy laws of the United States and California. This duty of privacy and confidentiality extends to client medical records. CMIA (Confidentiality of Medical Information Act) and HIPPA requires a healthcare provider who creates, maintains, preserves, stores, abandons, destroys, or disposes of medical records to do so in a manner that preserves the confidentiality of the information contained within those records.
In California, under specific conditions and/or requirements, clients have a right to see and receive copies of their medical records, and the provider may charge certain fees for making the records available. See California Health and Safety Code, Section 123100 et seq . The Professional is expected to understand and follow the California State laws concerning the release of medical records.
3.7 Financial Dealings
When a client consults a Professional, this involves entering into a contractual relationship. Professionals must be honest and open in any financial arrangements with clients. 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 client prior to the appointment. If a client does not pay a fee, the Professional still has a duty to apply the standard of care expected of an Ayurvedic Professional.
Professionals must not exploit clients’ vulnerability or lack of medical knowledge when billing for treatment or services. Professionals must not encourage their clients to give, lend or bequeath money or gifts that will directly or indirectly benefit them.
Professionals must not put pressure on clients or their families to make donations to other people or organizations. Professionals 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. Professionals may not engage in fee splitting or kickbacks for referrals.
3.8 Commercial Activities
Professionals must make a clear distinction between their practice and any commercial activity in which they may be involved. Professionals must ensure that none of their business affairs influence the care of their clients.
Promoting products to clients solely for personal financial gain is unethical. If Professionals sell or recommend any product or service to a client, they must be appropriately qualified to offer such products or advice and they must be confident that this will be of benefit to the client.
Before selling or recommending such a product or service, Professionals must declare to the client that they have such an interest. Professionals must ensure that clients can differentiate between the prescribing of a product and the marketing of a product.
4. Relationship with Colleagues
4.1 Communication with other HealthCare Professionals
Professionals should work in cooperation with other healthcare professionals such as the primary care physician, specialists and psychotherapists to obtain best results for each individual client. At times this may simply be a matter of communication in the mutual care of the client. However, if the client’s needs exceed the Professional’s training or expertise, the client should be referred to a qualified 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 client consulting their provider.
When communication with another healthcare professional is indicated, Professionals should inform their client of the reasons for this and discuss the matter. Whatever the type of communication with other healthcare professionals (e.g., telephone, fax, letter etc.), a copy of all communication should be kept in the client’s file or a secure file dedicated to client case correspondence. A copy of such correspondence should be made available to the client on request.
If a client decides to transfer from one Professional to another, the first Professional must share all records and details of treatment including herbs used with the Professional taking over care, after the client has given consent.
Professionals must never attempt to persuade the client of another professional to seek treatment with them. If Professionals treat the client of another professional because of holiday, illness, referral for specific treatment, or any other reason, they must not attempt to solicit the client, either directly or by default, to continue treatment with them, unless the client decides to switch their practitioner.
4.2 Honorable Conduct
The Professional must act in an honorable manner in relationship with the public. Public communication may include advertising, contact through the media (e.g., newspapers, magazine or other publications, television, radio, world-wide-web, social media, public talks and discussions with inquirers etc.). In all public communications, the Ayurveda Professional should act in a manner consistent with this Code. The Professional must avoid making misleading claims about curing disease or in any way implying abilities beyond the Professional’s competence, training, and scope of practice.
Professionals must always conduct themselves in an honorable manner in their relations with other colleagues and healthcare practitioners. It is inappropriate to openly criticize treatment prescribed or administered by another healthcare professional. Differences of opinion are to be expected, and opinions should always be presented in an unambiguous and tactful manner.
Professionals must not undermine a client’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 Professionals hear such criticism voiced by clients or colleagues, they must act with the utmost discretion and professionalism and be extremely cautious about voicing any critical opinion, even if you hold such views.
If Professionals have evidence or are reliably informed that another practitioner’s conduct, health or professional work pose a threat to clients, they have a responsibility to act to protect the clients’ safety.
