Patient Care

Psychoanalysis is a method of treating children, adolescents and adults with emotional and mental disorders that attempts to reduce suffering and disability and enhance growth and autonomy. While the psychoanalytic relationship is predicated on respecting human dignity, it necessarily involves a power differential between psychoanalyst, patient and, particularly in the case of children, the family that, if ignored, trivialized or misused, can compromise or derail treatment and inflict significant damage on both parties to treatment*. Constant self examination and reflection by the psychoanalyst and liberal use of formal consultation are obvious safeguards for the patient, as well as the treating psychoanalyst.

 

No code of ethics can be encyclopedic in providing answers to all ethical questions that may arise in the practice of the profession of psychoanalysis. Sound judgment and integrity of character are indispensable in applying ethical principles to particular situations and individuals. The major goal of this code is to facilitate the psychoanalyst's best efforts in all areas of analytic work and to encourage early and full discussion of ethical questions with colleagues and members of local and national ethics committees. These revised Principles presuppose a psychoanalyst's life-long commitment to act ethically and to encourage similar ethical behavior in colleagues and students. It is expected that over time all psychoanalysts will enrich and add cumulatively to the guidance provided by the Principles with their own experience and values, and that the Principles will evolve, based on the profession's insights and experience.

 

General Principles of Ethics for Psychoanalysts

 

Introduction:

The American Psychoanalytic Association has adopted the following Principles of Ethics and associated Standards to guide members in their professional conduct toward their patients and, in the case of minors, toward their parent(s) or guardian(s) as well as supervisees, students, colleagues and the public. These Principles and Standards substantially revise and update the ethical principles contained in the previous Principles of Ethics published by the American Psychoanalytic Association in December 1975, and revised in 1983. The revisions take account of evolving moral sensibilities and observed deficiencies in the earlier codes. As ethical standards change, behaviors that were acceptable in the past may no longer be considered ethical. In this regard, however, these evolving standards should not be used to punish individuals retroactively. These revised principles emphasize constraints on behaviors that are likely to misuse the power differential of the transference-countertransference relationship to the detriment of patients and, in the case of minors, their parent (s) or guardian (s) as well.

 

The new code seeks to identify the parameters of the high standard of care expected of psychoanalysts in treatment, teaching, and research. By specifying standards of expected conduct, the code is intended to inform all psychoanalysts in considering and arriving at ethical courses of action and to alert members and candidates to departures from the wide range of acceptable practices. When doubts about the ethics of a psychoanalyst's conduct arise, early intervention is encouraged. Experience indicates that when ethical violations are thought to have occurred, prompt consultation and mediation tend to serve the best interests of all parties concerned. When indicated, procedures for filing, investigating and resolving complaints of unethical conduct are addressed in the Provisions for Implementation of the Principles and Standards of Ethics for Psychoanalysts.

 

There are times when ethical principles conflict, making a choice of action difficult. In ordering ethical obligations, one's duty is to the patient directly, or indirectly through supervision or consultation with the treating psychoanalyst. In the case of patients who are minors there are also ethical obligations to parent(s) or guardian(s) which change as the patient becomes older and more mature. Thereafter, ethical obligations are to the profession, to students and colleagues, and to society. The ethical practice of psychoanalysis requires the psychoanalyst to be familiar with these Principles and Standards; to conduct regular self-examination; to seek consultation promptly when ethical questions arise; and to reach just sanctions when judging the actions of a colleague.

 

Guiding General Principles:

I. Professional Competence. The psychoanalyst is committed to provide competent professional service. The psychoanalyst should continually strive to improve his or her knowledge and practical skills. Illnesses and personal problems that significantly impair the psychoanalyst's performance of professional responsibilities should be acknowledged and addressed in appropriate fashion as soon as recognized.

 

II. Respect for Persons. The psychoanalyst is expected to treat patients and their families, students and colleagues with respect and care. Discrimination on the basis of age, disability, ethnicity, gender, race, religion, sexual orientation or socioeconomic status is ethically unacceptable.

 

III. Mutuality and Informed Consent. The treatment relationship between the patient and the psychoanalyst is founded upon trust and informed mutual agreement or consent. At the outset of treatment, the patient should be made aware of the nature of psychoanalysis and relevant alternative therapies. The psychoanalyst should make agreements pertaining to scheduling, fees, and other rules and obligations of treatment tactfully and humanely, with adequate regard for the realistic and therapeutic aspects of the relationship. Promises made should be honored.

When the patient is a minor these same general principles pertain but the patient's age and stage of development should guide how specific arrangements will be handled and with whom.

 

IV. Confidentiality. Confidentiality of the patient's communications is a basic patient's right and an essential condition for effective psychoanalytic treatment and research. A psychoanalyst must take all measures necessary to not reveal present or former patient confidences without permission, nor discuss the particularities observed or inferred about patients outside consultative, educational or scientific contexts. If a psychoanalyst uses case material in exchanges with colleagues for consultative, educational or scientific purposes, the identity of the patient must be sufficiently disguised to prevent identification of the individual, or the patient's authorization must be obtained after frank discussion of the purpose(s) of the presentation, other options, the probable risks and benefits to the patient, and the patient's right to refuse or withdraw consent.

 

V. Truthfulness. The psychoanalytic treatment relationship is founded on thoroughgoing truthfulness. The psychoanalyst should deal honestly and forthrightly with patients, patient's families in the case of those who are minors, students, and colleagues. Being aware of the ambiguities and complexities of human relationships and communications, the psychoanalyst should engage in an active process of self-monitoring in pursuit of truthful therapeutic and professional exchanges.

 

VI. Avoidance of Exploitation. In light of the vulnerability of patients and the inequality of the psychoanalyst-analysand dyad, the psychoanalyst should scrupulously avoid any and all forms of exploitation of patients and their families, current or former, and limit, as much as possible the role of self-interest and personal desires. Sexual relations between psychoanalyst and patient or family member, current or former, are potentially harmful to both parties, and unethical. Financial dealings other than reimbursement for therapy are unethical.

 

VII. Scientific Responsibility. The psychoanalyst is expected to be committed to advancing scientific knowledge and to the education of colleagues and students. Psychoanalytic research should conform to generally accepted scientific principles and research integrity and should be based on a thorough knowledge of relevant scientific literature. Every precaution should be taken in research with human subjects, and in using clinical material, to respect the patient's rights especially the right to confidentiality, and to minimize potentially harmful effects.

 

VIII. Protection of the Public and the Profession. The psychoanalyst should strive to protect the patients of colleagues and persons seeking treatment from psychoanalysts observed to be deficient in competence or known to be engaged in behavior with the potential of affecting such patients adversely. S/he should urge such colleagues to seek help. Information about unethical or impaired conduct by any member of the profession should be reported to the appropriate committee at local or national levels.

 

IX. Social Responsibility. A psychoanalyst should comply with the law and with social policies that serve the interests of patients and the public. The Principles recognize that there are times when conscientious refusal to obey a law or policy constitutes the most ethical action. If a third-party or patient or in the case of minor patients, the parent(s) or guardian(s) demands actions contrary to ethical principles or scientific knowledge, the psychoanalyst should refuse. A psychoanalyst is encouraged to contribute a portion of his or her time and talents to activities that serve the interests of patients and the public good.

 

X. Personal Integrity. The psychoanalyst should be thoughtful, considerate, and fair in all professional relationships, uphold the dignity and honor of the profession, and accept its self-imposed disciplines. He or she should accord members of allied professions the respect due their competence.

 

Standards Applicable to the Principles of Ethics for Psychoanalysts

The American Psychoanalytic Association is aware of the complicated nature of the psychoanalyst-patient relationship and the conflicting expectations of therapists and patients in contemporary society. In addition, the Association recognizes that this complexity is increased when the patient is a minor and parent(s) and guardian(s) are a natural, if changing, part of the therapeutic picture. The following ethical standards are offered as a more specific and practical guide for putting into practice the Guiding Principles. The Standards represent practices that psychoanalysts have found over time to be generally conducive to morally appropriate professional conduct. A discussion of situation-dependent guidelines and dilemmas will be presented in a separate document, a Casebook on Ethics.

 

I. Competence

1. Psychoanalysts are expected to work within the range of their professional competence and to refuse to assume responsibilities for which they are untrained.

2. Psychoanalysts should strive to keep up to date with changes in theories and techniques and to make appropriate use of professional consultations both psychoanalytic and in allied psychotherapeutic fields such as psychopharmacology.

3. Psychoanalysts should seek to avoid making claims in public presentations that exceed the scope of their competence.

4. Psychoanalysts should take steps to correct any impairment in his or her analyzing capacities and do whatever is necessary to protect patients from such impairment.

 

II. Respect for Persons and Nondiscrimination

1. Psychoanalysts should try to eliminate from their work the effects of biases based on age, disability, ethnicity, gender, race, religion, sexual orientation or socioeconomic status.

2. The psychoanalyst should refuse to observe organizational policies that discriminate with regard to age, disability, ethnicity, gender, race, religion, sexual orientation, or socioeconomic status.

 

III. Mutuality and Informed Consent

1. Psychoanalytic treatment exists by virtue of an informed choice leading to a mutually accepted agreement between a psychoanalyst and a patient or the parent(s) or guardian(s) of a minor patient.

2. It is not ethical for a psychoanalyst to take advantage of the power of the transference relationship to aggressively solicit patients, students or supervisees into treatment or to prompt testimonials from current or former patients. Neither is it ethical to take such advantage in relation to parent(s) or guardian(s) of current or former minor patients.

3. It is unethical for a psychoanalyst to use his/her position of power in analytic organization, professional status or special relationship with a potential patient or parent or guardian of a minor patient to coerce or manipulate the person into treatment.

4. Careful attention should be given to the process of referral to avoid conflicts of interest with other patients and colleagues. Referrals between members of the same family, including spouses, and significant others, should be especially scrutinized and disclosure should be made to patients about the relationship in the initial stages of the referral so that preferable alternatives may be considered.

5. All aspects of the treatment contract which are applicable should be discussed with the patient during the initial consultation process. The psychoanalyst's policy of charging for missed sessions should be understood in advance of such a charge. The applications of this policy to third party payment for services should be discussed and agreed upon by the patient. In the case of patients who are minors, these matters should be discussed early on with the parent(s) or guardian(s) as well as with the patient as age and capability dictate.

6. A reduced fee does not limit any of the ethical responsibilities of the treating psychoanalyst.

7. The psychoanalyst should not unilaterally discontinue treating a patient without adequate notification discussion with the patient and, if a minor, with the parent (s) or guardian (s) and an offer of referral for further treatment. Consultation should be considered.

 

IV. Confidentiality

1. All information about the specifics of a patient's life is confidential, including the name of the patient and the fact of treatment. The psychoanalyst should resist disclosing confidential information to the full extent permitted by law. Furthermore, it is ethical, though not required, for a psychoanalyst to refuse legal, civil or administrative demands for such confidential information even in the face of the patient's informed consent and accept instead the legal consequences of such a refusal.[1]

2. The psychoanalyst should never share confidential information about a patient with nonclinical third-parties (e.g., insurance companies) without the patient's or, in the case of a minor patient, the parent's or guardian's informed consent. For the purpose of claims review or utilization management, it is not a violation of confidentiality for a psychoanalyst to disclose confidential information to a consultant psychoanalyst, provided the consultant is also bound by the confidentiality standards of these Principles and the informed consent of the patient or parent or guardian of a minor patient has first been obtained. If a third-party payer or a patient or parent or guardian of a minor patient demands that the psychoanalyst act contrary to these Principles, it is ethical for the psychoanalyst to refuse such demands, even with the patient's or, in the case of a minor patient, the parent's or guardian's informed consent.[2]

3. The psychoanalyst of a minor patient must seek to preserve the patient's confidentiality, while keeping parents or guardians informed of the course of treatment in ways appropriate to the age and stage of development of the patient, the clinical situation and these Principles.

4. The psychoanalyst should take particular care that patient records and other documents are handled so as to protect patient confidentiality. A psychoanalyst may direct an executor to destroy such records and documents after his or her death.

5. It is not a violation of confidentiality for a psychoanalyst to disclose confidential information about a patient in a formal consultation or supervision in which the consultant or supervisor is also bound by the confidentiality requirements of these Principles. On seeking consultation, the psychoanalyst should first ascertain that the consultant or supervisor is aware of and accepts the requirements of the Confidentiality standard.

6. If the psychoanalyst uses confidential case material in clinical presentations or in scientific or educational exchanges with colleagues, either the case material must be disguised sufficiently to prevent identification of the patient, or the patient's informed consent must first be obtained. If the latter, the psychoanalyst should discuss the purpose(s) of such presentations, the possible risks and benefits to the patient's treatment and the patient's right to withhold or withdraw consent. In the case of a minor patient, parent(s) or guardian(s) should be consulted and, depending on the age and developmental stage, the matter may be discussed with the patient as well.

7. Supervisors, peer consultants and participants in clinical and educational exchanges have an ethical duty to maintain the confidentiality of patient information conveyed for purposes of consultative or case presentations or scientific discussions.

8. Candidate psychoanalysts-in-training are strongly urged to consider obtaining the patient's informed consent before beginning treatment, pertaining to disclosures of confidential information in groups or written reports required by the candidate's training. Where the patient is a minor, the candidate is strongly urged to consider obtaining informed consent from the parent(s) or guardian(s); age and stage of development will assist the candidate in determining if the patient should also be informed.

 

V. Truthfulness

1. Candidate psychoanalysts-in-training are strongly urged to inform psychoanalytic training patients and prospective psychoanalytic training patients that they are in training and supervised. Where the patient is a minor, the parent(s) or guardian(s) should also be informed. If asked, candidate psychoanalysts-in-training should not deny that they are being supervised as a requirement of their training.

2. The psychoanalyst should speak candidly with prospective patients or the parent(s) or guardian(s) if the patient is a minor about the benefits and burdens of psychoanalytic treatment.

3. The psychoanalyst should avoid misleading patients or parents or guardians of minor patients or the public with statements that are knowingly false, deceptive or misleading.

 

VI. Avoiding Exploitation

1. Sexual relationships involving any kind of sexual activity between the psychoanalyst and a current or former patient, or a parent or guardian of a current or former patient, or any member of the patient's immediate family whether initiated by the patient, the parent or guardian or family member or by the treating psychoanalyst, are unethical. Physical touching is not ordinarily regarded as a technique of value in psychoanalytic treatment. If touching occurs, whether of the patient by the psychoanalyst or the psychoanalyst by the patient, such an event should alert the psychoanalyst to the potential for misunderstanding of the event by the patient or the psychoanalyst. and consequent harm to the future course of treatment and consultation should be considered. Consultation should be considered if there is concern about the future course of treatment.

With children before the age of puberty touching between the patient and the psychoanalyst is likely to occur as in helping or during a patient's exuberant play. Also, a disruptive or out of control child may need to be restrained. The psychoanalyst needs to be alert to the multiple meanings for both parties of such touching. Keeping parent(s) or guardian(s) informed when this occurs may be useful. Consultation should be considered if the touching causes the psychoanalyst concern.

2. Marriage between a psychoanalyst and a current or former patient, or between a psychoanalyst and the parent or guardian of a patient or former patient is unethical, notwithstanding the absence of a complaint from the spouse and the legal rights of the parties.

3. It is not ethical for a psychoanalyst to engage in financial dealings with a patient, or in the case of a minor patient, the parent(s) or guardian(s) beyond reimbursement for treatment; or to use information shared by a patient or parent(s) or guardian(s) for the psychoanalyst's financial gain.

4. It is not ethical for a psychoanalyst to solicit financial contributions from a current or former patient or the parent/guardian of a current or former patient for any purpose; nor should a psychoanalyst give the names of current or former patients or their parents/guardians for purposes of financial solicitation by others.

5. If a patient or parent or guardian of a minor patient brings up the idea of a financial gift to a psychoanalytic organization or cause during treatment, it should be handled psychoanalytically and, if necessary, the patient should be informed that his or her confidentiality might be breached by the treating psychoanalyst's obligation to recuse him/herself from involvement in decisions governing use of the gift. If a gift is given nevertheless, the psychoanalyst is ethically obliged to refrain from any decision regarding its use by the recipient organization or cause.

6. If a current or former patient or the parent/guardian of a current or former patient, gives an unsolicited financial gift, or establishes a trust or foundation or other entity for the benefit of his/her psychoanalyst, or for the benefit of the professional or scientific work of said psychoanalyst, or for the benefit of the psychoanalyst's family, or the gift is placed under the control of the psychoanalyst, even if not directly beneficial to the psychoanalyst or his/her family, it is not ethical for the psychoanalyst to accept any financial benefit or to control its disposition.

7. It is ethical for a psychoanalyst to accept a bequest from the estate of a former patient, provided that it is promptly donated to an organization or cause from which the psychoanalyst or his/her family do not personally benefit and over which the psychoanalyst has no direct control.

8. It is unethical for a psychoanalyst to use his or her professional status, special relationship, or position of power in an analytic organization to solicit gifts or funds, sexual favors, special relationships, or other tangible benefit from patients, the parent(s) or guardian(s) of minor patients, members of the patient's immediate family, psychoanalysts-in-training or supervisees. Sexual relationships between current supervisors and supervisees are unethical.

9. Concurrent supervision of candidates by the spouse, significant other or other relative of their analysts should be avoided whenever possible in the interest of maintaining the independence and objectivity of both the supervisory and analytic processes.

 

VII. Scientific Responsibility

1. The psychoanalyst should take every precaution in using clinical material to respect the patient's rights and to minimize the impact of its use on the patient's privacy and dignity. In the case of minor patients the impact on parent(s) or guardian(s) needs to be considered. Particular care should be exercised in using material from a patient who is still undergoing treatment.

2. It is unethical for a psychoanalyst to make public presentations or submit for publication in scientific journals falsified material that does not refer to actual observations drawn from the clinical situation. Such clinical material must be disguised sufficiently to protect identification of the patient.

3. The psychoanalyst should exercise caution in disguising patient material to avoid misleading colleagues as to the source and significance of his or her scientific conclusions.

 

VIII. Safeguarding the Public and the Profession

1. The psychoanalyst should seek consultation when, in the course of treating a patient, the work becomes continuously confusing or seriously disturbing to either the psychoanalyst or the patient, or both. On occasion in the treatment of a minor, the relationship between the psychoanalyst and parental figure may cause sustained disturbance or confusion for the psychoanalyst. In such a situation consultation is indicated.

2. A psychoanalyst who undergoes a serious illness and extended convalescence, or whose analyzing capacities are impaired, must consult with a colleague and/or medical specialist to clarify the significance of his or her condition for continuing to work.

3. A request by a patient, a parent/guardian of a minor patient, or a colleague that the psychoanalyst seek consultation should receive respectful and reflective consideration.

4. If a psychoanalyst is officially notified by a representative of an institute or society that a possible impairment of his/her clinical judgment or analyzing ability exists, the psychoanalyst must consult with no less than two colleagues, one of whom may be a non-analyst medical specialist, each acceptable to the notifying body. If impairment is found, remedial measures be followed by the psychoanalyst in order to protect patients from harm and to prevent degradation of the standards of care in the profession.

