Code of Ethics
This code outlines the expected standards of behaviour for all members of the Association des ostéopathes du Nouveau-Brunswick / Association of Osteopaths of New Brunswick Inc. (hereinafter called “AONB”). It is to be read in conjunction with the AONB’s Mission Statement, Standards of Practice, By-laws and other relevant documents as well as the applicable federal and provincial legislation. Nothing in this Code shall be construed as permitting breach of any law or interpreted in any way that would discourage a member from complying with their legal obligations (statute and common law).
The Code provides guidance for thinking about ethical issues; it cannot provide a final answer to all ethical questions that may arise during professional practice. Failure to specify any particular responsibility or practice in this Code does not negate the existence of these responsibilities or practices.
The AONB is a not-for-profit organization founded in 2005. It is the first organization to represent osteopaths who practice (or want to practice) in New Brunswick. It groups together educated osteopaths who have received thorough training that meets world-wide training criteria. The AONB is an independent association that is not affiliated with any schools.
Since it has no legal power, the AONB must respect its mandate to protect the public by guaranteeing that its members are competent and qualified when they register with the AONB. Osteopathy, like any health profession, involves risks of harm due to insufficient training and/or competency. For osteopaths who practice in New Brunswick, the creation of the AONB was necessary in order to guarantee the public and the public health care system that osteopathy will be practiced safely.
The competency of AONB members (hereinafter called “members”) is based mainly on clinical competency, having the required basic training; and respecting the members’ charter, which states that we must clearly inform the public that osteopathic therapy as defined above and practiced by AONB members is outside the framework of the New Brunswick public health care system.
2. General Provisions
Osteopathy is a preventive and curative form of manual healthcare. Its goal is to reestablish individuals’ optimal functioning and allow them to feel the best they can. The aim of this health profession is to maintain and restore mobility, motility, and the rhythms of all tissues in the human body through manual treatment of the dysfunctions in the micro mobility.
It has two foundations: (i) knowledge of anatomy, physiology, and the resulting mechanisms of movement, and (2) the art of palpation and the resulting philosophical and therapeutic principles. It is differentiated from other disciplines by its unique way of analyzing and understanding the body systems (musculoskeletal, visceral, fascia, membrane, cranial, fluid, neuro-endocrine, postural, and emotional) and the relationships between them. Osteopathy is particularly concerned with finding the causes of biodynamic imbalances. It is based on a living tradition that moves forward with the therapist’s personal experience and research in all health-related fields.
Osteopaths are manual health practitioners who use the four basic principles of osteopathy as defined by the founder of osteopathy, Andrew Taylor Still, in 1872:
- The human body functions as a whole: “The body is a unit;”
- Structure and function are interdependent: “Structure governs function,” and this applies to the patient’s therapy;
- Fluids circulate freely within the body: “The rule of the artery is supreme;”
- The organism has an inherent capacity for self-regulation.
Osteopaths use a gentle, precise, and developed palpation and in-depth knowledge of anatomy and physiology to evaluate and normalize the movement of the body’s tissues, paying particular attention to the interactions between various mechanisms. Osteopaths know how to analyze the signs and symptoms they encounter and organize them in an osteopathic analysis chart. This allows them to implement a personalized treatment for each patient. They are also able to refer patients to other private or public sector health professionals if needed.
The role of osteopaths is prevention, especially with pediatric and neonatal patients. Osteopaths learn how to act in a safe, effective, and competent manner and to respect the physical, emotional, psychological, and spiritual integrity of each person who consults them.
2.3. Osteopathic Therapy
Practicing professional osteopathy means any precise palpation used to identify, evaluate, or treat any of the causes of somatic dysfunction.
Palpation mainly concerns quantitative and qualitative modifications (frequency, rhythm, direction, tension, etc.) of the organism’s tissues and changes made to the mobility of the organism’s structures while taking into account the interactions between the different systems.
The goal of osteopathic therapy is to re-establish the subject’s homeostasis at a local, regional, and general level through manual adjustment and normalization. These manual treatments respect the physiology of patients’ joints. This ensures the patient’s physical, postural, emotional, and spiritual health. AONB members may and are able to refuse osteopathic therapy through a “diagnosis of exclusion” and are able to refer their patients to the relevant service in the public health care system.
3. AONB Members’ Duties And Obligations
3.1. Patient values, beliefs, goals and rights
- Members shall listen to their patients and show respect for their values, beliefs and goals.
- Members shall respect the moral and legal rights of their patients, and shall act to ensure that these rights are respected by all staff in their employ.