5. Relationship with the Public
5.1 Honorable Conduct
Professionals must always conduct themselves 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 Professionals are required to conduct themselves in a manner congruent with the Code to avoid making misleading claims about curing disease or in any way implying abilities beyond their competence.
5.2 Advertising
Professionals should provide clients, colleagues and other professionals with good, factual information about their professional qualifications, the services they provide and their practice arrangements. Professionals should do this in a way that puts clients first and preserves their trust.
Professionals in a clinical setting should not mislead a client into believing that they are medical doctors, unless they are legally recognized as such within the country in which they practice. If Professionals possess doctorates in other subjects, they must make it clear that, while being able to use the doctor title, they are not medical doctors.
6. Ayurveda Professional’s Health
The interests and safety of clients must come first at all times. If Professionals know that they have a serious condition, which could be transmitted to clients, 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 healthcare professional on whether, and in what ways, they should modify their clinical practice.
Professionals should not rely on their own assessment of the risk they pose to clients.
The above paragraph also applies, if Professionals have become dependent on alcohol or any other drugs, prescribed or otherwise, to an extent that may affect their practice.
7. Practice Management and Safety
The Professional should comply with all applicable federal, state and local laws. The Professional should obtain all permits and pay all taxes required for the Professional to operate legally from that location.
California is one of the few states that has a Health Freedom Law, which under certain conditions exempts a person from penalties for practicing medicine without a license. The law provides protection if the person avoids certain prohibited activities, provides mandatory disclosures to the client, and obtains a written acknowledgment from the client stating that s/he received the mandatory disclosure. CAAM recommends that the Professional understands and strictly follows the requirements of California’s Health Freedom Law. See Cal. Bus. & Prof. Code §§ 2053.5 and 2053.6.
It is recommended that the Professional carry professional malpractice insurance.
The Professional should maintain client records as discussed in Section 3.6 above.
All employees, independent contractors and other individuals (e.g., students, volunteers, etc.) (the “Staff”) assisting the Professional in their practice must have the proper training, education and experience reasonably necessary to perform their required tasks. CAAM recommends the Professional provide their staff notice of Code provisions that may be relevant to services provided by the Staff. CAAM also recommends that the Professional utilize confidentiality and business associate agreements as discussed in Section 3.4 above.
7.1 Staff
Professionals must ensure that their Staff are capable of performing the tasks for which they are employed. Professionals are responsible for the actions of their Staff, including students or
colleagues. Staff should be aware of the relevant parts of the Code of Ethics and Professional Conduct that relates to their duties or responsibilities within the practice.
7.2 Treatment
At the outset of consultation, Professionals 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 client on how and when to use them. Herb products must be clearly labeled with the content, the client's name, and the professional’s name and contact details.
Professionals must keep accurate, comprehensive, easily understood and legible case notes including the following details: (please refer 3.6 section)
Client’s name, address, date of birth and telephone number
Date of each consultation
Presenting symptoms
Relevant medical and family history
Clinical findings
Record of the client’s consent to treatment
Treatments and advice given on initial and subsequent visits
Details of client’s progress
Professionals serve as custodians of their clients’ records. In practices where they work with other colleagues, they should enter into an agreement on ownership and hence the responsibility for these records. On no account should records be transferred to another practice without the authorization of the client. A request for such transfer should be dealt with promptly.
Client records must always be kept secure and confidential. If professionals retire or otherwise cease practice at any particular address, appropriate arrangements must be made by the Professional for the safe custody of records.
8. Infringement of the Code of Ethics and Professional Conduct
Violation of this Code may subject the Professional to disciplinary action, up to and including termination of their membership in CAAM, and loss of the related privileges and benefits of CAAM membership. By accepting professional membership in CAAM, the Professional agrees to abide by this Code.
Thanks to National Ayurvedic Medical Association (NAMA) upon whose work this Code of Ethics and Professional Conduct is based.
1111 South Ogden Drive, Los Angeles, CA 90019.