5. It is ethical for a psychoanalyst to consult with the patient of a colleague without giving notice to the colleague, if the consultation has been requested by the patient.

6. It is ethical for a psychoanalyst to intervene on behalf of a colleague's patient if he or she has evidence from a direct or indirect consultation with the colleague's patient or from supervision of the colleague's work with the patient that the colleague may be conducting him/herself unethically toward the patient or may be so impaired as to threaten the patient's welfare.

7. It is ethical for a psychoanalyst to accept for treatment the current patient of a colleague if consultation with a third colleague indicates that it is in the best interest of the patient to do so.

8. In the event that a credible threat of imminent bodily harm to a third party by a patient becomes evident, the psychoanalyst should take reasonable appropriate steps to protect the third-party from bodily harm, and may breach patient confidentiality if necessary only to the extent necessary to prevent imminent harm from occurring. The same applies to a credible threat of suicide.

9. In the case of a minor where the psychoanalyst is concerned that a credible threat of serious self injury or suicide is imminent, the psychoanalyst should take appropriate steps. This would include the notification of parent(s) or guardian(s) even if a breach of confidentiality is required. Under these circumstances, any breach of confidentiality should be restricted to the minimum necessary to prevent harm of the minor child.

10. When a psychoanalyst becomes convinced that abuse is occurring the psychoanalyst may report adult or child abuse of a patient or by a patient to the appropriate governmental agency in keeping with local laws. Should the patient be a minor, informing parent(s) or guardian(s) needs to be considered. In these circumstances, confidentiality may be breached to the minimum extent necessary. However, in keeping with General Principle IX, a psychoanalyst may also refuse to comply with local reporting laws if that psychoanalyst believes that to do so would seriously undermine the treatment or damage the patient. Given the complexities of these matters, a psychoanalyst who is concerned that abuse of an adult or child is occurring is encouraged to continue to explore the situation and to consider utilizing consultation to determine what course of action would be most helpful.[3]

11. Local psychoanalytic societies and institutes have an obligation to promote the competence of their members and to initiate confidential inquiries in response to ethics complaints.

 

IX. Social Responsibility

1. The psychoanalyst should make use of all legal, civil, and administrative means to safeguard patients' rights to confidentiality, to ensure the protection of patient treatment records from third party access, and to utilize any other ethical measures to ensure and maintain the privacy essential to the conduct of psychoanalytic treatment.

2. The psychoanalyst is urged to support laws and social policies that promote the best interests of patients and the ethical practice of psychoanalysis.

3. The psychoanalyst is encouraged to contribute his or her time and talents, if necessary without monetary compensation, to consultative and educational activities intended to improve public welfare and enhance the quality of life for the mentally ill and economically deprived members of the community.

 

X. Integrity

1. Psychoanalysts and candidate psychoanalysts-in-training should be familiar with the Principles of Ethics and Standards, other applicable professional ethics codes, and their application to psychoanalysis.

2. Psychoanalysts should strive to be aware of their own beliefs, values, needs and limitations and to monitor how these personal interests impact their work.

3. Psychoanalysts should cooperate with ethics investigations and proceedings conducted in accordance with the Provision for Implementation of the Principles and Standards of Ethics for Psychoanalysts. Failure to cooperate is itself an ethics violation.

Preface

The Principles listed in the Ethical Standards of Practice of Dance Therapists Registered, members of the Academy of Dance Therapists Registered, and members of the American Dance Therapy Association are principles which embody a professional level in the practice of dance/movement therapy. Concomitant with the Code of Ethical Practice, the Standards are guidelines for personal conduct, and serve as a model for practicing dance/movement therapists.

 

Principles

Principle 1: Education and training. In the interest of the public and profession as a whole, an individual practices dance/movement therapy only after adequate preparation.

A. Dance: Intensive and extensive dance experience is fundamental and should include a wide range of movement skills to include teaching, performing, and choreography.

 

B. Dance Therapy Training: Training including academic education and fieldwork with supervision by a member of the Academy of Dance Therapists Registered (ADTR) or a person who has the equivalent qualifications, is essential. It is A.D.T.A.. policy that courses at the professional or training level should be taught by a person with a minimum of an ADTR.

 

1. Education:

 

a. There are formal educational requirements.

b. For specific information on competencies and course content refer to Standards for Graduate Dance Therapy Programs.

2. Internship/Fieldwork: Dance/movement therapy skills are developed in a clinical setting* under overall supervision by a member of the Academy of Dance Therapists Registered (ADTR). For specific skills refer to the document cited above.

PRINCIPLE 2: THERAPEUTIC RESPONSBILITIES. A dance/movement therapist establishes a therapeutic alliance with the client, which includes the following:

 

A. Establishment with the responsible parties (client where possible, parent, guardian, or appropriate authority), of a mutually acceptable contract, regarding treatment goals, methods of implementation, relation to other therapists, and conditions of termination.

 

B. Provision of an appropriate setting for clinical work with reasonable standards of safety, security and privacy.

 

C. Referral of the client to the appropriate professional or agency when circumstances might result in either ineffective or harmful treatment.

 

D. Maintenance of systematic clinical reports containing discreet but pertinent information which can be available for evaluation by supervisors and other professionals for case presentations and personal review. See Principle 6A.

 

E. Does not work with clients in a role that is either exploitive or decreases objectivity. Is aware of the potentially powerful role between therapists and persons such as clients, students, and subordinates and avoids exploitation of the trust and dependency of such persons.

 

a. Does not solicit or accept requests from individuals with whom the therapist is in a dual relationship where one of these roles represents conflicting or competitive interests. Examples of such dual relationships, include but are not limited to, research and treatment with students, supervisory, friends, employees, or relatives.

 

b. Sexual intimacies with clients are unethical.

 

F. Collaborate with other professionals when appropriate.

PRINCIPLE 3: COGNIZANCE AND COMPLIANCE WITH LAWS AND REGULATIONS. The dance/movement therapist has the responsibility to know and follow state and national laws regulating therapeutic practice. Such knowledge and compliance assures the protection of research subjects, client welfare and confidentiality. Client's privacy and confidentiality is considered of the highest priority except when there is clear and imminent danger to an individual or society.

PRINCIPLE 4: SUPERVISION. Supervision refers to the interaction necessary to clarify and improve the treatment process. Professional supervision varies with the development of a dance/movement therapist's professional skills.

 

A. Specifics of Supervision:

 

1. Upon completion of training (see Principle 1) and Dance Therapy Registry (DTR), a practicing dance/movement therapist should have ongoing supervision by a member of the Academy of Dance Therapists Registered (ADTR) or qualified supervisor** in a clinical setting.

 

2. A member of the Academy of Dance Therapists Registered (ADTR) functions with peer review, self-evaluation, and consultation or supervision.

 

3. A member of the Academy of Dance Therapists Registered (ADTR) engaged in private practice has additional responsibilities regarding supervision (see Principle 5).

PRINCIPLE 5: PRIVATE PRACTICE. A member of the Academy of Dance Therapists Registered (ADTR) in private practice respects the following guidelines:

 

A. Entrance into Private Practice:

 

1. The individual is sanctioned by the American Dance Therapy Association to engage in private practice of dance/movement therapy only when identified by that professional organization as a member of the Academy of Dance Therapists Registered (ADTR).

 

2. A member of the Academy of Dance Therapists Registered (ADTR) in private practice follows all aspects of the Code of Ethical Practice, specifically those regarding knowledge of state and federal regulations required to meet the qualifications recognized for independent practice.

 

3. A member of the Academy of Dance Therapists Registered (ADTR) in private practice establishes financial arrangements for professional services consistent with the fees charged by other professionals for comparable work.

 

B. On-Going Training and Supervision:

 

1. An understanding of psychotherapy through intense study is essential.

 

2. on-going supervision with a member of the Academy of Dance Therapists Registered (ADTR) or another qualified supervisor** is recommended.

PRINCIPLE 6: LEGAL AND PERSONAL RIGHTS. A dance/movement therapist protects and respects clients' rights.

A. Maintains the confidentiality of written records.

 

B. Engages in discussion of clients for professional purposes only, and avoids identity of client except when essential.

 

C. Obtains permission before using any client information contained within audio or video tapes.

 

D. Respects right of informed consent and other legal requirements when involving clients, client's records or videotapes for research purposes.

 

E. Preserves the client's anonymity outside the clinical setting.

 

F. Refrains from discriminating because of race, color, religion, age, sex, national origin, marital status, sexual orientation of clients, and physical or mental disability.

 

PRINCIPLE 7: AFFILIATIONS. . A dance/movement therapist should not affiliate professionally with individuals or organizations who oppose or are in conflict with the stated purposes and ethical standards of the American Dance Therapy Association.

PRINCIPLE 8: PROFESSIONAL CONDUCT AND REPRESENTATION. A dance/movement therapist supplying information to the public, either directly or indirectly, about the field of dance/movement therapy or the services, qualification and affiliations of dance/movement therapists, has an obligation to report fairly and accurately. For example:

 

A. A dance/movement therapist does not use affiliation with the American Dance Therapy Association for purposes that are misleading to the public.

 

1. A dance/movement therapist may not use the title Dance Therapist Registered (DTR) or member of the Academy of Dance Therapists Registered (ADTR) without having received the appropriate Certificate of Registration from the American Dance Therapy Association.

 

2. A dance/movement therapist may not use membership in the American Dance Therapy Association to imply exact experience or qualifications, or to suggest misleading levels of status or professional performance.

 

B. The use of the initials "D.T." or any variations thereof, to mislead the public, is unethical.

 

C. A dance/movement therapist assists the public in identifying dance/movement therapists competent to give dependable professional service.

 

a. Reports on substandard services rendered by fellow professionals only when professionally, legally, or ethically required.

 

b. Reports legal or ethical violations or professional concerns of fellow professionals to the appropriate person(s) or committee within the organization.

 

D. Adheres to professional rather than commercial standards in announcing services.

 

PRINCIPLE 9: TREATMENT LIMITATIONS. A dance/movement therapist recognizes the boundaries of competency and limits of responsibility.

A. Practices within the limitations of the therapist's training, expertise,

and area of specialization.

 

B. Consults with other specialists when necessary, and/or refers clients to them.

 

PRINCIPLE 10: THE TREATMENT ORIENTATION. A dance/movement therapist understands and follows the procedures and treatment orientation of the facility with which the therapist chooses to associate, and functions accordingly.

A. The dance/movement therapist adheres to the agreed upon employment contract with the employing facility.

 

B. The dance/movement therapist respects the rights and reputation of the employing facility and acts accordingly.

 

* A clinical setting should be a licensed or accredited treatment

facility which provides clinical experience and in-service

education.

 

** A qualified supervisor is a person with clinical competencies and experience at least equivalent

to a member of the Academy of Dance Therapists Registered (ADTR).

 

Approved

ADTA Board of Directors

 

October 1977

Revised, May, 1979

Revised, October, 1981

Revised, October, 1983

Revised, October,. 1985

Revised, November, 1988

Revised, April, 1996

 

Policies and Procedures Governing Violations of the Code of Ethical Practice

of the American Dance Therapy Association are available upon request.

AMERICAN DANCE THERAPY ASSOCIATION, INC. Suite 108, 2000 Century Plaza Columbia, Maryland 21044

Preamble

These principles of professional conduct for pharmacists are established to guide the pharmacists in his relationships with patients, fellow practitioners, other health professionals, and the public.

 

A Pharmacist should hold the health and safety of patients to be of first consideration; he should render to each patient the full measure of his ability as an essential health practitioner.

 

A Pharmacist should never knowingly condone the dispensing, promoting, or distributing of drugs or medical devices, or assist therein, which are not of good quality, which do not meet standards required by law, or which lack therapeutic value for the patient.

 

A Pharmacist should always strive to perfect and enlarge his professional knowledge. He should utilize and make available this knowledge as may be required in accordance with his best professional judgment.

A Pharmacist has the duty to observe the law, to uphold the dignity and honor of the profession, and to accept its ethical principles. He should not engage in any activity which will bring discredit to the profession and should expose, without fear or favor, illegal or unethical conduct in the profession.

A Pharmacist should seek at all times only fair and reasonable remuneration for his services. He should never agree to, or participate in, transactions with practitioners of other health professions or any other person under which fees are divided or which may cause financial or other exploitation in connection with the rendering of professional services.

 

A Pharmacist should respect the confidential and personal nature of his professional records; except where the best interest of the patient requires or the law demands, he should not disclose such information to anyone without proper patient authorization.

 

A Pharmacist should not agree to practice under terms or conditions which tend to interfere with or impair the proper exercise of professional judgment and skill, which tend to cause a deterioration of the quality of his service, or which require him to consent to unethical conduct.

A Pharmacist should strive to provide information to patients regarding professional services truthfully, accurately, and fully and should avoid misleading patients regarding the nature, cost, or value of the pharmacist's professional services.

A Pharmacist should associate with organizations having for their objective the betterment of the profession of pharmacy; he should contribute of his time and funds to carry on the work of these organizations.

 

Approved by APHA Active and Life members August 1969

Amended December 1975

I. Introduction

 

The dental profession holds a special position of trust within society. As a consequence, society affords the profession certain privileges that are not available to members of the public-at-large. In return, the profession makes a commitment to society that its members will adhere to high ethical standards of conduct. These standards are embodied in the ADA Principles of Ethics and Code of Professional Conduct (ADA Code). The ADA Code is, in effect, a written expression of the obligations arising from the implied contract between the dental profession and society.

Members of the ADA voluntarily agree to abide by the ADA Code as a condition of membership in the Association. They recognize that continued public trust in the dental profession is based on the commitment of individual dentists to high ethical standards of conduct.

 

The ADA Code has three main components: The Principles of Ethics, the Code of Professional Conduct and the Advisory Opinions.

 

The Principles of Ethics are the aspirational goals of the profession. They provide guidance and offer justification for the Code of Professional Conduct and the Advisory Opinions. There are five fundamental principles that form the foundation of the ADA Code: patient autonomy, nonmaleficence, beneficence, justice and veracity. Principles can overlap each other as well as compete with each other for priority. More than one principle can justify a given element of the Code of Professional Conduct. Principles may at times need to be balanced against each other, but, otherwise, they are the profession's firm guideposts.

 

The Code of Professional Conduct is an expression of specific types of conduct that are either required or prohibited. The Code of Professional Conduct is a product of the ADA's legislative system. All elements of the Code of Professional Conduct result from resolutions that are adopted by the ADA's House of Delegates. The Code of Professional Conduct is binding on members of the ADA, and violations may result in disciplinary action.

The Advisory Opinions are interpretations that apply the Code of Professional Conduct to specific fact situations. They are adopted by the ADA's Council on Ethics, Bylaws and Judicial Affairs to provide guidance to the membership on how the Council might interpret the Code of Professional Conduct in a disciplinary proceeding.

The ADA Code is an evolving document and by its very nature cannot be a complete articulation of all ethical obligations. The ADA Code is the result of an on-going dialogue between the dental profession and society, and as such, is subject to continuous review.

 

Although ethics and the law are closely related, they are not the same. Ethical obligations may-and often do-exceed legal duties. In resolving any ethical problem not explicitly covered by the ADA Code, dentists should consider the ethical principles, the patient's needs and interests, and any applicable laws.

 

II. Preamble

The American Dental Association calls upon dentists to follow high ethical standards which have the benefit of the patient as their primary goal. Recognition of this goal, and of the education and training of a dentist, has resulted in society affording to the profession the privilege and obligation of self-government.

The Association believes that dentists should possess not only knowledge, skill and technical competence but also those traits of character that foster adherence to ethical principles. Qualities of compassion, kindness, integrity, fairness and charity complement the ethical practice of dentistry and help to define the true professional.

The ethical dentist strives to do that which is right and good. The ADA Code is an instrument to help the dentist in this quest.

 

III. Principles. Code of Professional Conduct and Advisory Opinions

 

Section 1 PRINCIPLE: PATIENT AUTONOMY ("self-governance").

The dentist has a duty to respect the patient's rights to self-determination and confidentiality.

This principle expresses the concept that professionals have a duty to treat the patient according to the patient's desires, within the bounds of accepted treatment, and to protect
the patient's confidentiality. Under this principle, the dentist's primary obligations include involving patients in treatment decisions in a meaningful way, with due consideration being given to the patient's needs, desires and abilities, and safeguarding the patient's privacy.

 

Code of Professional Conduct

1.A. PATIENT INVOLVEMENT.

The dentist should inform the patient of the proposed treatment, and any reasonable alter-natives, in a manner that allows the patient to become involved in treatment decisions.

 

1.B. PATIENT RECORDS.

Dentists are obliged to safeguard the confidentiality of patient records. Dentists shall maintain patient records in a manner consistent with the protection of the welfare of the patient. Upon request of a patient or another dental practitioner, dentists shall provide any information in accordance with applicable law that will be beneficial for the future treatment of that patient.

 

Advisory Opinion

1.B.1. FURNISHING COPIES OF RECORDS.
A dentist has the ethical obligation on request of either the patient or the patient's new dentist to furnish in accordance with applicable law, either gratuitously or for nominal cost, such dental records or copies or summaries of them, including dental X-rays or copies of them, as will be beneficial for the future treatment of that patient. This obligation exists whether or not the patient's account is paid in full.

 

1.B.2. CONFIDENTIALITY OF PATIENT RECORDS.
The dominant theme in Code Section l.B is the protection of the confidentiality of a patient's records. The statement in this section that relevant information in the records should be released to another dental practitioner assumes that the dentist requesting the information is the patient's present dentist. There may be circumstances where the former dentist has an ethical obligation to inform the present dentist of certain facts. Code Section 1.B assumes that the dentist releasing relevant information is acting in accordance with applicable law. Dentists should be aware, that the laws of the various jurisdictions in the United States are not uniform, and some confidentiality laws appear to prohibit the transfer of pertinent information, such as HIV seropositivity. Absent certain knowledge that the laws of the dentist's jurisdiction permit the forwarding of this information, a dentist should obtain the patient's written permission before forwarding health records which contain information of a sensitive nature, such as HIV seropositivity, chemical dependency or sexual preference. If it is necessary for a treating dentist to consult with another dentist or physician with respect to the patient, and the circumstances do not permit the patient to remain anonymous, the treating dentist should seek the permission of the patient prior to the release of data from the patient's records to the consulting practitioner. If the patient refuses, the treating dentist should then contemplate obtaining legal advice regarding the termination of the dentist/patient relationship.

 

Section 2 PRINCIPLE: NONMALEFICENCE ("do no harm").

The dentist has a duty to refrain from harming the patient.

This principle expresses the concept that professionals have a duty to protect the patient from harm. Under this principle, the dentist's primary obligations include keeping know-ledge and skills current, knowing one's own limitations and when to refer to a specialist or other professional, and knowing when and under what circumstances delegation of patient care to auxiliaries is appropriate.