3.2. Patient-professional relationship
- Members shall value the well-being of patients over their personal interests.
- Members shall take all reasonable steps to minimize risk to patients and to prevent harm. Members shall appropriately manage any harm that arises.
- If an emergency arises during treatment, members shall provide appropriate assistance.
- Members shall maintain appropriate patient-professional boundaries.
- Members shall not discriminate against any patient on grounds of age, ancestry, place of origin, colour, ethnic origin, citizenship, creed (religion), disability, family status, gender, gender identity, gender expression, marital status, medical condition, national or ethnic origin, physical or mental disability, political affiliation, race, religion, sexual orientation or socioeconomic status.
- Once a patient is accepted into the practice, members shall provide professional services until: a) they are no longer required; b) the patient declines further treatment; c) another osteopath or health care professional has assumed responsibility; or d) until the patient has been given reasonable notice of the member’s intent to terminate the relationship.
- Members must not practice their profession while in a state that may compromise the quality of their services.
- Members must not practice their profession while under the influence of a substance that can cause inebriety, weaken or alter mental faculties, or provoke a loss of consciousness.
- Members must make it clear that they are not physician osteopaths.
- Members must indicate that they are AONB members if they include an address of practice in New Brunswick, in order to avoid confusion among the population, public, other therapists (medical and non-medical), and patients about osteopath’s titles.
- Members must display their diplomas and the certificate from the AONB where patients can see them.
3.3 Informed decision-making
- Members shall provide all necessary and sufficient information about osteopathy treatment in a manner the patient can understand, doing their best to answer questions as completely as possible. Information shall be transparent, accurate, complete, and evidence-based where possible.
- Members shall respect the right of capable patients to give or refuse consent.
- Members shall guide substitute decision makers in making decisions in accordance with the accepted substitute decision-making standards.
- Members shall be attentive to unrealistic expectations, explaining to patients what can and cannot be reasonably expected from treatment. Members shall not misuse the power imbalance to influence decision making. They shall inform their patients when their personal values influence their recommendations.
- Members shall respect requests for a second opinion from a colleague or other health professional.
- Members shall protect the emotional and physical privacy of their patients.
- Members shall protect all personal and health information.
- Members shall respect that patients own their health care information.
- Members shall only disclose health information to third parties with the patient’s consent, such as sharing information with other health care professionals within the circle of care. The Members shall only disclose the necessary information, and shall ensure that the given information is not inadvertently conveyed to unintended parties.
3.6 Fees, remuneration
- Members shall charge fees that are reasonable for services rendered.
- Members shall refrain from any action that permits remuneration for referral services.
- Members shall provide a fee schedule before initiating treatment.
- Members shall ask for payment only after service has been rendered.
- Members shall practice within the limits of their knowledge and skill.
- Members shall recognize their limitations and make appropriate and timely referrals for the well-being of their patients.
- Members shall maintain complete and accurate clinical records.
- Members shall engage in lifelong learning to maintain their clinical skills.
- Members shall be accountable for their decisions, whether they result in action or inaction.
3.9 Abuse, harassment
- Members shall refrain from behaviour that may be construed as harassment or abuse of patients, associates, or employees. They shall ensure a professional environment free of intimidation and hostility.
- Members shall refrain from use of their authority to coerce patients, associates or employees.
- Members shall advertise in a manner that is truthful, accurate, verifiable, not misleading to the public, and in compliance with the standard of practice, Code of Ethics and By-laws of the AONB.
- Members shall refrain from using advertising that:
- Provides unsubstantiated claims or guarantees of successful results;
- Makes comparative statements about service quality, health providers, and products and/or endorses products for financial gain; and
- Questions or diminishes the skills of other providers or the services of other clinics or facilities.
3.11 Unethical behavior
- Members shall intervene promptly if any member of their practice provides incompetent care.
- Members shall take reasonable steps to address unethical conduct by colleagues and other health care professionals.
- Members charged with criminal acts shall report the charges as well as the court’s findings to the AONB.
- Members shall work collaboratively with other professionals in planning and implementation of care.
- Members shall respect other members of the health care team, notwithstanding any philosophical differences regarding treatment, and share information with other professionals in the circle of care.
- Members shall utilize osteopathic research that contributes to improving patient outcomes and improving patient care.
- Members shall support current research standards.
