. . .

"It is well for a man to respect his own vocation whatever it is, and to think himself bound to uphold it, and to claim for it the respect it deserves."

"We have committed the Golden

Rule to memory; let us now apply

it to our professional life."

CODE OF ETHICS

THE

American Chiropractic Association

INCORPORATED

237

eodc of8tltics

For Members of the AMERICAN CHIROPRACTIC

ASSOCIATION, INC.

Adopted by the ACA House of Delegates and approved by the ACA ExecutitJe Board of Governors as the officifli Code of Ethics during the annual contJention in Los Angeles, California, June, 1966. RetJised-July 7, 1974.

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A Statement of Purpose We believe that the chiropractic profession of America

should occupy that place in its own and the public esteem to which it is entitled and that the chiropractor should be a leader in his community-in character, in learning, in dignified bearing, and in courteous relations with his professional colleagues. We believe that these things can be accomplished only by organized efforts and do hereby resolve ourselves into an organized associa­tion dedicated and pledged to the following objectives:

1) To maintain the science and art of chiropractic as a separate and distinct health profession dedicated to the service of mankind.

2) To maintain unimpaired the chiropractic principle and practice based on the premise that the relationship between structure and function in the human body is a significant health factor.

3) To protect, promote, and promulgate the advance· ment of the philosophy, science and art of chiropractic and the professional welfare of members of this assoda· tion in every legitimate and ethical way. This to the end that people in every locality shall have knowledge of the health benefits of chiropractic and the unhamper­ed right and opportunity of obtaining the qualified ser­vices of doctors of chiropractic of unquestionable stand­ing and ability.

Since they serve humanity in the specialized "science and art which utilizes the inherent recuperative powers of the body and the relationship between the musculo­skeletal structures and functions of the body, particularly of the spinal column and the nervous system in the restoration and maintenance of health," doctors of chiro­pract.ic have a unique health service to offer not avail­able from any other source.

Members are authorized to do all things necessary and proper and to exercise such power and authority as are consistent with the general purposes of the organization, in the best interests of the profession and the public health and welfare under the Code of Ethics and the Bylaws and the ACA Master Plan .

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American eltiropractic Association, Juc.

eodc of8tltics T HE SCOPE of a Code of Chirorractic Ethics com­

prises duties and obligations o chiropractors and patients, the duties and obligations of chiroprac­

tors to each other, and the reciprocal obligations of chiropractors and the public.

Fundamental Principles The transcendent principles upon which chiropractic

ethics are based are these:

1. The ultimate end and object of the chiroprac­tor's effort should be: "The greatest good for the patient."

2. The rules of conduct of chiropractor and pa­tient, and of chiropractors toward each other, should be but facets of the Golden Rule: "There­fore all things whatsoever ye would that men should do to you, do ye even so to them."

It naturally follows that the various articles of this Code are but special applications of these great principles.

Part 1.

RECIPROCAL DUTIES AND OBLIGATIONS OF CHIROPRACTORS AND THEIR PATIENTS

Article I. Duties of the Chiropractor to the Patient.

. Section 1. The chiropractic profession has for its objective the greatest service it can render humanity. Therefore, financial gain becomes a secondary con­sideration.

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Section 2. The chiropractor should hold himself in constant readiness to respond to calls of the sick. He should bear in mind the great responsibility his vocation involves and should so conduct himself as to acquire the confidence and respect of his patients. The diiro­practor is bound to keep secret whatever he may hear or observe respecting the private affairs of his patient and the family, while in the discharge of his professional duties. Should it be evident, however, that such secrecy would result in harm to others, it becomes his duty to protect the innocent party or parties. Occasions may arise, however, when he may be compelled by law to reveal some such confidences in the interests of the commonwealth.

Section 3. The chiropractor should attend his patient as often as is necessary to insure continued favorable progress, but should avoid unnecessary visits lest he expose himself to being accused of mercenary motives.

Section 4. A chiropractor should not express gloomy forebodings regarding a patient's condition nor magnify the gravity of the case. He should endeavor to be cheer­ful and hopeful in mind and manner, thus inspiring confidence and courage in the patient. However, it is the chiropractor's duty to acquaint some judicious friend or relative of the patient with the true facts, should the case prove to be of a serious nature.