2.A. EDUCATION.
The privilege of dentists to be accorded professional status rests primarily in the knowledge, skill and experience with which they serve their patients and society. All dentists, therefore, have the obligation of keeping their knowledge and skill current.

 

2.B. CONSULTATION AND REFERRAL.
Dentists shall be obliged to seek consultation, if possible, whenever the welfare of patients will be safeguarded or advanced by utilizing those who have special skills, knowledge, and experience. When patients visit or are referred to specialists or consulting dentists for consultation:

1. The specialists or consulting dentists upon completion of their care shall return the patient, unless the patient expressly reveals a different preference, to the referring dentist, or, if none, to the dentist of record for future care.

2. The specialists shall be obliged when there is no referring dentist and upon a completion of their treatment to inform patients when there is a need for further dental care.

 

ADVISORY OPINION

2.B.1. SECOND OPINIONS.
A dentist who has a patient referred by a third party* for a “second opinion” regarding a diagnosis or treatment plan recommended by the patient's treating dentist should render the requested second opinion in accordance with this Code of Ethics. In the interest of the patient being afforded quality care, the dentist rendering the second opinion should not have a vested interest in the ensuing recommendation.

*A third party is any party to a dental prepayment contract that may collect premiums, assume financial risks, pay claims, and/or provide administrative services.

 

 

2.C. USE OF AUXILIARY PERSONNEL.
Dentists shall be obliged to protect the health of their patients by only assigning to qualified auxiliaries those duties which can be legally delegated. Dentists shall be further obliged to prescribe and supervise the patient care provided by all auxiliary personnel working under their direction.

 

2.D. PERSONAL IMPAIRMENT.
It is unethical for a dentist to practice while abusing controlled substances, alcohol or other chemical agents which impair the ability to practice. All dentists have an ethical obligation to urge chemically impaired colleagues to seek treatment. Dentists with first-hand knowledge that a colleague is practicing dentistry when so impaired have an ethical responsibility to report such evidence to the professional assistance committee of a dental society.

 

ADVISORY OPINION

2.D.1. ABILITY TO PRACTICE.
A dentist who contracts any disease or becomes impaired in any way that might endanger patients or dental staff shall, with consultation and advice from a qualified physician or other authority, limit the activities of practice to those areas that do not endanger patients or dental staff. A dentist who has been advised to limit the activities of his or her practice should monitor the aforementioned disease or impairment and make additional limitations to the activities of the dentist's practice, as indicated.

 

2.E. POSTEXPOSURE, BLOODBORNE PATHOGENS.
All dentists, regardless of their bloodborne pathogen status, have an ethical obligation to immediately inform any patient who may have been exposed to blood or other potentially infectious material in the dental office of the need for postexposure evaluation and followup and to immediately refer the patient to a qualified health care practitioner who can pro-vide postexposure services. The dentist's ethical obligation in the event of an exposure incident extends to providing information concerning the dentist's own bloodborne pathogen status to the evaluating health care practitioner, if the dentist is the source individual, and to submitting to testing that will assist in the evaluation of the patient. If a staff member or other third person is the source individual, the dentist should encourage that person to cooperate as needed for the patient's evaluation.

2.F. PATIENT ABANDONMENT.
Once a dentist has undertaken a course of treatment, the dentist should not discontinue that treatment without giving the patient adequate notice and the opportunity to obtain the services of another dentist. Care should be taken that the patient's oral health is not jeopardized in the process.

 

2.G. PERSONAL RELATIONSHIPS WITH PATIENTS.
Dentists should avoid interpersonal relationships that could impair their professional judgment or risk the possibility of exploiting the confidence placed in them by a patient.

 

Section 3 PRINCIPLE: BENEFICENCE ("do good").

The dentist has a duty to promote the patient's welfare.

This principle expresses the concept that professionals have a duty to act for the benefit of others. Under this principle, the dentist's primary obligation is service to the patient and the public-at-large. The most important aspect of this obligation is the competent and timely delivery of dental care within the bounds of clinical circumstances presented by the patient, with due consideration being given to the needs, desires and values of the patient. The same ethical considerations apply whether the dentist engages in fee-for-service, managed care or some other practice arrangement. Dentists may choose to enter into contracts governing the provision of care to a group of patients; however, contract obligations do not excuse dentists from their ethical duty to put the patient's welfare first.

CODE OF PROFESSIONAL CONDUCT

3.A. COMMUNITY SERVICE.
Since dentists have an obligation to use their skills, knowledge and experience for the improvement of the dental health of the public and are encouraged to be leaders in their community, dentists in such service shall conduct themselves in such a manner as to maintain or elevate the esteem of the profession.

 

3.B. GOVERNMENT OF A PROFESSION.
Every profession owes society the responsibility to regulate itself. Such regulation is achieved largely through the influence of the professional societies. All dentists, therefore,
have the dual obligation of making themselves a part of a professional society and of observing its rules of ethics.

 

3.C. RESEARCH AND DEVELOPMENT.
Dentists have the obligation of making the results and benefits of their investigative efforts available to all when they are useful in safeguarding or promoting the health of the public.

 

3.D. PATENTS AND COPYRIGHTS.
Patents and copyrights may be secured by dentists provided that such patents and copy-rights shall not be used to restrict research or practice.

 

3.E. ABUSE AND NEGLECT.
Dentists shall be obliged to become familiar with the signs of abuse and neglect and to report suspected cases to the proper authorities, consistent with state laws.

 

ADVISORY OPINION

3.E.1. REPORTING ABUSE AND NEGLECT.
The public and the profession are best served by dentists who are familiar with identifying the signs of abuse and neglect and knowledgeable about the appropriate intervention resources for all populations.

A dentist's ethical obligation to identify and report the signs of abuse and neglect is, at a minimum, to be consistent with a dentist's legal obligation in the jurisdiction where the dentist practices. Dentists, therefore, are ethically obliged to identify and report suspected cases of abuse and neglect to the same extent as they are legally obliged to do so in the jurisdiction where they practice. Dentists have a concurrent ethical obligation to respect an adult patient's right to self-determination and confidentiality and to promote the welfare of all patients. Care should be exercised to respect the wishes of an adult patient who asks that a suspected case of abuse and/or neglect not be reported, where such a report is not mandated by law. With the patient's permission, other possible solutions may be sought.

Dentists should be aware that jurisdictional laws vary in their definitions of abuse and neglect, in their reporting requirements and the extent to which immunity is granted to good faith reporters. The variances may raise potential legal and other risks that should be considered, while keeping in mind the duty to put the welfare of the patient first. Therefore a dentist's ethical obligation to identify and report suspected cases of abuse and neglect can vary from one jurisdiction to another.

Dentists are ethically obligated to keep current their knowledge of both identifying abuse and neglect and reporting it in the jurisdiction(s) where they practice.

 

Section 4 PRINCIPLE: JUSTICE ("fairness").

The dentist has a duty to treat people fairly.

This principle expresses the concept that professionals have a duty to be fair in their dealings with patients, colleagues and society. Under this principle, the dentist's primary obligations include dealing with people justly and delivering dental care without prejudice. In its broadest sense, this principle expresses the concept that the dental profession should actively seek allies throughout society on specific activities that will help improve access to care for all.

 

4.A. PATIENT SELECTION.
While dentists, in serving the public, may exercise reasonable discretion in selecting patients
for their practices, dentists shall not refuse to accept patients into their practice or deny dental service to patients because of the patient's race, creed, color, sex or national origin.

 

ADVISORY OPINION

4.A.1. PATIENTS WITH BLOODBORNE PATHOGENS. A dentist has the general obligation to provide care to those in need. A decision not to provide treatment to an individual because the individual is infected with Human Immunodeficiency Virus, Hepatitis B Virus, Hepatitis C Virus or another bloodborne pathogen, based solely on that fact, is unethical. Decisions with regard to the type of dental treatment provided or referrals made or suggested should be made on the same basis as they are made with other patients. As is the case with all patients, the individual dentist should determine if he or she has the need of another's skills, knowledge, equipment or experience. The dentist should also determine, after consultation with the patient's physician, if appropriate, if the patient's health status would be significantly compromised by the provision of dental treatment.

 

4.B. EMERGENCY SERVICE.
Dentists shall be obliged to make reasonable arrangements for the emergency care of their patients of record. Dentists shall be obliged when consulted in an emergency by patients not of record to make reasonable arrangements for emergency care. If treatment is provided, the dentist, upon completion of treatment, is obliged to return the patient to his or her regular dentist unless the patient expressly reveals a different preference.

 

4.C. JUSTIFIABLE CRITICISM.
Dentists shall be obliged to report to the appropriate reviewing agency as determined by the local component or constituent society instances of gross or continual faulty treatment by
other dentists. Patients should be informed of their present oral health status without dis-paraging comment about prior services. Dentists issuing a public statement with respect to
the profession shall have a reasonable basis to believe that the comments made are true.

 

ADVISORY OPINION

4.C.1. MEANING OF "JUSTIFIABLE" 
Patients are dependent on the expertise of dentists to know their oral health status. Therefore, when informing a patient of the status of his or her oral health, the dentist should exercise care that the comments made are truthful, informed and justifiable. This may involve consultation with the previous treating dentist(s), in accordance with applicable law, to determine under what circumstances and conditions the treatment was performed. A difference of opinion as to preferred treatment should not be communicated to the patient in a manner which would unjustly imply mistreatment. There will necessarily be cases where it will be difficult to determine whether the comments made are justifiable. Therefore, this section is phrased to address the discretion of dentists and advises against unknowing or unjustifiable disparaging statements against another dentist. However, it should be noted that, where comments are made which are not supportable and therefore unjustified, such comments can be the basis for the institution of a disciplinary proceeding against the dentist making such statements.

 

4.D. EXPERT TESTIMONY.
Dentists may provide expert testimony when that testimony is essential to a just and fair disposition of a judicial or administrative action.

 

ADVISORY OPINION

4.D.1. CONTINGENT FEES.
It is unethical for a dentist to agree to a fee contingent upon the favorable outcome of the litigation in exchange for testifying as a dental expert.

 

4.E. REBATES AND SPLIT FEES.
Dentists shall not accept or tender "rebates" or "split fees."

 

Section 5 PRINCIPLE: VERACITY ("truthfulness").

The dentist has a duty to communicate truthfully.

This principle expresses the concept that professionals have a duty to be honest and trust-worthy in their dealings with people. Under this principle, the dentist's primary obligations include respecting the position of trust inherent in the dentist-patient relationship, communicating truthfully and without deception, and maintaining intellectual integrity.

5.A. REPRESENTATION OF CARE.
Dentists shall not represent the care being rendered to their patients in a false or misleading manner.

ADVISORY OPINIONS

5.A.1. DENTAL AMALGAM AND OTHER RESTORATIVE MATERIALS.
Based on current scientific data, the ADA has determined that the removal of amalgam restorations from the non-allergic patient for the alleged purpose of removing toxic substances from the body, when such treatment is performed solely at the recommendation or suggestion of the dentist, is improper and unethical. The same principle of veracity applies to the dentist's recommendation concerning the removal of any dental restorative material.

 

5.A.2. UNSUBSTANTIATED REPRESENTATIONS.
A dentist who represents that dental treatment or diagnostic techniques recommended or performed by the dentist has the capacity to diagnose, cure or alleviate diseases, infections or other conditions, when such represen-tations are not based upon accepted scientific knowledge or research, is acting unethically.

 

5.B. REPRESENTATION OF FEES.
Dentists shall not represent the fees being charged for providing care in a false or misleading manner.

ADVISORY OPINIONS

5.B.1. WAIVER OF COPAYMENT.
A dentist who accepts a third party* payment under a copayment plan as payment in full without disclosing to the third party* that the patient's payment portion will not be collected, is engaged in overbilling. The essence of this ethical impropriety is deception and misrepresentation; an overbilling dentist makes it appear to the third party* that the charge to the patient for services rendered is higher than it actually is.

 

5.B.2. OVERBILLING.
It is unethical for a dentist to increase a fee to a patient solely because the patient is covered under a dental benefits plan.

 

5.B.3. FEE DIFFERENTIAL.
Payments accepted by a dentist under a governmentally funded program, a component or constituent dental society sponsored access program, or a participating agreement entered into under a program of a third party* shall not be considered as evidence of overbilling in determining whether a charge to a patient, or to another third party* in behalf of a patient not covered under any of the aforecited programs constitutes overbilling under this section of the Code.

 

5.B.4. TREATMENT DATES.
A dentist who submits a claim form to a third party* reporting incorrect treatment dates for the purpose of assisting a patient in obtaining benefits under a dental plan, which benefits would otherwise be disallowed, is engaged in making an unethical, false or misleading representation to such third party.*

 

5.B.5. DENTAL PROCEDURES.

A dentist who incorrectly describes on a third party* claim form a dental procedure in order to receive a greater payment or reimbursement or incorrectly makes a non-covered procedure appear to be a covered procedure on such a claim form is engaged in making an unethical, false or misleading representation to such third party.*

 

5.B.6. UNNECESSARY SERVICES.
A dentist who recommends and performs unnecessary dental services or procedures is engaged in unethical conduct.

*A third party is any party to a dental prepayment contract that may collect premiums, assume financial risks, pay claims, and/or provide administrative services.

 

5.C. DISCLOSURE OF CONFLICT OF INTEREST.
A dentist who presents educational or scientific information in an article, seminar or other program shall disclose to the readers or participants any monetary or other special interest the dentist may have with a company whose products are promoted or endorsed in the presentation. Disclosure shall be made in any promotional material and in the presentation itself.

 

5.D. DEVICES AND THERAPEUTIC METHODS.
Except for formal investigative studies, dentists shall be obliged to prescribe, dispense, or promote only those devices, drugs and other agents whose complete formulae are available to the dental profession. Dentists shall have the further obligation of not holding out as exclusive any device, agent, method or technique if that representation would be false or misleading in any material respect.

 

ADVISORY OPINIONS

5.D.1. REPORTING ADVERSE REACTIONS.
A dentist who suspects the occurrence of an adverse reaction to a drug or dental device has an obligation to communicate that information to the broader medical and dental community, including, in the case of a serious adverse event, the Food and Drug Administration (FDA).

 

5.D.2. MARKETING OR SALE OF PRODUCTS OR PROCEDURES.
Dentists who, in the regular conduct of their practices, engage in or employ auxiliaries in the marketing or sale of products or procedures to their patients must take care not to exploit the trust inherent in the dentist-patient relationship for their own financial gain. Dentists should not induce their patients to purchase products or undergo procedures by misrepresenting the product's value, the necessity of the procedure or the dentist's professional expertise in recommending the product or procedure.

 

In the case of a health-related product, it is not enough for the dentist to rely on the manufacturer's or distributor's representations about the product's safety and efficacy. The dentist has an independent obligation to inquire into the truth and accuracy of such claims and verify that they are founded on accepted scientific knowledge or research.

Dentists should disclose to their patients all relevant information the patient needs to make an informed purchase decision, including whether the product is available elsewhere and whether there are any financial incentives for the dentist to recommend the product that would not be evident to the patient.

 

5.E. PROFESSIONAL ANNOUNCEMENT.
In order to properly serve the public, dentists should represent themselves in a manner that contributes to the esteem of the profession. Dentists should not misrepresent their training and competence in any way that would be false or misleading in any material respect.*

 

5.F. ADVERTISING.
Although any dentist may advertise, no dentist shall advertise or solicit patients in any form of communication in a manner that is false or misleading in any material respect.*

 

ADVISORY OPINIONS

5.F.1. ARTICLES AND NEWSLETTERS.
If a dental health article, message or newsletter is published under a dentist's byline to the public without making truthful disclosure of the source and authorship or is designed to give rise to questionable expectations for the purpose of inducing the public to utilize the services of the sponsoring dentist, the dentist is engaged in making a false or misleading representation to the public in a material respect.

 

5.F.2. EXAMPLES OF "FALSE OR MISLEADING."
The following examples are set forth to provide insight into the meaning of the term "false or misleading in a material respect." These examples are not meant to be all-inclusive. Rather, by restating the concept in alternative language and giving general examples, it is hoped that the membership will gain a better understanding of the term. With this in mind, statements shall be avoided which would:

a) contain a material misrepresentation of fact, b) omit a fact necessary to make the statement considered as a whole not materially misleading, c) be intended or be likely to create an unjustified expectation about results the dentist can achieve, and
d) contain a material, objective representation, whether express or implied, that the advertised services are superior in quality to those of other dentists, if that representation is not subject to reasonable substantiation.

Subjective statements about the quality of dental services can also raise ethical concerns. In particular, statements of opinion may be misleading if they are not honestly held, if they misrepresent the qualifications of the holder, or the basis of the opinion, or if the patient reasonably interprets them as implied statements of fact. Such statements will be evaluated on a case by case basis, considering how patients are likely to respond to the impression made by the advertisement as a whole. The fundamental issue is whether the advertisement, taken as a whole, is false or misleading in a material respect.

 

5.F.3. UNEARNED, NONHEALTH DEGREES.
A dentist may use the title Doctor or Dentist, DDS, DMD or any additional earned, advanced academic degrees in health service areas in an announcement to the public. The announcement of an unearned academic degree may be misleading because of the likelihood that it will indicate to the public the attainment of specialty or diplomate status.
For purposes of this advisory opinion, an unearned academic degree is one which is awarded by an educational institution not accredited by a generally recognized accrediting body or is an honorary degree.

The use of a nonhealth degree in an announcement to the public may be a representation which is misleading because the public is likely to assume that any degree announced is related to the qualifications of the dentist as a practitioner.

Some organizations grant dentists fellowship status as a token of membership in the organization or some other form of voluntary association. The use of such fellowships in advertising to the general public may be misleading because of the likelihood that it will indicate to the public attainment of education or skill in the field of dentistry.
Generally, unearned or nonhealth degrees and fellowships that designate association, rather than attainment, should be limited to scientific papers and curriculum vitae. In all instances, state law should be consulted. In any review by the council of the use of designations in advertising to the public, the council will apply the standard of whether the use of such is false or misleading in a material respect.

 

5.F.4. REFERRAL SERVICES.
There are two basic types of referral services for dental care: not-for-profit and the com-mercial. The not-for-profit is commonly organized by dental societies or community services. It is open to all qualified practitioners in the area served. A fee is sometimes charged the practitioner to be listed with the service. A fee for such referral services is for the purpose of covering the expenses of the service and has no relation to the number of patients referred.

In contrast, some commercial referral services restrict access to the referral service to a limited number of dentists in a particular geographic area. Prospective patients calling the service may be referred to a single subscribing dentist in the geographic area and the respective dentist billed for each patient referred. Commercial referral services often advertise to the public stressing that there is no charge for use of the service and the patient may not be informed of the referral fee paid by the dentist. There is a connotation to such advertisements that the referral that is being made is in the nature of a public service. A dentist is allowed to pay for any advertising permitted by the Code, but is generally not permitted to make payments to another person or entity for the referral of a patient for professional services. While the particular facts and circumstances relating to an individual commercial referral service will vary, the council believes that the aspects outlined above for commercial referral services violate the Code in that it constitutes advertising which is false or misleading in a material respect and violates the prohibitions in the Code against fee splitting.