3.14 Conflict of interest
- Members are responsible for recognizing a conflict of interest before it arises. Once they are aware of a conflict or potential conflict of interest, members shall manage it promptly and appropriately in the best interest of the patient. A conflict of interest occurs when a person in a position of trust has primary interests or obligations that require professional judgment, as well as a secondary interest sufficient to influence or appear to influence the objective discharge of his or her primary interest (professional duties).
- Members shall practice in an honest and upright manner.
- Members shall uphold the reputation of their profession and act to preserve public trust.
- Members shall refrain from practicing while impaired in any way.
- Members shall clearly and accurately represent themselves, never overstating or embellishing their abilities, education, experience or qualifications.
3.16 Compliance with the law
- Members must comply with the obligations imposed by any applicable laws and regulations.
- Members must respect contractual commitments taken on while practicing their profession.
- Members must not usurp a title or assume a false title.
- If procedures are unrealistic or not adequately tested, members must not tell patients or their families that the procedures are beneficial or safe. Any kind of fraud is prohibited.
3.18 Prohibited from prescribing medications
- Members must not prescribe medications.
- Members treating athletes (with the goal of protecting athletes’ health and fighting against doping) must not sell, offer, give, or administer any substance or perform any procedure prohibited by applicable laws and regulations, nor can they facilitate or encourage their use.
3.19 Involvement in illegal practices
- Members must protect their title by not allowing anyone who is not qualified to professionally practice osteopathy and by not letting anyone who works under them or is under their responsibility perform activities that violate conditions set by applicable laws and regulations.
3.20 Discrediting the profession
- Even when not practicing their profession, Members must refrain from all acts that discredit osteopathy.
3.21 Economic regulations
- Non-competition clause:
- Members must not participate in any unfair competition such as poaching or attempting to poach clients.
- Members must not lower their fees in order to compete. However, Members are free to provide services at no cost.
- Limits to practice location:
- Members cannot set up practice in the same building as a colleague’s practice without both their permission and the authorization from the AONB.
3.22 Practice regulations
- Effective space management:
- At their place of practice, Members must have the proper setup, in accordance with security standards. The setup must ensure the comfort, privacy, and dignity of patients and persons who may accompany them. The rooms must be adapted to ensure professional confidentiality and quality health care.
- Insurance requirements:
- Members are obligated to have a professional civil liability insurance policy that is suited to the profession and that complies with the coverage required by the laws and regulations of NB and Canada. The insurance policy must be from a reputable, solvent insurance company.
3.23 Rapport with other professionals
- Rapport with other health professionals:
- Members must maintain positive rapport with all health care professionals, whether medical or not. They must respect the professional independence of all professionals and respect the personal choices of all patients.
- Rapport with the College of Physicians and Surgeons of New Brunswick:
- Practicing osteopathy according to clause 43 of the New Brunswick Medical Act:
43(1) A person licensed under this Act who practices medicine in violation of any condition or limitation contained in his licence commits an offence.
43(2) A person who practices medicine:
- while his licence is suspended or revoked, or
- without a licence, commits an offence.
1989, c.45, art.33.; 2009. C.42, s.27.
- Practicing osteopathy according to clause 43 of the New Brunswick Medical Act:
- Right to practice:
- In a letter to the AONB dated July 6, 2009, Ed Schollenberg, M.D, LLB, FRCPC, registrar of the College of Physicians and Surgeons of New Brunswick, stated that the Medical Act had been modified. The changes included the term « osteopathy », which no longer applies solely to physicians practicing osteopathy. The term is no longer considered protected, and there is no regulation against using the term osteopathy or osteopath in practice. He explained that the College will take action only if practitioners lead patients to believe that they are physicians.
- Members are authorized to use the designations Osteopath and Osteopathy, accompanied by the workplace or clinic address in New Brunswick.
- AONB titles indicate the qualification level of the members. D.O, D.O.M.P, and B.S.O must be accompanied by AONB (ex. D.O.AONB) so that the terminology does not lead clients to believe that the graduates are physicians.
3.24 Final Clauses
- Members must notify the AONB if they modify their conditions of practice or if they discontinue practice.
- Any modifications made by the AONB while applying the code of ethics must be reasoned.
- The code of ethics came into effect on May 31, 2008.
- This code of ethics (amendment) came into effect on November 8, 2020. Every person who meets the member requirements of the AONB and becomes a member must sign the code, adhere to the code, and pay the annual membership fees.
Coming Into Force
This Code of Ethics came into force on the 31st of May, 2008.
WITNESSED the Seal of the Corporation
This Code of Ethics (Amendment) comes into force on the 8th day of November, 2020.
WITNESSED the Seal of the Corporation