Section 5. While the chiropractor has the right to select his cases, once having accepted one he should not abandon it because it seems incurable or for any other reason, unless he gives the patient or the patient's friends or relatives sufficient notice of withdrawal to permit them to secure other attendance.

Section 6. Since a patient has the right to dismiss a chiropractor for reasons satisfactory to himself, so like­wise the chiropractor may decline to attend patients when self respect or dignity seem to him to require this step; as, for example, when a patient persistently refuses to follow directions .

Section 7. In difficult or protracted cases consulta­tions are advisable, and the chiropractor should be ready to act upon any desire the patient may express for a con­sultation, even though he may not himself feel the need

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for it. Nothing is so likely to retain the patient's con­fidence as sincerity in this respect.

Section 8. The intimate relation into which the chiropractor is broug~t with his patient give~ him the opportunity to exercise a .powerful mora.l mfluence, which should always be used I!l the best possible ma_nne.r. The chiropractor may sometimes be aslced to assist 10

practices of questionable propri~ty. ~mong these m~y be mentioned the pretense of disease 10 order. to ~vOid jury or military duty; the conc:al~ent of orgamc disease in order to secure favorable life msurance; or the pro­curement of abortion when not necessary to save the life of the mother. To all such propositions the chiropractor should present an inflexible opposition.

Article II. Duties of Patients to Their Chiropractors. Section 1. Since chiropractors are required by the

nature of their profession to sacrifice com~ort, e~e, an~ even their health for the welfare of the1r patients, It forthwith becomes the duty of patients ~o un~erst.and this and to realize that they have certam obligations toward their chiropractors.

Section 2. The patient should select a chiropractor in whose knowledge, skill, and integrity he can place confidence. A chiropractor once having been selected should not be dismissed for light reasons, because the chiropractor who is acquainted with t~e conditions, tendencies, and temperaments of a famtly, can more successfully handle their cases.

Section 3. The patient should consult his chiroprac­tor as early as possible after signs of illness. He should unreservedly state any factors he may have in mind that might contribute to his condition, w.ith t~e realiza­tion that all such statements are of a confidential nature.

Section 4. The patient should obey h~s chiropract~r·s directions as regards fre'lue';~CY of adjustments, dtet, sanitation, and other hygtentc measures ~hat. may be indicated in his case. Nor should he permit hunself to deviate from the outlined course through any advice from outsiders without first consulting his chiropractor.

Section 5. If the patient desires a consultation, he should make a frank statement to that effect. On the

SIX

other hand, if he wishes to dismiss his chiropractor he should, in justice and common courtesy, state his reasons in a friendly manner. Such a course need not of necessity cltange the social relations of the parties.

PART 2. DUTIES OF CHIROPRACTORS TO THE PROFESSION AND TO EACH OTHER

Article I. Duties to the Profession. Section 1. Inasmuch as the chiropractor has of his

own free will and accord chosen chiropractic as his vocation, he must be willing to assume certain obliga­tions. Since he is about to profit from the scientific labor of his predecessors and associates, it becomes his duty to enrich the scientific lore, to elevate the position of the profession; and always to conduct himself as a gentleman of pure character and high moral standards.

Section 2. The honor and dignity of the chiropractic profession may best be upheld, its sphere of influence expanded, and its science advanced through the associa­tion of all chiropractors in state and national organiza­tions. Hence it is the duty of each chiropractor to associate himself with such bodies.

Section 3. In order to extend the sphere of respect, recognition and integrity of the profession, the in­dividual chiropractor, or doctor of chiropractic, or chiro­practic physician, shall refrain from personal advertising of any nature.

Personal advertising is defined as any advertising by an individual or group of doctors in any public media wherein the name, address, telephone number(s), with or without a personal photograph is given. At no time shall any ad deal with the particular abilities or accom­plishments of the individual or infer any superiority over that of another doctor. An ACA member shall never employ a professional agent.

Members who hold a valid specialty certificate of cur­rent diplomate status may list such specialty in telephone directories, personal stationery or any other professional listings; provided, however, such listings are of ethical and professional status and within the limits of the code

SEVEN

of ethics on advertising and that the certifying board is approved by the American Chiropractic Association.