 

5.F.5. INFECTIOUS DISEASE TEST RESULTS.

An advertisement or other communication intended to solicit patients which omits a material fact or facts necessary to put the information conveyed in the advertisement in a proper context can be misleading in a material respect. A dental practice should not seek to attract patients on the basis of partial truths which create a false impression.

For example, an advertisement to the public of HIV negative test results, without con-veying additional information that will clarify the scientific significance of this fact, contains a misleading omission. A dentist could satisfy his or her obligation under this advisory opinion to convey additional information by clearly stating in the advertisement or other communication: "This negative HIV test cannot guarantee that I am currently free of HIV."

 

5.G. NAME OF PRACTICE.
Since the name under which a dentist conducts his or her practice may be a factor in the selection process of the patient, the use of a trade name or an assumed name that is false or misleading in any material respect is unethical. Use of the name of a dentist no longer actively associated with the practice may be continued for a period not to exceed one year.*

 

ADVISORY OPINION

5.G.1. DENTIST LEAVING PRACTICE.
Dentists leaving a practice who authorize continued use of their names should receive competent advice on the legal implications of this action. With permission of a departing dentist, his or her name may be used for more than one year, if, after the one year grace period has expired, prominent notice is provided to the public through such mediums as a sign at the office and a short statement on stationery and business cards that the departing dentist has retired from the practice.

 

5.H. ANNOUNCEMENT OF SPECIALIZATION AND LIMITATION OF PRACTICE.
This section and Section 5-I are designed to help the public make an informed selection between the practitioner who has completed an accredited program beyond the dental degree and a practitioner who has not completed such a program. The special areas of dental practice approved by the American Dental Association and the designation for ethical specialty announcement and limitation of practice are: dental public health, endodontics, oral and maxillofacial pathology, oral and maxillofacial radiology, oral and maxillofacial surgery, orthodontics and dentofacial orthopedics, pediatric dentistry, periodontics and prosthodontics.

Dentists who choose to announce specialization should use "specialist in" or "practice limited to" and shall limit their practice exclusively to the announced special area(s) of dental practice, provided at the time of the announcement such dentists have met in each approved specialty for which they announce the existing educational requirements and standards set forth by the American Dental Association. Dentists who use their eligibility to announce as specialists to make the public believe that specialty services rendered in the dental office are being rendered by qualified specialists when such is not the case are engaged in unethical conduct. The burden of responsibility is on specialists to avoid any inference that general practitioners who are associated with specialists are qualified to announce themselves as specialists.

 

GENERAL STANDARDS.
The following are included within the standards of the American Dental Association for determining the education, experience and other appropriate requirements for announcing specialization and limitation of practice:
1. The special area(s) of dental practice and an appropriate certifying board must be approved by the American Dental Association.

2. Dentists who announce as specialists must have successfully completed an educational program accredited by the Commission on Dental Accreditation, two or more years in length, as specified by the Council on Dental Education and Licensure, or be diplomates of an American Dental Association recognized certifying board. The scope of the individual specialist's practice shall be governed by the educational standards for the specialty in which the specialist is announcing.

3. The practice carried on by dentists who announce as specialists shall be limited exclusively to the special area(s) of dental practice announced by the dentist.

 

STANDARDS FOR MULTIPLE-SPECIALTY ANNOUNCEMENTS.
The educational criterion for announcement of limitation of practice in additional specialty areas is the successful completion of an advanced educational program accredited by the Commission on Dental Accreditation (or its equivalent if completed prior to 1967)* in each area for which the dentist wishes to announce. Dentists who are presently ethically announcing limitation of practice in a specialty area and who wish to announce in an additional specialty area must submit to the appropriate constituent society documentation of successful completion of the requisite education in specialty programs listed by the Council on Dental Education and Licensure or certification as a diplomate in each area for which they wish to announce.

 

*Completion of three years of advanced training in oral and maxillofacial surgery or two years of advanced training in one of the other recognized dental specialties prior to 1967.

 

ADVISORY OPINIONS

5.H.1. DUAL DEGREED DENTISTS.
Nothing in Section 5.H shall be interpreted to prohibit a dual degreed dentist who practices medicine or osteopathy under a valid state license from announcing to the public as a dental specialist provided the dentist meets the educational, experience and other standards set forth in the Code for specialty announcement and further providing that the announcement is truthful and not materially misleading.

 

5.H.2. SPECIALIST ANNOUNCEMENT OF CREDENTIALS IN NON-SPECIALTY INTEREST AREAS.
A dentist who is qualified to announce specialization under this section may not announce to the public that he or she is certified or a diplomate or otherwise similarly credentialed in an area of dentistry not recognized as a specialty area by the American Dental Association unless:
1. The organization granting the credential grants certification or diplomate status based on the following: a) the dentist's successful completion of a formal, full-time advanced education program (graduate or postgraduate level) of at least 12 months' duration; and b) the dentist's training and experience; and c) successful completion of an oral and written examination based on psychometric principles; and
2. The announcement includes the following language: [Name of announced area of dental practice] is not recognized as a specialty area by the American Dental Association.
Nothing in this advisory opinion affects the right of a properly qualified dentist to announce specialization in an ADA-recognized specialty area(s) as provided for under Section 5.H of
this Code or the responsibility of such dentist to limit his or her practice exclusively to the special area(s) of dental practice announced. Specialists shall not announce their credentials in a manner that implies specialization in a non-specialty interest area.

 

5.I. GENERAL PRACTITIONER ANNOUNCEMENT OF SERVICES.
General dentists who wish to announce the services available in their practices are permitted to announce the availability of those services so long as they avoid any communications that express or imply specialization. General dentists shall also state that the services are being provided by general dentists. No dentist shall announce available services in any way that would be false or misleading in any material respect.*

ADVISORY OPINIONS

5.I.1. GENERAL PRACTITIONER ANNOUNCEMENT OF CREDENTIALS IN NON-SPECIALTY INTEREST AREAS.
A general dentist may not announce to the public that he or she is certified or a diplomate or otherwise similarly credentialed in an area of dentistry not recognized as a specialty area by the American Dental Association unless:
1. The organization granting the credential grants certification or diplomate status based on the following: a) the dentist's successful completion of a formal, full-time advanced education program (graduate or postgraduate level) of at least 12 months' duration; and b) the dentist's training and experience; and c) successful completion of an oral and written examination based on psychometric principles;
2. The dentist discloses that he or she is a general dentist; and
3. The announcement includes the following language: [Name of announced area of dental practice] is not recognized as a specialty area by the American Dental Association.

 

5.I.2. CREDENTIALS IN GENERAL DENTISTRY.
General dentists may announce fellowships or other credentials earned in the area of general dentistry so long as they avoid any communications that express or imply specialization and the announcement includes the disclaimer that the dentist is a general dentist. The use of abbreviations to designate credentials shall be avoided when such use would lead the reasonable person to believe that the designation represents an academic degree, when such is not the case.

*Advertising, solicitation of patients or business or other promotional activities by dentists or dental care delivery organizations shall not be considered unethical or improper, except for those promotional activities which are false or misleading in any material respect. Notwithstanding any ADA Principles of Ethics and Code of Professional Conduct or other standards of dentist conduct which may be differently worded, this shall be the sole standard for determining the ethical propriety of such promotional activities. Any provision of an ADA constituent or component society's code of ethics or other standard of dentist conduct relating to dentists' or dental care delivery organizations' advertising, solicitation, or other promotional activities which is worded differently from the above standard shall be deemed to be in conflict with the ADA Principles of Ethics and Code of Professional Conduct

 

IV. Interpretation and Application of Principles of Ethics and Code of Professional Conduct

 

The foregoing ADA Principles of Ethics and Code of Professional Conduct set forth the ethical duties that are binding on members of the American Dental Association. The component and constituent societies may adopt additional requirements or interpretations not in conflict with the ADA Code.

 

Anyone who believes that a member-dentist has acted unethically may bring the matter to the attention of the appropriate constituent (state) or component (local) dental society. Whenever possible, problems involving questions of ethics should be resolved at the state or local level. If a satisfactory resolution cannot be reached,
the dental society may decide, after proper investigation, that the matter warrants issuing formal charges and conducting a disciplinary hearing pursuant to the proce-dures set forth in the ADA Bylaws, Chapter XII. PRINCIPLES OF ETHICS AND CODE OF PROFESSIONAL CONDUCT AND JUDICIAL PROCEDURE. The Council on Ethics, Bylaws and Judicial Affairs reminds constituent and component societies that before a dentist can be found to have breached any ethical obligation the dentist is entitled to a fair hearing.

 

A member who is found guilty of unethical conduct proscribed by the ADA Code or code of ethics of the constituent or component society, may be placed under a sentence of censure or suspension or may be expelled from membership in the Association. A member under a sentence of censure, suspension or expulsion has the right to appeal the decision to his or her constituent society and the ADA Council on Ethics, Bylaws and Judicial Affairs, as provided in Chapter XII of the ADA Bylaws.

Code of Ethics

 

It Shall Be the Ideal, the Resolve, and the Duty of the Members of The American Optometric Association:

TO KEEP the visual welfare of the patient uppermost at all times;

 

TO ENHANCE continuously their educational and technical proficiency to the end that their patients shall receive the benefits of all acknowledged improvements in visual care;

 

TO SEE THAT no person shall lack for visual care, regardless of his financial status;

 

TO ADVISE the patient whenever consultation with an optometric colleague or reference for other professional care seems advisable;

 

TO HOLD in professional confidence all information concerning a patient and to use such data only for the benefit of the patient;

 

TO CONDUCT themselves as exemplary citizens;

 

TO MAINTAIN their offices and their practices in keeping with professional standards;

 

TO PROMOTE and maintain cordial and unselfish relationships with members of their own profession and of other professions for the exchange of information to the advantage of mankind in every possible way, In collaboration with this association, better care of the visual needs of mankind.

This Code sets forth principles of ethics and professional practice developed to promote sound professional practice in order to safeguard the welfare of consumers of psychological services, and the integrity of the profession.The Code also provides expectations with regard to members' professional behaviour.

Following the general principles which operate in all situations, a number of sections identify and explicate specific applications.

 

GENERAL PRINCIPLES

• Responsibility:

Members remain personally responsible for the professional decisions they make.

1. Members are expected to be cognisant of the reasonably foreseeable consequences of their actions and to endeavour to ensure that their services are used appropriately.

2. Members shall have ultimate regard for the highest standards of their profession.

• Competence:

Members shall bring and maintain appropriate skills and learning in their areas of professional practice.

1. Members must not misrepresent their competence, qualifications, training or experience.

2. Members must refrain from offering advice or undertaking work beyond their professional competence.

• Propriety:

The welfare of clients and the public, and the integrity of the profession, shall take precedence over a member's self interest and over the interests of the member's employer and colleagues.

1. Members must respect the confidentiality of information obtained from clients in the course of their professional work. They may reveal such information to others only with the consent of the person or the person's legal representative. However in those unusual circumstances where failure to disclose may result in clear risk to the client or to others, the member may disclose minimal information necessary to avert risk. Members must inform their clients of the legal and other limits of confidentiality.

2. Members must be sensitive to cultural, contextual, gender and role differences and the impact of those on their professional practice on clients. Members must not act in a discriminatory manner nor condone discriminatory practices against clients on the basis of those differences.

3. Members must refrain from any act which would tend to bring the profession into public disrepute.

4. Members must be mindful of the legal context in which they work, their obligations towards clients and employers, and their duties towards clients.

5. Where the demands of an organisation require members to violate this Code, members must clarify the nature of the conflict between the demands and these principles. They must inform all parties of members' ethical responsibilities and seek a constructive resolution of the conflict.

Section A

PSYCHOLOGICAL ASSESSMENT PROCEDURES

1. Members must ensure that assessment procedures are chosen, administered, and interpreted appropriately and accurately.
2. Members must supply clients with explanations of the nature and purpose of the procedures used and results of the assessment, in language the recipient can understand and with appropriate accompanying contextual information, unless an explicit exception to this right has been agreed upon in advance.
3. Members responsible for the development and standardisation of psychological tests and other assessment techniques must use established scientific procedures and observe relevant psychometric standards. They must specify the purposes and uses of the assessment techniques and clearly indicate the limits of their applicability.
4. Members must not endorse, or otherwise lend credence to, inappropriate use or interpretation of assessment results.
5. Members offering scoring and interpretation services must have appropriate evidence for the validity of the programs and procedures used in arriving at interpretations.
6. Members must not compromise the effective use of psychological tests, nor render them open to misuse, by publishing or otherwise disclosing their contents to persons unauthorised or unqualified to receive such information.
7. Assessment data obtained on an individual for one purpose, may subsequently be used for another purpose only with the informed written consent of that individual. This does not apply to the subsequent use of such data in research provided that the anonymity of the individual is preserved and the interests of the client initiating the assessment are safeguarded.
8. Members must not use or otherwise facilitate the use of obsolete assessment data.
9. Members must not permit, encourage or promote the use of psychological assessment techniques by inappropriately trained or otherwise unqualified persons through teaching, sponsorship, supervision, or employment.

Section B

RELATIONSHIPS WITH CLIENTS

1. Undue invasion of privacy must be avoided in the collection and dissemination of information. Information obtained in consulting relationships, or evaluative data concerning clients, may be communicated only for professional purposes and only to persons legitimately concerned with the case and with the informed consent of the client. Written and oral reports may present only data
   germane to the purposes of the evaluation.
2. Members must make and keep adequate records for a minimum of seven years since last client contact unless legal requirements specify otherwise. In the case of records collected while the client was a child, records should be retained at least until the individual attains the age of 25 years.
3. Members must make provisions for maintaining confidentiality in the access, storage and disposal of records, subject to the legal requirements of their employment conditions.
4. Members must not refuse any reasonable request from clients, or former clients, for the release of data for which they have professional responsibility. Such psychological data may be released only to appropriately qualified persons who have a legitimate interest in the data, subject to the legal requirements of the member's employment conditions.
5. When working with young persons or other clients who are unable to give voluntary, informed consent, members must protect these clients' best interests and will regard their responsibilities as being directed to the parents, next of kin, or guardians. The member shall endeavour to obtain the consent of young people and these other clients.
6. Members must not disclose information about criminal acts of a client unless there is an overriding legal obligation to do so or when failure to disclose may result in clear risk to themselves or others.
7. Members must avoid dual relationships that could impair their professional judgement or increase the risk of exploitation. Examples of such dual relationships include, but are not limited to, provision of psychological services to employees, students, supervisees, close friends or relatives.
8. Members must not exploit their professional relationships with clients sexually or otherwise.
9. Sexual relationships between members and current clients must not occur. When a therapeutic procedure entails some level of physical intimacy with a client, informed written consent must be obtained from the client or the client's legal guardian prior to the introduction of that procedure.
10. No member may engage in a sexual relationship with a former client when less than two years have expired since the ending or termination of the professional relationship.
11. In circumstances where more than two years have elapsed since the ending or termination of the professional relationship between the member and former client, in determining whether a sexual relationship between the member and former client is unethical, the following matters will be taken into consideration: a) the length of the professional relationship; b) the nature of the professional relationship; c) the client's mental state at the time he or she commenced the sexual relationship with the member; d) the circumstances in which the professional relationship ended or was terminated; and e) the duration of time that has expired since the ending of the professional relationship. Additionally, any other salient matters may be taken into consideration when evaluating the conduct of a member who has engaged in a sexual relationship with a former client.
12. Where it has been established that a sexual relationship existed between a member and a former client after the expiry of 24 months from the ending or termination of a professional relationship, the onus shall be on the member to establish that the client was not vulnerable to exploitation as a consequence of the prior professional relationship.
13. When a member agrees to provide services to a client at the request of a third party, the member assumes the responsibility of clarifying the nature of the relationships with all parties concerned.
14. Members must make advance financial arrangements that safeguard the best interests of and are clearly understood by clients. They must avoid financial arrangements which may, currently or subsequently, influence deleteriously the psychological services provided.
15. Members must not receive private fees, gratuities or other remuneration for professional work with persons who are entitled to the member's services through an agency or institution unless the client freely chooses to consult the member privately. Members must demonstrate that the client's decision was made voluntarily and that their obligations to their organisation or institution are respected.
16. Members must not actively solicit private consultations from clients who receive or are entitled to receive the member's services through an agency or institution.
17. Members must neither receive nor give respectively any remuneration for referring clients to or accepting referrals from other professionals for professional services.
18. In terminating relationships with clients, members shall have due regard for the psychological processes inherent in the services being provided and the psychological wellbeing of the client. Should changes in members' employment, health or other factors necessitate early termination of a relationship with a client, members shall provide clients with an explanation of the need for such early termination. They shall take all reasonable steps to safeguard clients' ongoing welfare.
19. Members must terminate a consulting relationship when it is reasonably clear that the client is not benefiting from it. They must offer to help the client locate alternative sources of assistance. When a client indicates to a member that he or she would like a second opinion the member must offer every practical assistance to obtain a competent second opinion.
20. When there is evidence of a problem or a condition with which the member is not competent to deal, the member must make this clear to the client and must refer the client to an appropriate source of expertise.
21. Members must not convey confidential communications from other professionals to a client without permission from the authors of such communications and they must clearly establish the limits of confidentiality before supplying confidential information to another professional person.

Section C

TEACHING OF PSYCHOLOGY

1. Members who are responsible for education and training programs must ensure that the programs are competently designed and delivered, and that they meet the accreditation requirements for which claims are made by the program.
2. Members must make every effort to ensure that published information concerning any educational program in which they have a teaching or organising role is accurate and not misleading, especially with respect to expectations of, and possible benefits to, participants.
3. When teaching, members must present information accurately and objectively.
4. Members must recognise the power they hold over students or supervisees and avoid engaging in conduct that is personally demeaning to students or supervisees.
5. Members must not establish fee charging or consultative relationships with students they teach or are likely to examine.
6. Members must not require or otherwise coerce a student to participate in a classroom or other training demonstration if there is reason to suppose that the student is likely to suffer distress from the experience.
7. Members must instruct students witnessing case demonstrations that they are required to preserve the anonymity of the participant and in every way to safeguard the participant's privacy.

Section D

SUPERVISION AND TRAINING

1. Members who supervise the work of students or junior colleagues have a responsibility to promote awareness of and adherence to the provisions of this Code.
2. It is unethical for members who are providing supervision or training to require or coerce supervisees or trainees to disclose personal information either directly or in the context of any training procedure. Where self disclosure is a normal expectation of a given training procedure, informed consent must be obtained from participants prior to training.
3. Members must not engage their supervisees, or junior colleagues for whom they have administrative responsibility, in psychotherapy or any similar procedure except with the informed consent of the supervisee when such consent is given for the specific purpose of training in that procedure.

Section E

RESEARCH

1. In planning psychological research, members must undertake a careful evaluation of the ethical issues involved. Whatever guidance is sought from others, the responsibility for ensuring ethical practice in research remains with the principal investigators and cannot be shared. It is the responsibility of members to ensure that research is conducted in such a manner that the welfare of participants is not compromised.
2. It is a responsibility of members conducting research to comply with guidelines and requirements for ethical accountability in research within their setting such as any current National Health and Medical Research Council Guidelines on Human Experimentation. It is unethical for a member to initiate or undertake research without complying with appropriate ethical procedures.
3. Members must be aware that in all scientific research with human participants, there is a need to balance the welfare of others who ultimately may benefit from the findings of the investigation against any discomfort or risks to participants.
4. Members must preserve and protect the respect and dignity of all participants and endeavour to ensure that participants' consent to be involved in the research is voluntary. Wherever possible, participants must be appropriately informed of the nature and purpose of the investigation. Members must inform participants of the nature of the research and that they are free to participate or to decline to participate or to withdraw from the research. Such informed consent must be appropriately documented.
5. When potential research participants are individuals such as students, employees or subordinates, members must not use a position of authority to exert undue pressure for the purpose of securing their participation in a particular research project. Members must also take special care to protect the prospective participants from adverse consequences of declining or withdrawing from participation.
6. When research participation is a course requirement, the member must ensure that the prospective participant is given the choice of equitable alternative activities.
7. For persons who are legally incapable of giving informed consent, members must provide an appropriate explanation, obtain the participant's consent and obtain appropriate consent from the persons who are legally responsible for participants' welfare.
8. Before deciding that research does not require informed written consent of research participants, members must consult with colleagues or gatekeepers and ethics committees as appropriate.
9. Members must not offer excessive financial or other inappropriate inducements to obtain research participants.
10. When it is necessary for scientific reasons to conduct a study without fully informing participants of its true purpose prior to the commencement of the study, the member must ensure that participants do not suffer distress from the research procedure. Participants must be informed of the purpose of the investigation at the conclusion of the research. Also, members must be careful to maintain the quality of their relationship with participants and to correct any mistaken attitudes or beliefs that participants may have about the research.
11. Wherever possible the procedures for establishing confidentiality must be explained to participants at the outset of the research. Members must obtain informed written consent from research participants if there is to be anticipated further use of personally identifiable research data. Test results or other confidential data obtained in a research study must not be disclosed in situations or circumstances which might lead to identification of the participants unless their informed written consent has been obtained.
12. The member must take all reasonable steps to ensure that participants are not exposed to risk of injury incidental to the procedures used, for example, from faulty stimulus presentation or recording equipment.
13. When the research necessarily involves participants in physical or mental stress, the member must inform participants concerning the procedures to be used, and the physical and psychological effects to be expected. No research procedures likely to cause severe distress should be used under any circumstances. If unexpected stress reactions of significance occur, the member has the responsibility immediately to alleviate such reactions and to terminate the investigation. If a research procedure involves participants in high levels of emotional arousal, it is incumbent on the member to ensure that no psychologically vulnerable person participates.
14. Members must anticipate the subsequent effects of research participation and provide information on services available for participants to alleviate any unnecessary distress that follows from their participation. Members must not engage in other professional relationships with research participants in relation to resolving any such distress.
15. When working in a multidisciplinary research team or other context in which members do not have sole decision-making authority, they must make these ethical principles known to other members of the research team or other decision-makers, and seek their adoption prior to engaging in the research.
16. Members must provide an opportunity for participants to obtain appropriate information about the nature, results, and conclusion of the research.
17. Members must make provisions for maintaining confidentiality in the access, storage and disposal of research data, subject to the legal requirements of their institutions.
18. Members must take all reasonable steps to minimise the discomfort, illness and pain of animals. The care of laboratory animals must be directly supervised by a person competent to ensure their comfort, health and humane treatment, and the care and use of animals in research must be consistent with National Health and Medical Research Council Statement on Animal Experimentation.

Section F

REPORTING AND PUBLICATION OF RESEARCH RESULTS

1. Members must not fabricate data or falsify results in their publications. If members discover significant errors in their publications they must take reasonable steps to correct such errors in an appropriate manner.
2. Members must not present substantial portions or elements of another's work or data as their own.
3. Authorship is assigned to persons only for work they have actually performed or to which they have contributed.
4. Minor contributions may be acknowledged in a footnote or in an introductory statement. In each case the author(s) must obtain a contributor's consent before including his or her name. Multiple authors are responsible for specifying the order in which their names appear on the title page. Where a member is given access to data collected and owned by another researcher or group of researchers, authorship must be mutually agreed before the commencement of data analysis.
5. A student is usually listed as principal author on any multiple-authored article that is substantially based on the student's dissertation or thesis. The student's supervisor will usually be second author to such a publication. If the student does not submit a manuscript for publication in a reasonable period of time after completion of the research (“reasonable period” should be determined by the Psychology Academic Organisational Unit (AOU) Head), then the supervisor may publish the research and assume primary authorship and the student must be listed as an author.
6. Members must not publish, as original data, data that have been previously published. Data can be republished when they are accompanied by proper acknowledgment. Data must be kept after publication in accordance with the member's institutional requirements.
7. After research results are published or publicly available, members must not withhold the data on which their conclusions are based from other competent professionals who seek to verify the substantive claims through reanalysis and who intend to use such data only for that purpose, provided that the confidentiality of the participants can be protected.
8. Members who review material submitted for publication, grant, or other research proposal review must respect the confidentiality of and the proprietary rights in such information of those who submitted it.
9. Members must declare any vested interest in their research including acknowledgment of funding sources and other interests in the research.

Section G

PUBLIC STATEMENTS AND ADVERTISING

1. Public statements include, but are not limited to, communication by means of periodical, book, circular, brochure, list, directory, business card, television, radio, facsimile, or electronic transmission such as email or the Internet. Public statements made by members in announcing or advertising the availability of psychological products, publications or services, must not contain:
   
   1. any statement which is false, fraudulent, unfair, misleading or deceptive or likely to mislead or deceive;
   2. testimonials or endorsements that are solicited in exchange for remuneration or have the potential to exploit clients or other service recipients;
   3. any statement claiming or implying superiority for the member over any or all other members;
   4. any statement intended or likely to create false or unjustified expectations of favourable results;
   5. any statement intended or likely to appeal to a client's fears, anxieties or emotions concerning the possible results of failure to obtain the offered services;
   6. any claim unjustifiably stating or implying that the member uses exclusive or superior apparatus, methods or materials;
   7. any statement which is vulgar, sensational or otherwise such as would bring, or tend to bring, the member or the profession of psychology into disrepute.
2. When announcing or advertising professional services, members may list the following to describe the provider and services provided: name, postal and email addresses, telephone and facsimile numbers, consultation hours, languages spoken, appropriate information concerning fees, relevant academic qualifications earned from accredited institutions of higher learning, APS membership (Honorary Fellow, Fellow, Member and Associate Member), APS College membership, registration status, and a brief simple statement of the type of psychological services offered.
3. In announcing or advertising the availability of psychological products, publications or services, members must not present their affiliation with any organisation in a manner that falsely implies sponsorship or certification by that organisation.
4. Members must not offer or provide inducement to representatives of the press, radio, television, or other communication medium in anticipation of or in return for professional publicity in a news item. A paid advertisement must be identified as such, unless it is apparent from the context that it is a paid advertisement. If communicated to the public by use of radio or television, an advertisement must be prerecorded and approved for broadcast by the member, and a recording of the actual transmission must be retained by the member.
5. Members must not participate for direct personal gain in commercial announcements or advertisements recommending to the public the purchase or use of proprietary or single-source products or services when that participation is based solely upon their identification as members.
6. Public announcements or advertisements soliciting research participants in which clinical services or other professional services are offered as an inducement must make clear the nature and limits of the services as well as the costs and other obligations to be accepted by participants in the research.
7. Members must, when they become aware of such misrepresentation, correct others who represent the member's professional qualifications, or associations with products or services in a manner incompatible with these guidelines.
8. Members may participate in any lecture, talk, public appearance, transmission, or publication on any subject and be identified therein by name, academic qualifications and the fact that they are members provided that:
   
   1. where the subject matter or part of the subject matter thereof concerns a matter in which the member is or has been professionally engaged, the member has the express consent of the client concerned and it is not contrary to the interests of the client to do so;
   2. where the subject matter thereof concerns psychological or a related professional subject the member shall not (except in the context of a lecture or talk given in the education of psychologists) claim or imply pre-eminence in that or any other psychological subject;
   3. they are competent to express a view on the subject.

Section H

MEMBERS' RELATIONSHIPS WITH PROFESSIONALS

1. Members must act with due regard for the needs, special competencies and obligations of their colleagues in psychology and other professions.
2. Publication credit must be assigned to those who have contributed to a publication in proportion to their professional contributions.
3. Members must not solicit business from any client in a similar existing relationship with another professional in pursuit of individual gain.
4. If a member is approached by a person who is already receiving similar services from another professional, the member must carefully consider all the implications of becoming involved and must discuss these with the prospective client. The welfare of the client must be paramount in these considerations and the member must proceed with caution and sensitivity towards all parties concerned.
5. Should a member have cause to disagree with a colleague in psychology or another profession on professional issues, the member must, nevertheless, refrain from making intemperate criticism in a manner which casts doubt on that colleague's professional competence.
6. A member who knows or suspects a Code violation by another member should follow the Procedures attached to this Code.

PROCEDURES FOR PERSONS CONSIDERING INVOKING ANY SECTION OF THE CODE

1. Complaints from members
   The circumstances leading a member to consider invoking the Code may include, but not be restricted to, the following:
   1. A member who may personally observe, or otherwise become aware of, behaviour by a member which appears to contravene sections of the Code;
   2. A member who might be approached by a client of psychological services asking for advice or information on procedures for redress of what he or she perceives as unprofessional conduct or unethical behaviour by another member. In this circumstance, the member should first investigate with the client the possibility of the client taking action in accordance with Section 2 of these Procedures.
   3. A member who might be approached by a member of some other professional body who may express concern about interdisciplinary ethics or practice involving a member. Action by the other professional in accordance with Section 2 of these Procedures should be investigated as a possibility first of all.
   4. A member who may be required by an employer to perform professional duties or to handle data, or otherwise act, in a way which would contravene sections of the Code.
2. Assisting a member of the public and other professionals with complaints
   Where a client of psychological services or another professional asks for advice or action to obtain redress, rather than enquiring into the circumstances and becoming a party to the complaint, a member should:
   1. Whether or not the psychologist in question is a member of the Society, advise the complainant of his or her rights under the State or Territory Psychologists Registration Acts and suggest that the complainant contact the relevant Psychologists Registration Board in the first instance.
   2. Advise the complainant to confirm through the National Office that the psychologist whose conduct is in question is a member of the Society;
   3. Suggest that, if the latter psychologist is a member, the complainant should inform the Executive Director in writing of his or her complaint and of any other action taken in respect to the relevant Psychologists Registration Board.
3. Invocation of the Code by a member
   In circumstances where there is factual knowledge, or reasonable grounds for believing, that a Section of the Code has been or is being violated, the member on his or her own behalf, or on behalf of a member of the public or other professional who requests assistance to invoke the Code, should:
   1. Approach the member whose conduct is in question in a friendly and helpful way, drawing attention to the actions that are thought to be in breach of the Code and quoting the section of the Code which may have been breached.
   2. If the matter in question does not appear to be amenable to informal resolution or if it is deemed inappropriate to approach the other member, or if the approach proves ineffective, then the member should:
      
      1. Contact the Executive Director or his/her delegate at the National Office for advice on applying the Code and what actions by the member may be deemed appropriate in the circumstances; and/or
      2. Draw the matter to the attention of the Executive Director of the Society in writing
   3. If, when contacted, the member whose conduct is in question admits to that conduct and to a breach of the Code, expresses regret and agrees to cease that conduct, the matter may still be serious enough to contact the Executive Director or to report the matter to the Executive Director in writing.
   4. If the advice of the Executive Director or his or her nominee is that the matter should be referred to the relevant Psychologists Registration Board, then the member should refer the concerns in writing to the relevant Board, and notify the Executive Director that this action has been taken.
   5. Issues of confidentiality and natural justice are important considerations in choosing and engaging in any line of action,
4. Co-operation in Processing Complaints
   1. Where an enquiry is instituted by the Society following an allegation of a Code violation, the member whose conduct is in question must cooperate with the enquiry.
   2. A member whose conduct is in question and who is contacted by another member in accordance with Section 3.1 of these Procedures is enjoined to respond sensitively and constructively when contacted.
   3. It is in the interests of all parties that complaints be dealt with promptly. Long delay in responding or failure to respond to an investigation by the Society into an alleged Code violation by a member against whom a complaint has been lodged may in and of itself be considered a violation of General Principle I (b).
    

PREAMBLE

Rehabilitation counselors are committed to facilitating the personal, social, and economic independence of individuals with disabilities. In fulfilling this commitment, rehabilitation counselors work with people, programs, institutions, and service delivery systems. Rehabilitation counselors provide services within the Scope of Practice for Rehabilitation Counseling (see the Scope of Practice document) and recognize that both action and inaction can be facilitating or debilitating. It is essential that rehabilitation counselors demonstrate adherence to ethical standards and ensure that the standards are enforced vigorously. The Code of Professional Ethics for Rehabilitation Counselors, henceforth referred to as the Code, is designed to facilitate these goals.

The fundamental spirit of caring and respect with which the Code is written is based upon five principles of ethical behavior 1 . These include autonomy, eneficence, nonmaleficence, justice, and fidelity, as defined below:

 

Autonomy: To honor the right to make individual decisions.
Beneficence: To do good to others.
Nonmaleficence: To do no harm to others.
Justice: To be fair and give equally to others.
Fidelity: To be loyal, honest, and keep promises.

The primary obligation of rehabilitation counselors is to their clients, defined in the Code as individuals with disabilities who are receiving services from ehabilitation counselors. Regardless of whether direct client contact occurs or whether indirect services are provided, rehabilitation counselors are obligated to adhere to the Code. At times, rehabilitation counseling services may be provided to individuals other than those with disabilities, such as a student population. In all instances, the primary obligation remains with the client and adherence to the Code is required.

The basic objective of the Code is to promote public welfare by specifying ethical behavior expected of rehabilitation counselors. The Enforceable Standards within the Code are the exacting standards intended to provide guidance in specific circumstances and will serve as the basis for processing ethical complaints initiated against certificants.

Rehabilitation counselors who violate the Code are subject to disciplinary action. Since the use of the Certified Rehabilitation Counselor (CRC ® ) and Canadian Certified Rehabilitation Counselor (CCRC ® ) designations are a privilege granted by the Commission on Rehabilitation Counselor Certification (CRCC ® ), CRCC reserves unto itself the power to suspend or to revoke the privilege or to approve other penalties for a violation. Disciplinary penalties are imposed as warranted by the severity of the offense and its attendant circumstances. All disciplinary actions are undertaken in accordance with published procedures and penalties designed to assure the proper enforcement of the Code within the framework of due process and equal protection under the law.

CRCC is a registered service mark of the Commission on Rehabilitation Counselor Certification. All rights reserved.
CRC is a registered certification mark of the Commission on Rehabilitation Counselor Certification. All rights reserved.
CCRC is a registered certification mark of the Commission on Rehabilitation Counselor Certification. All rights reserved.

1 Beauchamp, T.L., & Childress, J.F. (1994), 4 th Ed. Principles of Biomedical Ethics. Oxford: Oxford University Press. Kitchener,
K.S. (1984). Ethics in Counseling Psychology: Distinctions and Directions. Counseling Psychologists, 12 (3), 43-55..2

ENFORCEABLE STANDARDS OF ETHICAL PRACTICE
SECTION A: THE COUNSELING RELATIONSHIP
A.1. CLIENT WELFARE
a. DEFINITION OF CLIENT. The primary obligation of rehabilitation counselors will be to their clients, defined as individuals with disabilities who are receiving services from rehabilitation counselors.

b. REHABILITATION AND COUNSELING PLANS. Rehabilitation counselors will work jointly with their clients in devising and revising integrated, individual rehabilitation and counseling plans that contain realistic and mutually agreed upon goals and are consistent with abilities and circumstances of clients.

c. CAREER AND EMPLOYMENT NEEDS. Rehabilitation counselors will work with their clients in considering employment that is consistent with the overall abilities, vocational limitations, physical restrictions, psychological limitations, general temperament, interest and aptitude patterns, social skills, education, general qualifications, and cultural and other relevant characteristics and needs of clients. Rehabilitation counselors will neither place nor participate in placing clients in positions that will result in damaging the interest and the welfare of clients, employers, or the public.

d. AUTONOMY. Rehabilitation counselors will respect the autonomy of the client if actions such as involuntary commitment or initiation of guardianship are taken that diminish client autonomy. The assumption of responsibility for decision-making on behalf of the client will be taken only after careful deliberation. The rehabilitation counselor will advocate for client resumption of responsibility as quickly as possible.

A.2. RESPECTING DIVERSITY
a. RESPECTING CULTURE. Rehabilitation counselors will demonstrate respect for clients' cultural backgrounds.

b. INTERVENTIONS. Rehabilitation counselors will develop and adapt interventions and services to incorporate consideration of clients' cultural perspectives and recognition of barriers external to clients that may interfere with achieving effective rehabilitation outcomes.

c. NON-DISCRIMINATION. Rehabilitation counselors will not condone or engage in discrimination based on age, color, culture, disability, ethnic group, gender, race, religion, sexual orientation, marital status, or socioeconomic status.

A.3. CLIENT RIGHTS
a. DISCLOSURE TO CLIENTS. When counseling is initiated, and throughout the counseling process as necessary, rehabilitation counselors will inform clients, preferably through both written and oral means, of their credentials, the purposes, goals, techniques, procedures, limitations, potential risks, and benefits of services to be performed, and other pertinent information. Rehabilitation counselors will take steps to ensure that clients understand the implications of diagnosis, the intended use of tests and reports, fees, and billing arrangements. Clients have the right to (1) expect confidentiality and will be provided with an explanation of its limitations, including disclosure to supervisors and/or treatment team professionals; (2) obtain clear information about their case records; (3) actively articipate in the development and implementation of rehabilitation counseling plans; and (4) refuse any recommended services and be advised of the consequences of such refusal..3

b. THIRD PARTY REFERRAL. Rehabilitation counselors who have direct contact with a client at the request of a third party will define the nature of their relationships and role to all rightful, legal parties with whom they have direct contact. Direct contact is defined as any written, oral, or electronic communication. Legal parties may include clients, legal guardians, referring third parties, and attorneys actively involved in a matter directly related to rehabilitation services.

c. INDIRECT SERVICE PROVISION. Rehabilitation counselors who are employed by third parties as case consultants or expert witnesses, and who engage in communication with the individual with a disability, will fully disclose to the individual with a disability and/or his or her designee their role and limits of their relationship. Communication includes all forms of written or oral interactions regardless of the type of communication tool used. When there is no pretense or intent to provide rehabilitation counseling services directly to the individual with a disability, and where there will be no communication, disclosure by the rehabilitation counselor is not required. When serving as case consultants or expert witnesses, rehabilitation counselors will provide unbiased, objective opinions. Rehabilitation counselors acting as expert witnesses will generate written documentation, either in the form of case notes or a report, as to their involvement and/or conclusions.

d. FREEDOM OF CHOICE. To the extent possible, rehabilitation counselors will offer clients the freedom to choose whether to enter into a counseling relationship and to determine which professional(s) will provide counseling. Restrictions that limit choices of clients will be fully explained. Rehabilitation ounselors will honor the rights of clients to consent to participate and the right to make decisions with regard to rehabilitation services. Rehabilitation counselors will inform clients or the clients' legal guardians of factors that may affect decisions to participate in rehabilitation services, and they will obtain written consent or will acknowledge consent in writing after clients or legal guardians are fully informed of such factors.

e. INABILITY TO GIVE CONSENT. When counseling minors or persons unable to give voluntary informed consent, rehabilitation counselors will obtain written informed consent from legally responsible parties. Where no legally responsible parties exist, rehabilitation counselors will act in the best interest of clients. f. INVOLVEMENT OF SIGNIFICANT OTHERS. Rehabilitation counselors will attempt to enlist family understanding and involvement of family and/or ignificant others as a positive resource if (or when) appropriate. The client or legal guardian's permission will be secured prior to any involvement of family and/or significant others.