Direct mail advertising to "Box Holder", "Occupant", or "Resident", bearing the name, address, telephone number(s) of any doctors shall be prohibited. Direct mail to a doctor's own patient list containing educational material may be permitted.

At no time will mailed material be flamboyant or showy, make promise of cure, free examination, free x-rays, free consultation, special technics or methods or imply superiority in any manner. Further, the mat~rial must not castigate other health sciences or make claims that cannot be substantiated by laboratory and diagnostic procedures. The material should never contain state­ments · of any kind that might be construed as false or misleading.

Group or institutional sponsorship of advertising or public relations news releases is bela in the highest re­gard by the ACA and when utilized must be identified with the group, association or society sponsors and not that of any individual. Radio and TV talks or programs shall propound factual educational material beneficial to the profession and shall not reflect the personal philoso­phy of any one doctor of chiropractic.

An ACA member shall not employ a solicitor or other agent for the purposes of soliciting patients.

Professional announcements concerning-opening office, closing office, addition of personnel, removal of office-shall be limited to four insertions in all com­munications media.

In r~ference to personal newspaper advertising, the follow1ng rules shall apply: The use of an ad shall be restricted to announcement of opening, closing, removal to new location, period of absence, such as a vacation. The use of a photograph with ad is permissible only when announcing opening of office. The size of the ad shall not exceed 2 inches x 4 inches, and shall not be enclosed with a bold border.

Signs used to designate chiropractic offices and clinics shall be of the size and fashion utilized by the other professions in the area or community.

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Telephone directory listing is restricted to name, address, hours, phone number and location. An "if no answer" designation may be used in conjunction with the listing. No display ads are permitted. Type style shall be light face, bold face fype is not permitted. In reference to telephone advertising, the following rules shall apply: The size of the listing shall not exceed one column inch or be enclosed with a bold border. The use of a photograph shall not be permitted.

Nothing in this section shall be in conflict with state statutes which regulate professional advertising.

"By their works ye shall know them" is a statement of truth. The best possible public relations is the· "word-of­mouth" commendations of a satisfied public, and this can be procured only through conscientious endeavor and well merited results.

Section 4. It is equally derogatory to professional character for a chiropractor to hold a patent for any special technic, method, device, or appliance that might be applicable to the practice of chiropractic, or to keep secret the nature of any such things. Such concealment or restriction is inconsistent with the beneficence and liberality which should characterize the chiropractic pro­fession, because it is the duty of the chiropractor to avail himself of every opportunity to observe the action and study the merits of all new types of technic or methods of procedure in the application of chiropractic principles to the alleviation of human ailments, and to subject them to the analysis of scientific investigation. For the chiro­practor should always bear in mind that the great object of his profession is to cure the sick, and it is his solemn duty to investigate thoroughly and without prejudice whatever offers any probability of adding to his knowl­edge of the art and science of chiropractic.

Section 5. Chiropractors should safeguard their pro­fession by exposing those who might attempt to practice without proper credentials, and by reporting acts of dishonesty to the proper authorities.

Section 6. Procedure for Filing and Handling Com-plaints in Matters of Ethics. ·

1. The ACA may reprimand, suspend, or expel a member for violation of its Code of Ethics or

NINE

bylaws, or for an act which unfavorably affects the chiropractic profession, or the reputatioa or inter­ests of ACA or its members. a. A member who believes another is guilty of

violation of the Code of Ethics or bylaws may make a written complaint to the executive board of governors at least thirty (30) days before a regular or special board meeting.

b. Notification of a hearing before the board is sent to the accused and the accuser by certified mail.

c. A copy of the charges against him is sent to the accused.

d. After hearing testimony by the accuser, the accused and their witnesses, the executive board of governors will meet in executive session to consider the testimony and decide if the charges are to be sustained.

e. If the board by a two-thirds (2/3) vote, sustains the charges against a member, they .have the authority to discipline the accused by: (a) cen­sure or reprimand, (b) suspension for a definite time, or (c) expulsion. A two-thirds (2/3) vote determmes the discipline.

f. If any one of the persons concerned is unable to attend a hearing because of distance, the delegate is authorized to notify all involved, conduct a hearing, take testimony, and report to the executive board of governors for action.

g. Any member or former member who feels the action of the executive board of governors was unfair has the right to appeal to the House of Delegates at their next regular meeting. ·

h. The decision of the House of Delegates is irrevocable.