A.4. PERSONAL NEEDS AND VALUES
In the counseling relationship, rehabilitation counselors will be aware of the intimacy and responsibilities inherent in the counseling relationship, maintain respect or clients, and avoid actions that seek to meet their personal needs at the expense of clients.

A.5. SEXUAL INTIMACIES WITH CLIENTS
a. CURRENT CLIENTS. Rehabilitation counselors will not have any type of sexual intimacies with clients and will not counsel persons with whom they have had a sexual relationship.

b. FORMER CLIENTS. Rehabilitation counselors will not engage in sexual intimacies with former clients within a minimum of 5 years after terminating the counseling relationship. Rehabilitation counselors who engage in such relationship after 5 years following termination will have the responsibility to examine and document thoroughly that such relations do not have an exploitative nature, based on factors such as duration of counseling, amount of time since counseling, termination circumstances, client's personal history and mental status, adverse impact on the client, and actions by the counselor suggesting a plan to initiate a sexual relationship with the client after termination. Rehabilitation counselors will seek peer consultation prior to engaging in a sexual relationship with a former client..4

A.6. NON-PROFESSIONAL RELATIONSHIPS WITH CLIENTS
a. POTENTIAL FOR HARM. Rehabilitation counselors will be aware of their influential positions with respect to clients, and will avoid exploiting the trust and dependency of clients. Rehabilitation counselors will make every effort to avoid non-professional relationships with clients that could impair professional judgment or increase the risk of harm to clients. (Examples of such relationships include, but are not limited to, familial, social, financial, business, close personal relationships with clients, or volunteer or paid work within an office in which the client is actively receiving services.) When a non-professional relationship cannot be avoided, rehabilitation counselors will take appropriate professional precautions such as informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and no exploitation occurs.

b. SUPERIOR/SUBORDINATE RELATIONSHIPS. Rehabilitation counselors will not accept as clients, superiors or subordinates with whom they have administrative, supervisory, or evaluative relationships.

A.7. MULTIPLE CLIENTS
When rehabilitation counselors agree to provide counseling services to two or more persons who have a relationship (such as husband and wife, or parents and children), rehabilitation counselors will clarify at the outset, which person or persons are clients and the nature of the relationships they will have with each involved person. If it becomes apparent that rehabilitation counselors may be called upon to perform potentially conflicting roles, they will clarify, adjust, or withdraw from such roles appropriately.

A.8. GROUP WORK
a. SCREENING. Rehabilitation counselors will screen prospective group counseling/therapy participants. To the extent possible, rehabilitation counselors will elect members whose needs and goals are compatible with goals of the group, who will not impede the group process, and whose well being will not be jeopardized by the group experience.

b. PROTECTING CLIENTS. In a group setting, rehabilitation counselors will take reasonable precautions to protect clients from physical or psychological trauma.

A.9. TERMINATION AND REFERRAL

a. ABANDONMENT PROHIBITED. Rehabilitation counselors will not abandon or neglect clients in counseling.
Rehabilitation counselors will assist in making appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacations, and following termination.

b. INABILITY TO ASSIST CLIENTS. If rehabilitation counselors determine an inability to be of professional assistance to clients, they will avoid entering or immediately terminate a counseling relationship.

c. APPROPRIATE TERMINATION. Rehabilitation counselors will terminate a counseling relationship, securing client agreement when possible, when it is reasonably clear that the client is no longer benefiting, when services are no longer required, when counseling no longer serves the client's needs or interests, or when there is failure to pay fees according to Section J of this document.

 

d. REFERRAL UPON TERMINATION. Rehabilitation counselors will be knowledgeable about referral resources and suggest appropriate alternatives. If clients decline the suggested referral, rehabilitation counselors have the right to discontinue the relationship..5

A.10. COMPUTER TECHNOLOGY

a. USE OF COMPUTERS. When computer applications are used in counseling services, rehabilitation counselors will ensure that (1) the client is intellectually, emotionally, and physically capable of using the computer application; (2) the computer application is appropriate for the needs of the client; (3) the client understands the purpose and operation of the computer applications; and (4) a follow-up of client use of a computer application is provided to correct possible misconceptions, discover inappropriate use, and assess subsequent needs.

b. EXPLANATION OF LIMITATIONS. Rehabilitation counselors will ensure that clients are provided information as a part of the counseling relationship that adequately explains the limitations of computer technology.

c. ACCESS TO COMPUTER APPLICATIONS. Rehabilitation counselors will provide reasonable access to computer applications in counseling services.

SECTION B: CONFIDENTIALITY

B.1. RIGHT TO PRIVACY
a. RESPECT FOR PRIVACY. Rehabilitation counselors will respect clients' rights to privacy and will avoid illegal and unwarranted disclosures of confidential information.

b. CLIENT WAIVER. Rehabilitation counselors will respect the right of the client or his/her legally recognized representative to waive the right to privacy.

c. EXCEPTIONS. When disclosure is required to prevent clear and imminent danger to the client or others, or when legal requirements demand that confidential information be revealed, the general requirement that rehabilitation counselors keep information confidential will not apply. Rehabilitation counselors will consult with other professionals when in doubt as to the validity of an exception.

d. CONTAGIOUS, FATAL DISEASES. Rehabilitation counselors will become aware of the legal requirements for disclosure of contagious and fatal diseases in their jurisdiction. In jurisdictions where allowable, a rehabilitation counselor who receives information will confirm that a client has a disease known to be communicable and/or fatal. If allowable by law, the rehabilitation counselor will disclose this information to a third party, who by his or her relationship with the client is at high risk of contracting the disease. Prior to disclosure, the rehabilitation counselor will ascertain that the client has not already informed the third party about his or her disease and that the client is not intending to inform the third party in the immediate future.

e. COURT-ORDERED DISCLOSURE. When court ordered to release confidential information without a client's permission, rehabilitation counselors will request to the court that the disclosure not be required due to potential harm to the client or counseling relationship.

f. MINIMAL DISCLOSURE. When circumstances require the disclosure of confidential information, rehabilitation counselors will endeavor to reveal only essential information. To the extent possible, clients will be informed before confidential information is disclosed.

g. EXPLANATION OF LIMITATIONS. When counseling is initiated and throughout the counseling process as necessary, rehabilitation counselors will inform clients of the limitations of confidentiality and will identify foreseeable situations in which confidentiality must be breached.

h. WORK ENVIRONMENT. Rehabilitation counselors will make every effort to ensure that a confidential work environment exists and that subordinates including employees, supervisees, clerical assistants, and volunteers maintain the privacy and confidentiality of clients..6

i. TREATMENT TEAMS. If client treatment will involve the sharing of client information among treatment team members, the client will be advised of this fact and will be informed of the team's existence and composition.

j. CLIENT ASSISTANTS. When a client is accompanied by an individual providing assistance to the client (e.g., interpreter, personal care assistant, etc.), rehabilitation counselors will ensure that the assistant is apprised of the need to maintain confidentiality.

B.2. GROUPS AND FAMILIES

a. GROUP WORK. In group work, rehabilitation counselors will clearly define confidentiality and the parameters for the specific group being entered, explain its importance, and discuss the difficulties related to confidentiality involved in group work. The fact that confidentiality cannot be guaranteed will be clearly communicated to group members.

b. FAMILY COUNSELING. In family counseling, unless otherwise directed by law, information about one family member will not be disclosed to another member without permission. Rehabilitation counselors will protect the privacy rights of each family member.

B.3. RECORDS

a. REQUIREMENT OF RECORDS. Rehabilitation counselors will maintain records necessary for rendering professional services to their clients and as required by laws, regulations, or agency or institution procedures.

b. CONFIDENTIALITY OF RECORDS. Rehabilitation counselors will be responsible for securing the safety and confidentiality of any counseling records they create, maintain, transfer, or destroy whether the records are written, taped, computerized, or stored in any other medium.

c. PERMISSION TO RECORD OR OBSERVE. Rehabilitation counselors will obtain and document written or recorded permission from clients prior to electronically recording or observing sessions. When counseling clients who are minors or individuals who are unable to give voluntary, informed consent, written or recorded permission of guardians must be obtained.

d. CLIENT ACCESS. Rehabilitation counselors will recognize that counseling records are kept for the benefit of clients, and therefore provide access to records and copies of records when requested by clients, unless prohibited by law. In instances where the records contain information that may be sensitive or etrimental
to the client, the rehabilitation counselor has a responsibility to adequately interpret such information to the client. In situations involving multiple clients, access to records will be limited to those parts of records that do not include confidential information related to another client.

e. DISCLOSURE OR TRANSFER. Rehabilitation counselors will obtain written permission from clients to disclose or transfer records to legitimate third parties unless exceptions to confidentiality exist as listed in Section

B.4. CONSULTATION

a. RESPECT FOR PRIVACY. Information obtained in a consulting relationship will be discussed for professional purposes only with persons clearly concerned with the case. Written and oral reports will present data germane to the purposes of the consultation, and every effort will be made to protect client identity and to avoid undue invasion of privacy.

 

b. COOPERATING AGENCIES. Before sharing information, rehabilitation counselors will make efforts to ensure that there are defined policies in other agencies serving the counselor's clients that effectively protect the confidentiality of information.

 

B.5. ALTERNATIVE COMMUNICATION

Rehabilitation counselors will make every effort to ensure that methods of exchanging information that utilize alternative means of communication (i.e., facsimile, cellular telephone, computer, or videoconferencing) will be conducted in such a manner that ensures protection of client confidentiality. If confidentiality cannot be
ensured, client or guardian permission must be obtained.

 

SECTION C: ADVOCACY AND ACCESSIBILITY

C.1. ADVOCACY

a. ATTITUDINAL BARRIERS. Rehabilitation counselors will strive to eliminate attitudinal barriers, including stereotyping and discrimination, toward individuals with disabilities and to increase their own awareness and sensitivity to such individuals.

 

b. ADVOCACY WITH COOPERATING AGENCIES. Rehabilitation counselors will remain aware of actions taken by cooperating agencies on behalf of their clients and will act as advocates of such clients to ensure effective service delivery.

 

c. EMPOWERMENT. Rehabilitation counselors will provide the client with appropriate information and will support their efforts at self-advocacy both on an individual and an organizational level.

C.2. ACCESSIBILITY

a. COUNSELING PRACTICE. Rehabilitation counselors will demonstrate, in their practice, an appreciation of the need to provide necessary accommodations, including accessible facilities and services, to individuals with disabilities.

 

b. BARRIERS TO ACCESS. Rehabilitation counselors will identify physical, communication, and transportation barriers to clients and will communicate information on barriers to public and private authorities to facilitate removal of barriers to access.

 

c. REFERRAL ACCESSIBILITY. Rehabilitation counselors, as advocates for individuals with disabilities, will ensure, prior to referring clients to programs, facilities, or employment settings, that they are appropriately accessible.

SECTION D: PROFESSIONAL RESPONSIBILITY

D.1. PROFESSIONAL COMPETENCE

a. BOUNDARIES OF COMPETENCE. Rehabilitation counselors will practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience. Rehabilitation counselors will demonstrate a commitment to gain knowledge, personal awareness, sensitivity, and skills pertinent to working with a diverse client population. Rehabilitation counselors will not misrepresent their role or competence to clients.

 

b. REFERRAL. Rehabilitation counselors will refer clients to other specialists as the needs of the clients dictate.

 

c. NEW SPECIALTY AREAS OF PRACTICE. Rehabilitation counselors will practice in specialty areas new to them only after appropriate education, training, and supervised experience. While developing skills in new specialty areas, rehabilitation counselors will take steps to ensure the competence of their work and to
protect clients from possible harm.

 

d. RESOURCES. Rehabilitation counselors will ensure that the resources used or accessed in counseling are credible and valid (e.g., web link, books used in Bibliotherapy, etc.).

 

e. QUALIFIED FOR EMPLOYMENT. Rehabilitation counselors will accept employment only for positions for which they are qualified by education, training, supervised experience, state and national professional credentials, and appropriate professional experience. Rehabilitation counselors will hire only individuals
who are qualified and competent for professional rehabilitation counseling positions.

 

f. MONITOR EFFECTIVENESS. Rehabilitation counselors will take reasonable steps to seek peer supervision to evaluate their efficacy as rehabilitation counselors.

 

g. ETHICAL ISSUES CONSULTATION. Rehabilitation counselors will take reasonable steps to consult with other rehabilitation counselors or related professionals when they have questions regarding their ethical obligations or professional practice.

 

h. CONTINUING EDUCATION. Rehabilitation counselors will engage in continuing education to maintain a reasonable level of awareness of current scientific and professional information in their fields of activity. They will take steps to maintain competence in the skills they use, will be open to new techniques, and will
develop and maintain competence for practice with the diverse and/or special populations with whom they work.

 

i. IMPAIRMENT. Rehabilitation counselors will refrain from offering or rendering professional services when their physical, mental, or emotional problems are likely to harm the client or others. They will seek assistance for problems, and, if necessary, will limit, suspend, or terminate their professional responsibilities.

D.2. LEGAL STANDARDS

 

a. LEGAL VERSUS ETHICAL. Rehabilitation counselors will obey the laws and statutes of the legal jurisdiction in which they practice unless there is a conflict with the Code, in which case they should seek immediate consultation and advice.

 

b. LEGAL LIMITATIONS. Rehabilitation counselors will be familiar with and observe the legal limitations of the services they offer to clients. They will discuss these limitations as well as all benefits available to clients they serve in order to facilitate open, honest communication and avoid unrealistic expectations.

D.3. ADVERTISING AND SOLICITING CLIENTS

 

a. ACCURATE ADVERTISING. Advertising by rehabilitation counselors shall not be restricted. Rehabilitation counselors will advertise or will represent their services to the public by identifying their credentials in an accurate manner that is not false, misleading, deceptive, or fraudulent. Rehabilitation counselors will only advertise the highest degree earned which is in counseling or a closely related field from a college or university that was accredited when the degree was awarded by one of the regional accrediting bodies recognized by the Council on Higher Education Accreditation.

 

b. TESTIMONIALS. Rehabilitation counselors who use testimonials will not solicit them from clients or other persons who, because of their particular circumstances, may be vulnerable to undue influence. Full disclosure of uses and the informed consent of the client or guardian will be obtained. Use of estimonials will be for a specified and agreed upon period of time.

 

c. STATEMENTS BY OTHERS. Rehabilitation counselors will make reasonable efforts to ensure that statements made by others about them or the profession of rehabilitation counseling are accurate.

 

d. RECRUITING THROUGH EMPLOYMENT. Employed rehabilitation counselors will not use their institutional affiliations or relationship with their employers to recruit clients, supervisees, or consultees for their separate private practices.

 

e. PRODUCTS AND TRAINING ADVERTISEMENTS. Rehabilitation counselors who develop products related to their profession or conduct workshops or training events will ensure that the advertisements concerning these.9 products or events are accurate and disclose adequate information for consumers to make informed choices.

 

f. PROMOTING TO THOSE SERVED. Rehabilitation counselors will not use counseling, teaching, training, or supervisory relationships to promote their products or training events in a manner that is deceptive or would exert undue influence on individuals who may be vulnerable. Rehabilitation counselors may adopt textbooks they have authored for instructional purposes.

D.4. CREDENTIALS

 

a. CREDENTIALS CLAIMED. Rehabilitation counselors will claim or will imply only professional credentials possessed and are responsible for correcting any known misrepresentations of their credentials by others. Professional credentials include graduate degrees in counseling or closely related fields, accreditation of
graduate programs, national voluntary certifications, government-issued certifications or licenses, or any other credential that might indicate to the public specialized knowledge or expertise in counseling.

 

b. CREDENTIAL GUIDELINES. Rehabilitation counselors will follow the guidelines for use of credentials that have been established by the entities that issue the credentials.

 

c. MISREPRESENTATION OF CREDENTIALS. Rehabilitation counselors will not attribute more to their credentials than the credentials represent, and will not imply that other rehabilitation counselors are not qualified because they do not possess certain credentials.

 

d. DOCTORAL DEGREES FROM OTHER FIELDS. Rehabilitation counselors who hold a master's degree in counseling or a closely related field, but hold a doctoral degree from other than counseling or a closely related field, will not use the title "Dr." in their practices and will not announce to the public in relation to their practice or status as a rehabilitation counselor that they hold a doctorate.

D.5. CRC CREDENTIAL

 

a. ACTING ON BEHALF OF CRCC. Certified Rehabilitation Counselors will not write, speak, nor act in ways that lead others to believe the counselor is officially representing CRCC unless the Commission has granted permission in writing.

 

b. SUPPORT OF CANDIDATES. Certified Rehabilitation Counselors will not initiate or support the candidacy of an individual for certification by CRCC if the individual is known to engage in professional practices that violate the Code of Professional Ethics for Rehabilitation Counselors.

D.6. PUBLIC RESPONSIBILITY

 

a. SEXUAL HARASSMENT. Rehabilitation counselors will not engage in sexual harassment. Sexual harassment is defined as sexual solicitation, physical advances, or verbal or nonverbal conduct that is sexual in nature, that occurs in connection with professional activities or roles, and that either (1) the rehabilitation counselor knows or is told the act is unwelcome, offensive, or creates a hostile workplace environment; or (2) is sufficiently severe or intense to be perceived as harassment to a reasonable person within the context in which it occurs. Sexual harassment may consist of a single intense or severe act or multiple persistent or pervasive acts.

 

b. REPORTS TO THIRD PARTIES. Rehabilitation counselors will be accurate, timely, and objective in reporting their professional activities and opinions to appropriate third parties including courts, health insurance companies, those who are the recipients of evaluation reports, and others.

 

c. MEDIA PRESENTATIONS. When rehabilitation counselors provide advice or comment by means of public lectures, demonstrations, radio or television programs, prerecorded tapes, printed articles, mailed material, or other media, they will take reasonable precautions to ensure that (1) the statements are based on appropriate professional counseling literature and practice; (2) the statements are otherwise consistent with the Code of Professional Ethics for Rehabilitation Counselors; and (3) the recipients of the information are not encouraged to infer that a professional rehabilitation counseling relationship has been established.

 

d. CONFLICTS OF INTEREST. Rehabilitation counselors will not use their professional positions to seek or receive unjustified personal gains, sexual favors, unfair advantage, or unearned goods or services.

 

e. DISHONESTY. Rehabilitation counselors will not engage in any act or omission of a dishonest, deceitful or fraudulent nature in the conduct of their professional activities.

D.7. RESPONSIBILITY TO OTHER PROFESSIONALS

 

a. DISPARAGING COMMENTS. Rehabilitation counselors will not discuss in a disparaging way the competency of other professionals or agencies, or the findings made, the methods used, or the quality of rehabilitation plans.

b. PERSONAL PUBLIC STATEMENTS. When making personal statements in a public context, rehabilitation counselors will clarify that they are speaking from their personal perspectives and that they are not speaking on behalf of all rehabilitation counselors or the profession.

 

c. CLIENTS SERVED BY OTHERS. When rehabilitation counselors learn that their clients have an ongoing professional relationship with another rehabilitation or treating professional, they will request release from clients to inform the other professionals and strive to establish positive and collaborative professional relationships. File reviews, second-opinion services, and other indirect services are not considered ongoing professional services.

SECTION E: RELATIONSHIPS WITH OTHER PROFESSIONALS

E.1. RELATIONSHIPS WITH EMPLOYERS AND EMPLOYEES

 

a. NEGATIVE CONDITIONS. Rehabilitation counselors will alert their employers to conditions that may be potentially disruptive or damaging to the counselor's professional responsibilities or that may limit their effectiveness.

 

b. EVALUATION. Rehabilitation counselors will submit regularly to professional review and evaluation by their supervisor or the appropriate representative of the employer.

 

c. DISCRIMINATION. Rehabilitation counselors, as either employers or employees, will engage in fair practices with regard to hiring, promotion, or training.

 

d. EXPLOITATIVE RELATIONSHIPS. Rehabilitation counselors will not engage in exploitative relationships with individuals over whom they have supervisory, evaluative, or instructional control or authority.

 

e. EMPLOYER POLICIES. In those instances where rehabilitation counselors are critical of policies, they will attempt to affect change through constructive action within the organization. Where such change cannot be affected, rehabilitation counselors will take appropriate further action. Such action may include referral to appropriate certification, accreditation, or state licensure organizations or termination of employment..11

E.2. CONSULTATION

 

a. CONSULTATION AS AN OPTION. Rehabilitation counselors may choose to consult with professionally competent persons about their clients. In choosing consultants, rehabilitation counselors will avoid placing the consultant in a conflict of interest situation that will preclude the consultant from being a proper party to the counselor's efforts to help the client. If rehabilitation counselors are engaged in a work setting that compromises this consultation standard, they will consult with other professionals whenever possible to consider justifiable alternatives.

 

b. CONSULTANT COMPETENCY. Rehabilitation counselors will be reasonably certain that they have, or the organization represented has, the necessary competencies and resources for giving the kind of consulting services needed and that appropriate referral resources are available.

E.3. AGENCY AND TEAM RELATIONSHIPS

 

a. CLIENT AS A TEAM MEMBER. Rehabilitation counselors will ensure that clients and/or their legally recognized representative are afforded the opportunity for full participation in their own treatment team.

 

b. COMMUNICATION. Rehabilitation counselors will ensure that there is fair mutual understanding of the rehabilitation plan by all agencies cooperating in the rehabilitation of clients and that any rehabilitation plan is developed with such mutual understanding.

 

c. DISSENT. Rehabilitation counselors will abide by and help to implement team decisions in formulating rehabilitation plans and procedures, even when not personally agreeing with such decisions, unless these decisions breach the Code.

 

d. REPORTS. Rehabilitation counselors will attempt to secure from other specialists appropriate reports and

evaluations, when such reports are essential for rehabilitation planning and/or service delivery.

SECTION F: EVALUATION, ASSESSMENT, AND INTERPRETATION

F.1. INFORMED CONSENT

 

a. EXPLANATION TO CLIENTS. Prior to assessment, rehabilitation counselors will explain the nature and purposes of assessment and the specific use of results in language the client (or other legally authorized person on behalf of the client) can understand. Regardless of whether scoring and interpretation are
completed by rehabilitation counselors, by assistants, or by computer or other outside services, rehabilitation counselors will take reasonable steps to ensure that appropriate explanations are given to the client.

 

b. RECIPIENTS OF RESULTS. The client's welfare, explicit understanding, and prior agreement will determine the recipients of test results. Rehabilitation counselors will include accurate and appropriate interpretations with any release of test results.

F.2. RELEASE OF INFORMATION TO COMPETENT PROFESSIONALS

 

a. MISUSE OF RESULTS. Rehabilitation counselors will not misuse assessment results, including test results and interpretations, and will take reasonable steps to prevent the misuse of such by others.

 

b. RELEASE OF RAW DATA. Rehabilitation counselors will ordinarily release data (e.g., protocols, counseling or interview notes, or questionnaires) in which the client is identified only with the consent of the client or the client's legal representative. Such data will be released only to persons recognized by rehabilitation
counselors as competent to interpret the data..12

F.3. RESEARCH AND TRAINING

 

a. DATA DISGUISE REQUIRED. Use of data derived from counseling relationships for purposes of training, research, or publication will be confined to content that is disguised to ensure the anonymity of the individuals involved.

 

b. AGREEMENT FOR IDENTIFICATION. Identification of a client in a presentation or publication will be permissible only when the client has agreed in writing to its presentation or publication.

F.4. PROPER DIAGNOSIS OF MENTAL DISORDERS

 

a. PROPER DIAGNOSIS. Rehabilitation counselors qualified to provide proper diagnosis of mental disorders will take special care when doing so. Assessment techniques (including personal interview) used to determine client care (e.g., locus of treatment, type of treatment, or recommended follow-up) will be carefully selected and appropriately used.

 

b. CULTURAL SENSITIVITY. Disability, socioeconomic, and cultural experience of clients will be considered when diagnosing mental disorders.

F.5. COMPETENCE TO USE AND INTERPRET TESTS

 

a. LIMITS OF COMPETENCE. Rehabilitation counselors will recognize the limits of their competence and perform only those testing and assessment services for which they have been trained. They will be familiar with reliability, validity, related standardization, error of measurement, and proper application of any technique utilized. Rehabilitation counselors using computer-based test interpretations will be trained in the construct being measured and the specific instrument being used prior to using this type of computer application.
Rehabilitation counselors will take reasonable measures to ensure the proper use of psychological assessment techniques by persons under their supervision.

 

b. APPROPRIATE USE. Rehabilitation counselors will be responsible for the appropriate application, scoring, interpretation, and use of assessment instruments, whether they score and interpret such tests themselves or use computerized or other services.

 

c. DECISIONS BASED ON RESULTS. Rehabilitation counselors will be responsible for decisions involving individuals or policies that are based on assessment results and will have a thorough understanding of educational and psychological measurement, including validation criteria, test research, and guidelines for test development and use.

 

d. ACCURATE INFORMATION. Rehabilitation counselors will provide accurate information and avoid false claims or misconceptions when making statements about assessment instruments or techniques. Special efforts will be made to avoid utilizing test results to make inappropriate diagnoses or inferences.

F.6. TEST SELECTION

 

a. APPROPRIATENESS OF INSTRUMENTS. Rehabilitation counselors will carefully consider the validity, reliability, psychometric limitations, and appropriateness of instruments when selecting tests for use in a given situation or with a particular client.

 

b. REFERRAL INFORMATION. If a client is referred to a third party provider for testing, the rehabilitation counselor will provide specific referral questions and sufficient objective data about the client so as to ensure that appropriate test instruments are utilized.

 

c. CULTURALLY DIVERSE POPULATIONS. Rehabilitation counselors will be cautious when selecting tests for disability or culturally diverse populations to avoid inappropriateness of testing that may be outside of socialized behavioral or cognitive patterns or functional abilities..13

 

d. NORM DIVERGENCE. Rehabilitation counselors will be cautious in using assessment techniques, making evaluations, and interpreting the performance of populations not represented in the norm group on which an instrument was standardized and will disclose such information.

F.7. CONDITIONS OF TEST ADMINISTRATION

 

a. ADMINISTRATION CONDITIONS. Rehabilitation counselors will administer tests under the same conditions that were established in the test standardization. When tests are not administered under standard conditions, as may be necessary to accommodate modifications for clients with disabilities or when unusual behavior or irregularities occur during the testing session, those conditions will be noted in interpretation.

 

b. COMPUTER ADMINISTRATION. When a computer or other electronic methods are used for test administration, rehabilitation counselors will be responsible for ensuring that programs function properly to provide clients
with accurate results.

 

c. UNSUPERVISED TEST-TAKING. Rehabilitation counselors will not permit unsupervised or inadequately supervised use of tests or assessments unless the tests or assessments are designed, intended, and validated for self-administration and/or scoring.

F.8. TEST SCORING AND INTERPRETATION

 

a. REPORTING RESERVATIONS. In reporting assessment results, rehabilitation counselors will indicate any reservations that exist regarding validity or reliability because of the circumstances of the assessment or the inappropriateness of the norms for the person tested.

 

b. DIVERSITY IN TESTING. Rehabilitation counselors will place test results and their interpretations in proper perspective considering other relevant factors including age, color, culture, disability, ethnic group, gender, race, religion, sexual orientation, marital status, and socioeconomic status.

 

c. RESEARCH INSTRUMENTS. Rehabilitation counselors will exercise caution when interpreting the results of research instruments possessing insufficient technical data to support respondent results. The specific purposes for the use of such instruments will be stated explicitly to the examinee.

 

d. TESTING SERVICES. Rehabilitation counselors who provide test scoring and test interpretation services to support the assessment process will confirm the validity of such interpretations. The interpretation of assessment data will be related to the particular goals of evaluation. Rehabilitation counselors will accurately describe the purpose, norms, validity, reliability, and applications of the procedures and any special qualifications applicable to their use.

 

e. AUTOMATED TESTING SERVICES. The public offering of an automated test interpretation service will be considered a professional-to-professional consultation. The formal responsibility of the consultant will be to the consultee, but the ultimate and overriding responsibility will be to the client.

F.9. TEST SECURITY

Rehabilitation counselors will maintain the integrity and security of tests and other assessment techniques consistent with legal and contractual obligations. Rehabilitation counselors will not appropriate, reproduce, or modify published tests or parts thereof without acknowledgment and permission from the publisher.

 

F.10. OBSOLETE TESTS AND OUTDATED TEST RESULTS

Rehabilitation counselors will not use data or test results that are obsolete or outdated for the current purpose.
Rehabilitation counselors will make every effort to prevent the misuse of obsolete measures and test data by others.

 

F.11. TEST CONSTRUCTION

Rehabilitation counselors will use established scientific procedures, relevant standards, and current professional knowledge for test design in the development, publication, and utilization of educational and psychological assessment techniques.

F.12. FORENSIC EVALUATION

When providing forensic evaluations, the primary obligation of rehabilitation counselors will be to produce objective findings that can be substantiated based on information and techniques appropriate to the evaluation, which may include examination of the individual with a disability and/or review of records. Rehabilitation
counselors will define the limits of their reports or testimony, especially when an examination of the individual with a disability has not been conducted.

 

SECTION G: TEACHING, TRAINING, AND SUPERVISION

G.1. REHABILITATION COUNSELOR EDUCATORS AND TRAINERS

a. RELATIONSHIP BOUNDARIES WITH STUDENTS AND SUPERVISEES. Rehabilitation counselors will clearly define and maintain ethical, professional, and social relationship boundaries with their students and supervisees. They will be aware of the differential in power that exists and the student or supervisee's possible incomprehension of that power differential. Rehabilitation counselors will explain to students and supervisees the potential for the relationship to become exploitive.

 

b. SEXUAL RELATIONSHIPS. Rehabilitation counselors will not engage in sexual relationships with students or supervisees and will not subject them to sexual harassment.

 

c. SUPERVISION PREPARATION. Rehabilitation counselors will supervise only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience. Rehabilitation counselors who are doctoral students serving as practicum or internship supervisors will be adequately prepared and supervised by the training program.

 

d. RESPONSIBILITY FOR SERVICES TO CLIENTS. Rehabilitation counselors who supervise the rehabilitation counseling services of others will perform direct supervision sufficient to ensure that rehabilitation counseling services provided to clients are adequate and do not cause harm to the client.

 

e. ENDORSEMENT. Rehabilitation counselors will not endorse students or supervisees for certification, licensure, employment, or completion of an academic or training program if they believe students or supervisees are not qualified for the endorsement. Rehabilitation counselors will take reasonable steps to assist students or supervisees who are not qualified for endorsement to become qualified.

G.2. REHABILITATION COUNSELOR EDUCATION AND TRAINING PROGRAMS

 

a. ORIENTATION. Prior to admission, rehabilitation counselor educators will orient prospective students to the counselor education or training program's expectations, including but not limited to the following: (1) the type and level of skill acquisition required for successful completion of the training, (2) subject matter to be covered, (3) basis for evaluation, (4) training components that encourage self-growth or self-disclosure as part of the training process, (5) the type of supervision settings and requirements of the sites for required clinical field experiences, (6) student evaluation and dismissal policies and procedures, and (7) up-to-date employment prospects for graduates.

 

b. EVALUATION. Rehabilitation counselor educators will clearly state, in advance of training, to students and internship supervisees, the levels of competency expected, appraisal methods, and timing of evaluations for both didactic and experiential components. Rehabilitation counselor educators will provide students and internship supervisees with periodic performance appraisal and evaluation feedback throughout the training program.

 

c. TEACHING ETHICS. Rehabilitation counselor educators will teach students and internship supervisees the ethical responsibilities and standards of the profession and the students' and supervisees' professional ethical responsibilities.

 

d. PEER RELATIONSHIPS. When students are assigned to lead counseling groups or provide clinical supervision for their peers, rehabilitation counselor educators will take steps to ensure that students placed in these roles do not have personal or adverse relationships with peers and that they understand they have the same ethical obligations as counselor educators, trainers, and supervisors. Rehabilitation counselor educators will make every effort to ensure that the rights of peers are not compromised when students are assigned to lead counseling groups or provide clinical supervision.

 

e. VARIED THEORETICAL POSITIONS. Rehabilitation counselor educators will present varied theoretical positions so that students may make comparisons and have opportunities to develop their own positions. Rehabilitation counselor educators will provide information concerning the scientific bases of professional
practice.

 

f. FIELD PLACEMENTS. Rehabilitation counselor educators will develop clear policies within their training program regarding field placement and other clinical experiences. Rehabilitation counselor educators will provide clearly stated roles and responsibilities for the student and the site supervisor. Rehabilitation counselor educators will confirm that site supervisors will be qualified to provide supervision and are informed of their professional and ethical responsibilities in this role. Rehabilitation counselor educators will not accept any form of professional services, fees, commissions, reimbursement, or remuneration from a site for student placement.

 

g. DIVERSITY IN PROGRAMS. Rehabilitation counselor educators will respond to their institution and program's recruitment and retention needs for training program administrators, faculty, and students with diverse backgrounds and special needs.

G.3. STUDENTS AND SUPERVISEES

 

a. LIMITATIONS. Rehabilitation counselors, through ongoing evaluation and appraisal, will be aware of the academic and personal limitations of students and supervisees that might impede performance. Rehabilitation counselors will assist students and supervisees in securing remedial assistance when needed, and will dismiss students or supervisees who are unable to provide competent service due to academic or personal limitations. Rehabilitation counselors will seek professional consultation and document their decision to dismiss or to refer students or supervisees for assistance. Rehabilitation counselors will advise students and supervisees of appeals processes as appropriate.

 

b. SELF-GROWTH EXPERIENCES. Rehabilitation counselor educators, when designing training groups or other experiences conducted by the rehabilitation counselor educators themselves, will inform students of the potential risks of self-disclosure. Rehabilitation counselor educators will respect the privacy of students by not requiring self-disclosure that could reasonably be expected to be harmful and student evaluation criteria will not include the level of the student's self-disclosure.

 

c. COUNSELING FOR STUDENTS AND SUPERVISEES. If students or supervisees request counseling, supervisors or rehabilitation counselor educators will provide them with acceptable referrals. Supervisors or rehabilitation counselor educators will not serve as rehabilitation counselors to students or supervisees
over whom they hold administrative, teaching, or evaluative roles unless this is a brief role associated with a training experience.

 

d. CLIENTS OF STUDENTS AND SUPERVISEES. Rehabilitation counselors will make every effort to ensure that clients are aware of the services rendered and the qualifications of the students and supervisees rendering those services. Clients will receive professional disclosure information and will be informed of the limits of confidentiality. Client permission will be obtained in order for the students and supervisees to use any information concerning the counseling relationship in the training process.

 

e. PROFESSIONAL DEVELOPMENT. Rehabilitation counselors who employ or supervise individuals will provide appropriate working conditions, timely evaluations, constructive consultations, and suitable opportunities for experience and training.

SECTION H: RESEARCH AND PUBLICATION

H.1. RESEARCH RESPONSIBILITIES

 

a. USE OF HUMAN PARTICIPANTS. Rehabilitation counselors will plan, design, conduct, and report research in a manner that reflects cultural sensitivity, is culturally appropriate, and is consistent with pertinent ethical principles, federal and state/provincial laws, host institutional regulations, and scientific standards
governing research with human participants.

 

b. DEVIATION FROM STANDARD PRACTICES. Rehabilitation counselors will seek consultation and observe stringent safeguards to protect the rights of research participants when a research problem suggests a deviation from standard acceptable practices.

 

c. PRECAUTIONS TO AVOID INJURY. Rehabilitation counselors who conduct research with human participants will be responsible for the participants' welfare throughout the research and will take reasonable precautions to avoid causing injurious psychological, physical, or social effects to their participants.

 

d. PRINCIPAL RESEARCHER RESPONSIBILITY. While ultimate responsibility for ethical research practice lies with the principal researcher, rehabilitation counselors involved in the research activities will share ethical obligations and bear full responsibility for their own actions.

 

e. MINIMAL INTERFERENCE. Rehabilitation counselors will take precautions to avoid causing disruptions in participants' lives due to participation in research.

 

f. DIVERSITY. Rehabilitation counselors will be sensitive to diversity and research issues with culturally diverse populations and they will seek consultation when appropriate.