Article II. Professional Services of Chiropractors to Each Other.

Section 1. All chiropractors and their immediate dependents are entitled to the gratuitous services of any one or more of the profession. The chiropractor is un-

TEN

able to care for himself when ill. Oftentimes the anxiety and solicitude he feels when someone of his immediate family is ill, renders him incompetent to care for _that one. In these circumstances chiropractors are espectally dependent on each other and professional aid should always be cheerfully and gratuitously afforded.

Section 2. Should a chiropractor in affluent cir?Im­stances require the services of a distant professiOnal brother for himself or his immediate dependents, he should pay the travel expe_nses and such other ho~<_>~ar­ium as may at least partially compensate the vtsttmg chiropractor for his loss of time.

Section 3. When, because of personal illness, a chiropractor refers his patients to a 6rother pra~itio~er, the recipient of such refer~nc~s should c9nstde: tt a courtesy and permit all fees mctdent to such s_ervtces to be paid the stck colleague. If, however, a chtropractor is absent on holiday pleasures, the fees resulting from such referred practice may rightfully be retained by the colleague to whom the patients have been referred.

Article III. Duties of Ollropractors in Regard to Consultations.

Section 1. Whether a consultation is arranged as the result of a patient's desire or upon the re<Juest of the chiropractor for another opinion, certam pro­cedures should always be followed.

Section 2. The utmost punctuality should be observ­ed by chiropractors when they are to hold consultations. Unavoidable professional duties may sometimes inter­fere and delay one or the other, in which case the first to arrive should wait a reasonable time for his colleague. If there is no appearance he may consider the consulta­tion postponed and wai~ fo_r another appointment. ~f, however, the first to arnve ts the one who was called tn consultation and he has traveled a considerable distance, he may proceed with his_ ex~ination and mak: a pri~ate written report of his fmdmgs to the attendmg chiro­practor. He should always exercise the utmost caution m what he says to the patient in the absence of the attending chiropractor.

ELEVEN

Section 3. In consultations the attending chiroprac­tor should put the necessary questions to the patient. Then the consulting chiropractor should make such ad­ditional inquiries and examinations as may be needed to satisfy him of the nature of the case but should avoid making a parade of any superior knowledge. Both chiropractors should then retire to a private room for deliberations.

Section 4. In consultation deliberations the attend­ing chiropractor ·should voice his opinion first, and other consultants in the order called. Should there be several consultants and their opinions equally divided, the attending chiropractor must make the decision. Should there be a wide diversity of opinion when only two are consulting, they should request a third opinion.

Section 5. The attending chiropractor should com­municate to the patient or his friends such results of the consultation as have been considered proper to express. But no discussion should take place before the patient or his friends, except in the presence of all the consulting chiropractors.

Section 6. The consulting chiropractor should not at any time take charge of a case on which be has been called as a consultant, without the consent of the attend­ing chiropractor.

Section 7. When a patient is referred by a chiro­practor to another chiropractor for x·rays or other specialty service, the doctor performing such services must meticulously respect the referring doctor's priority to the patient. He may not offer, suggest or perform any other service for the patient except that for which the patient was referred.

It is recognized that the doctor performing specialty services may have particular instructions and suggestions, but these must be given to the referring doctor, not to the patient, even though the patient may request them. The doctor performing specialized services is obliged to uphold and strengthen the professional image of the referring doctor, and may not detract therefrom by word or act. If he cannot in good conscience do so, be should not accept the referral.

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Article N. Duties of Oliropractors in Cases of Interference.

Section 1. ~ chirop.ractor should never permit him­self to_ fc:el ~nvtous . or Jealous of a brother practitioner. !he dtsttnctton whtch one successful chiropractor wins IS shared by the whole profession.

Section 2. The chiropractor in conversation with a patient who is under the care of another practitioner should observe the strictest caution and reserve. No cou_rse _of conduct shoul? ~e pursued that might, directly or mdtrectly, tend to dtmtnish the trust imposed in the chiropractor employed.

Section 3. A chiropractor should not take charge of a case which is, or recently has been, under the care of another practit!oner in th~ sam~ illness except in an emer.gency, or 10 consultatiOn wtth the chiropractor in prevtous attendance, or when the latter has relinquished the case or has been regularly notified that his services are no longer required.

Section 4. In cases of accident or sudden emergen­ci~s, more than one chiropractor may be sent for by alarmed frtends. Courtesy shoufd assign the patient to the first that arrives, and he should select from others such ad­ditional assistance as he may require. But he should also request that the family chiropractor be sent for (if there be one), and on his arrival resign the case into his hands.

Secti?~ _5. In_ a sparse population, a chiropractor when vtsttmg a stck person may be requested to see some neighboring patient who is regularly under the care of another. In such an event he should do what seems nece~sary at the time; interfere as little as possible with prev10us treatment; and assume no further direction of the case unless expressly desired, in which case he should request an immediate consultation with the practitioner previously employed.

S~ction 6. . A wealthy chiropractor should not give ~d.vtce g~atmtouslr to the affluent. In so doing he IDJures hts profess10nal brethren. The office of a chiro­practor can never be supported as a beneficent one. Hence it is defrauding the common fund when fees are dispensed with which might rightfully be claimed.

THIRTEEN

Section 7. In localities where chiropractors are licensed to practice obstetrics, if one is absent in a case he has been engaged to deliver and another chiropractor accomplishes the delivery, the latter is entitled to the fee but should resign the patient to the chiropractor original­ly employed.

Article V. Differences Between Chiropractors and Pecuniary Acknowledgments.

Section 1. Diversity of opinion and of interests may in the chiropractic profession, as in other professions, sometimes cause controversy and even contention. When such cases occur and cannot be readily terminated, they should be referred to the Board of Censors for arbitra­tion.

Section 2. Some general rules should be adopted by chiropractors in every town or district relative to fees from patients. These should be adhered to by chiro­practors as uniformly as circumstances will permit.

Section 3. It shall be considered unprofessional to split fees or to give or receive a commission in the ref­erence of patients for chiropractic service, except in cases where laboratory services are required and then the patient should be informed that tfiere is an extra charge for such service.

Section 4. Unfortunately every community has with­in its population a certain percentage of people who evade every financial obligation possible. Such persons prey upon the chiropractor as well as on members of other professions. Therefore, it is perfectly proper for the chtropractors of a community to make a list of the names of such individuals and to demand, before attend­ing them, some adequate security that the fees will be paid.

PART 3. RECIPROCAL DUTIES AND OBLIGATIONS OF

CHIROPRACTORS AND THE PUBLIC Article I. Duties of Chiropractors to the Public. Section 1. It is the duty of the chiropractor as a

good citizen to be vigilant for the welfare of the com­munity and to do his part in sustaining its burdens. He

FOURTEEN

should be ready to give counsel to the public on matters pertaining to his profession such as postural hygiene, general hygiene, and sanitary measures in the control and prevention of epidemics. He should comply with all local regulations concerning reportable diseases.

Section 2. Chiropractors should always be willing to testify in courts of jHstice on matters pertaining to the profession.

Section 3. There is no profession by the members of which gratuitous services are more freely dispensed than they are by chiropractors, but justice demands that some limit should be placed on the extent of such services. Poverty, professional brotherhood, the poorly remunerat­ed occupation of some individual patient, and certain of the public duties referred to in Section 1 of this Article should be recognized as presenting valid claims for gratuitous services. However, services rendered endow­ed institutions, mutual benefit societies, for life insurance or other health certification examinations, as well as services under Section 2 of this Article, should not justly be rendered without an appropriate fee.

Article II. Obligations of the Public to Chiropractors. Section 1. The benefits accruing to the public from

the active and constant labors of the chiropcactic profes­sion are so numerous that chiropractors are justfy enti­tled to the utmost consideration from the community. The public shoutd be willing to assist in the endowment of nonprofit chiropractic institutions, such as accredited colleges, sanitaria, hospitals, and clinics. Furthermore, the public should demand, through proper legislative channels, that chiropractic services become available to the inmates of all state institutions.

CONCLUSION Obviously it is impossible to cover all the innumer­

able ramifications of professional ethics in a treatise of this length. The foregoing merely points to certain gen­eral rules of conduct that should be followed in the interest of public welfare and for the ultimate good of the chiropractic profession. Application of the same principles should govern the practitioner in his behavior towara any incident that may not herein be specifically mentioned. I

I I