H.2. INFORMED CONSENT

 

a. TOPICS DISCLOSED. In obtaining informed consent for research, rehabilitation counselors will use language that is understandable to research participants and that (1) accurately explains the purpose and procedures to be followed; (2) identifies any procedures that are experimental or relatively untried; (3) describes the attendant discomforts and risks; (4) describes the benefits or changes in individuals or organizations that might reasonably be expected; (5) discloses appropriate alternative procedures that would be advantageous for participants; (6) offers to answer any inquiries concerning the procedures; (7) describes any limitations of confidentiality; and (8) instructs that participants are free to withdraw their consent and to discontinue participation in the project at any time.

 

b. DECEPTION. Rehabilitation counselors will not conduct research involving deception unless alternative procedures are not feasible and the prospective value of the research justifies the deception. When the methodological requirements of a study necessitate concealment or deception, the investigator will be required to explain clearly the reasons for this action as soon as possible..17

 

c. VOLUNTARY PARTICIPATION. Participation in research is typically voluntary and without any penalty for refusal to participate. Involuntary participation will be appropriate only when it can be demonstrated that participation will have no harmful effects on participants and is essential to the investigation.

 

d. CONFIDENTIALITY OF INFORMATION. Information obtained about research participants during the course of an investigation will be confidential. When the possibility exists that others may obtain access to such information, ethical research practice requires that the possibility, together with the plans for protecting confidentiality, will be explained to participants as a part of the procedure for obtaining informed consent.

 

e. PERSONS INCAPABLE OF GIVING INFORMED CONSENT. When a person is incapable of giving informed consent, rehabilitation counselors will provide an appropriate explanation, obtain agreement for participation, and obtain appropriate consent from a legally authorized person.

 

f. COMMITMENTS TO PARTICIPANTS. Rehabilitation counselors will take reasonable measures to honor all commitments to research participants.

 

g. EXPLANATIONS AFTER DATA COLLECTION. After data are collected, rehabilitation counselors will provide participants with full clarification of the nature of the study to remove any misconceptions. Where scientific or human values justify delaying or withholding information, rehabilitation counselors will take reasonable measures to avoid causing harm.

 

h. AGREEMENTS TO COOPERATE. Rehabilitation counselors who agree to cooperate with another individual in research or publication will incur an obligation to cooperate as agreed.

 

i. INFORMED CONSENT FOR SPONSORS. In the pursuit of research, rehabilitation counselors will give sponsors, institutions, and publication channels the same opportunity for giving informed consent that they accord to individual research participants. Rehabilitation counselors will be aware of their obligation to future researchers and will ensure that host institutions are given feedback information and proper acknowledgment.

H.3. REPORTING RESULTS

 

a. INFORMATION AFFECTING OUTCOME. When reporting research results, rehabilitation counselors will explicitly mention all variables and conditions known to the investigator that may have affected the outcome of a study or the interpretation of data.

 

b. ACCURATE RESULTS. Rehabilitation counselors will plan, conduct, and report research accurately and in a manner that minimizes the possibility that results will be misleading. They will provide thorough discussions of the limitations of their data and alternative hypotheses. Rehabilitation counselors will not engage in
fraudulent research, distort data, misrepresent data, or deliberately bias their results.

 

c. OBLIGATION TO REPORT UNFAVORABLE RESULTS. Rehabilitation counselors will make available the results of any research judged to be of professional value even if the results reflect unfavorably on institutions, programs, services, prevailing opinions, or vested interests.

 

d. IDENTITY OF PARTICIPANTS. Rehabilitation counselors who supply data, aid in the research of another person, report research results, or make original data available will take due care to disguise the identity of respective participants in the absence of specific authorization from the participants to do otherwise.

 

e. REPLICATION STUDIES. Rehabilitation counselors will be obligated to make sufficient original research data available to qualified professionals who may wish to replicate the study..18

H.4. PUBLICATION

a. RECOGNITION OF OTHERS. When conducting and reporting research, rehabilitation counselors will be familiar with and give recognition to previous work on the topic, observe copyright laws, and give full credit to those to whom credit is due.

 

b. CONTRIBUTORS. Rehabilitation counselors will give credit through joint authorship, acknowledgment, footnote statements, or other appropriate means to those who have contributed significantly to research or concept development in accordance with such contributions. The principal contributor will be listed first and minor technical or professional contributions are acknowledged in notes or introductory statements.

 

c. STUDENT RESEARCH. For an article that is substantially based on a student's dissertation or thesis, the student will be listed as the principal author.

 

d. DUPLICATE SUBMISSION. Rehabilitation counselors will submit manuscripts for consideration to only one journal at a time. Manuscripts that are published in whole or in substantial part in another journal or published work will not be submitted for publication without acknowledgment and permission from the previous publication.

 

e. PROFESSIONAL REVIEW. Rehabilitation counselors who review material submitted for publication, research, or other scholarly purposes will respect the confidentiality and proprietary rights of those who submitted it.

 

SECTION I: ELECTRONIC COMMUNICATION AND EMERGING APPLICATIONS

I.1. COMMUNICATION

a. COMMUNICATION TOOLS. Rehabilitation counselors will be held to the same level of expected behavior as defined by the Code of Professional Ethics for Rehabilitation Counselors regardless of the form of communication they choose to use (i.e., cellular phones, electronic mail, facsimile, video, audio-visual).

 

b. IMPOSTERS. In situations where it is difficult to verify the identity of the rehabilitation counselor, the client, or the client's guardian, rehabilitation counselors will take steps to address imposter concerns, such as using code words, numbers, or graphics.

 

c. CONFIDENTIALITY. Rehabilitation counselors will ensure that clients are provided sufficient information to adequately address and explain the limits of: (1) computer technology in the counseling process in general; and (2) the difficulties of ensuring complete client confidentiality of information transmitted through
electronic communication over the Internet through on-line counseling.

I.2. COUNSELING RELATIONSHIP

 

a. ETHICAL/LEGAL REVIEW. Rehabilitation counselors will review pertinent legal and ethical codes for possible violations emanating from the practice of distance counseling and supervision. Distance counseling is defined as any counseling that occurs at a distance through electronic means, such as web-counseling,
tele-counseling, or video-counseling.

 

b. SECURITY. Rehabilitation counselors will use encryption methods whenever possible. If encryption is not made available to clients, clients must be informed of the potential hazards of unsecured communication on the Internet. Hazards may include authorized or unauthorized monitoring of transmissions and/or
records of sessions.

 

c. RECORDS PRESERVATION. Rehabilitation counselors will inform clients whether the records are being preserved, how they are being preserved, and how long the records are being maintained.

 

d. SELF-DESCRIPTION. Rehabilitation counselors will provide information about themselves as would be available if the counseling were to take place face-to-face (e.g., possibly ethnicity or gender)..19

 

e. CONSUMER PROTECTION. Rehabilitation counselors will provide information to the client regarding all appropriate certification bodies and licensure boards to facilitate consumer protection, such as links to websites.

 

f. CRISIS CONTACT. Rehabilitation counselors will provide the name of at least one agency or counselor-on-call for purposes of crisis intervention within the client's geographical region.

 

g. UNAVAILABILITY. Rehabilitation counselors will provide clients with instructions for contacting them when they are unavailable through electronic means.

 

h. INAPPROPRIATE USE. Rehabilitation counselors will mention at their websites or in their initial contacts with potential clients those presenting problems they believe to be inappropriate for distance counseling.

 

i. TECHNICAL FAILURE. Rehabilitation counselors will explain to clients the possibility of technology failure and will provide an alternative means of communication.

 

j. POTENTIAL MISUNDERSTANDINGS. Rehabilitation counselors will explain to clients how to prevent and address potential misunderstandings arising from the lack of visual cues and voice intonations from the counselor or client.

SECTION J: BUSINESS PRACTICES

J.1. BILLING

 

Rehabilitation counselors will establish and maintain billing records that accurately reflect the services provided and the time engaged in the activity, and that clearly identify who provided the service.

J.2. TERMINATION

 

Rehabilitation counselors in fee for service relationships may terminate services with clients due to nonpayment of fees under the following conditions: a) the client was informed of payment responsibilities and the effects of nonpayment or the termination of payment by a third party, and b) the client does not pose an imminent danger to self or others. As appropriate, rehabilitation counselors will refer clients to another qualified professional to address issues unresolved at the time of termination.

J.3. CLIENT RECORDS

 

a. ACCURATE DOCUMENTATION. Rehabilitation counselors will establish and will maintain documentation that accurately reflects the services provided and that identifies who provided the service. If case notes need to be altered, it will be done so in a manner that preserves the original note and will be accompanied by the date of change, information that identifies who made the change, and the rationale for the change.

 

b. SUFFICIENT DOCUMENTATION. Rehabilitation counselors will provide sufficient documentation in a timely manner (e.g., case notes, reports, plans).

 

c. PRIVACY. Documentation generated by rehabilitation counselors will protect the privacy of clients to the extent that it is possible and appropriate, and will include only relevant information..20

 

d. MAINTENANCE. Rehabilitation counselors will maintain records necessary for rendering professional services to their clients and as required by applicable laws, regulations, or agency/institution procedures. Subsequent to file closure, records will be maintained for the number of years consistent with jurisdictional requirements or for a longer period during which maintenance of such records is necessary or helpful to provide reasonably anticipated future services to the client. After that time, records will be destroyed in a manner assuring preservation of confidentiality.

J.4. FEES AND BARTERING

 

a. ADVANCE UNDERSTANDING. Rehabilitation counselors will clearly explain to clients, prior to entering the counseling relationship, all financial arrangements related to professional services including the use of collection agencies or legal measures for nonpayment.

 

b. ESTABLISHING FEES. In establishing fees for professional rehabilitation counseling services, rehabilitation counselors will consider the financial status and locality of clients. In the event that the established fee structure is inappropriate for a client, assistance will be provided in attempting to find comparable services of acceptable cost.

 

c. BARTERING DISCOURAGED. Rehabilitation counselors will ordinarily refrain from accepting goods or services from clients in return for rehabilitation counseling services because such arrangements create inherent potential for conflicts, exploitation, and distortion of the professional relationship. Rehabilitation counselors will participate in bartering only if the relationship is not exploitative, if the client requests it, if a clear written contract is established, and if such arrangements are an accepted practice in the client's community or culture.

J.5. FEES FOR REFERRAL

 

a. ACCEPTING FEES FROM AGENCY CLIENTS. Rehabilitation counselors will not accept a private fee or other remuneration for rendering services to persons who are entitled to such services through the rehabilitation counselor's employing agency or institution. However, the policies of a particular agency may make explicit provisions for agency clients to receive rehabilitation counseling services from members of its staff in private practice. In such instances, the clients will be informed of other options open to them should they seek private rehabilitation counseling services.

 

b. REFERRAL FEES. Rehabilitation counselors will neither give nor receive commissions, rebates or any other form of remuneration when referring clients for professional services.

SECTION K: RESOLVING ETHICAL ISSUES

K.1. KNOWLEDGE OF STANDARDS

 

Rehabilitation counselors are responsible for learning the Code and should seek clarification of any standard that is not understood. Lack of knowledge or misunderstanding of an ethical responsibility will not be used as a defense against a charge of unethical conduct.

K.2. SUSPECTED VIOLATIONS

 

a. CONSULTATION. When uncertain as to whether a particular situation or course of action may be in violation of the Code of Professional Ethics for Rehabilitation Counselors, rehabilitation counselors will consult with other rehabilitation counselors who are knowledgeable about ethics, with colleagues, and/or with appropriate authorities, such as CRCC, state licensure boards, or legal counsel..

 

b. ORGANIZATION CONFLICTS. If the demands of an organization with which rehabilitation counselors are affiliated pose a conflict with the Code of Professional Ethics for Rehabilitation Counselors, rehabilitation counselors will specify the nature of such conflicts and express to their supervisors or other responsible officials their commitment to the Code of Professional Ethics for Rehabilitation Counselors. When possible, rehabilitation counselors will work toward change within the organization to allow full adherence to the Code of Professional Ethics for Rehabilitation Counselors.

 

c. INFORMAL RESOLUTION. When rehabilitation counselors have reasonable cause to believe that another rehabilitation counselor is violating an ethical standard, they will attempt to resolve the issue informally with the other rehabilitation counselor if feasible, providing that such action does not violate confidentiality rights that may be involved.

 

d. REPORTING SUSPECTED VIOLATIONS. When an informal resolution is not appropriate or feasible, rehabilitation counselors, upon reasonable cause, will take action such as reporting the suspected ethical violation to state or national ethics committees or CRCC, unless this action conflicts with confidentiality
rights that cannot be resolved.

 

e. UNWARRANTED COMPLAINTS. Rehabilitation counselors will not initiate, participate in, or encourage the filing of ethics complaints that are unwarranted or intended to harm a rehabilitation counselor rather than to protect clients or the public.

K.3. COOPERATION WITH ETHICS COMMITTEES

Rehabilitation counselors will assist in the process of enforcing the Code of Professional Ethics for Rehabilitation Counselors. Rehabilitation counselors will cooperate with investigations, proceedings, and requirements of the CRCC Ethics Committee or ethics committees of other duly constituted associations or
boards having jurisdiction over those charged with a violation.

 

Acknowledgements - CRCC recognizes the American Counseling Association for permitting the Commission to adopt, in part, the ACA Code of Ethics and Standards of Practice.

A copy of CRCC's Guidelines and Procedures for Processing Complaints along with a Complaint Form may be obtained from CRCC's web site at Hwww.crccertification.comH or by contacting CRCC at:

 

CRCC
300 N. Martingale Road, Suite 460

Schaumburg, IL 60173
(847) 944-1325

Adopted: 6/01
Effective: 1/02 21

 

 

Preamble
These Principles of professional conduct for pharmacists are established to guide the pharmacist in his relationship with patients, fellow practitioners, other health professionals and the public.

 

A Pharmacist should hold the health and safety of patients to be of first consideration; he should render to each patient the full measure of his ability as an essential health practitioner.

 

A Pharmacist should never knowingly condone the dispensing, promoting or distributing of drugs or medical devices, or assist therein, which are not of good quality, which do not meet standards required by law or which lack therapeutic value for the patient.

 

A Pharmacist should always strive to perfect and enlarge his professional knowledge. He should utilize and make available this knowledge as may be required in accordance with his best professional judgment.

 

A Pharmacist has the duty to observe the law, to uphold the dignity and honor of the profession, and to accept its ethical principles. He should not engage in any activity that will bring discredit to the profession and should expose, without fear or favor, illegal or unethical conduct in the profession.

 

A Pharmacist should seek at all times only fair and reasonable remuneration for his services. He should never agree to, or participate in, transactions with practitioners of other health professions or any other person under which fees are divided or which may cause financial or other exploitation in connection with the rendering of his professional services.

 

A Pharmacist should respect the confidential and personal nature of his professional records; except where the best interest of the patient requires or the law demands, he should not disclose such information to anyone without proper patient authorization.

 

A Pharmacist should not agree to practice under terms or conditions which tend to interfere with or impair the proper exercise of his professional judgment and skill, which tend to cause a deterioration of the quality of his service or which require him to consent to unethical conduct.

 

A Pharmacist should strive to provide information to patients regarding professional services truthfully, accurately, and fully and should avoid misleading patients regarding the nature, cost, or value of the pharmacist's professional services.

 

A Pharmacist should associate with organizations having for their objective the betterment of the profession of pharmacy; he should contribute of his time and funds to carry on the work of these organizations.

 

Approved by APHA Active and Life members August 1969

Amended December 1975
Revised July 1981

The ethical statements which have historically been subscribed to by the dental profession have had the benefit of the patient as their primary goal. Recognition of this goal, and of the education and training of a dentist, has resulted in society affording to the profession the privilege and obligation of self-government. The Association calls upon members of the profession to be caring and fair in their contact with patients. Although the structure of society may change, the overriding obligation of the dentist will always remain the duty to provide quality care in a competent and timely manner. All members must protect and preserve the high standards of oral health care provided to the public by the profession. They must strive to improve the care delivered - through education, training, research and, most of all, adherence to a stringent code of ethics, structured to meet the needs of the patient.

 

Principle-Section 1:
Service to the Public and Quality of Care

The dentist's primary professional obligation shall be service to the public. The competent and timely delivery of quality care within the bounds of the clinical circumstances presented by the patient, with due consideration being given to the needs and desires of the patient, shall be the most important aspect of that obligation. The same ethical considerations apply whether the dentist engages in fee-for-service, managed care or some other practice arrangement. Dentists may choose to enter into contracts governing the provision of care to a group of patients; however, contract obligations do not excuse dentists from their ethical duty to put the patient's welfare first.

Code of Professional Conduct

1-A. Patient Selection.

While dentists, in serving the public, may exercise reasonable discretion in selecting patients for their practices, dentists shall not refuse to accept patients into their practice or deny dental service to patients because of the patient's race, creed, color, sex, or national origin.

Advisory Opinion

1. A dentist has the general obligation to provide care to those in need. A decision not to provide treatment to an individual because the individual has AIDS or is HIV seropositive, based solely on that fact, is unethical. Decisions with regard to the type of dental treatment provided or referrals made or suggested, in such instances, should be made on the same basis as they are made with other patients, that is, whether the individual dentist believes he or she has need of another's skills, knowledge, equipment or experience and whether the dentist believes, after consultation with the patient's physician if appropriate, the patient's health status would be significantly compromised by the provision of dental treatment.

1-B. Patient Records.

Dentists are obliged to safeguard the confidentiality of patient records. Dentists shall maintain patient records in a manner consistent with the protection of the welfare of the patient. Upon request of a patient or another dental practitioner, dentists shall provide any information that will be beneficial for the future treatment of that patient.

Advisory Opinions

1. A dentist has the ethical obligation on request of either the patient or the patient's new dentist to furnish, either gratuitously or for nominal cost, such dental records or copies or summaries of them, including dental X-rays or copies of them, as will be beneficial for the future treatment of that patient. This obligation exists whether or not the patient's account is paid in full.
2. The dominant theme in Code Section 1-B is the protection of the confidentiality of a patient's records. The statement in this section that relevant information in the records should be released to another dental practitioner assumes that the dentist requesting the information is the patient's present dentist. The former dentist should be free to provide the present dentist with relevant information from the patient's records. This may often be required for the protection of both the patient and the present dentist. There may be circumstances where the former dentist has an ethical obligation to inform the present dentist of certain facts. Dentists should be aware, however, that the laws of the various jurisdictions in the United States are not uniform, and some confidentiality laws appear to prohibit the transfer of pertinent information, such as HIV seropositivity. Absent certain knowledge that the laws of the dentist's jurisdiction permit the forwarding of this information, a dentist should obtain the patient's written permission before forwarding health records which contain information of a sensitive nature, such as HIV seropositivity, chemical dependency or sexual preference. If it is necessary for a treating dentist to consult with another dentist or physician with respect to the patient, and the circumstances do not permit the patient to remain anonymous, the treating dentist should seek the permission of the patient prior to the release of data from the patient's records to the consulting practitioner. If the patient refuses, the treating dentist should then contemplate obtaining legal advice regarding the termination of the dentist/patient relationship.

1-C. Community Service.

Since dentists have an obligation to use their skills, knowledge, and experience for the improvement of the dental health of the public and are encouraged to be leaders in their community, dentists in such service shall conduct themselves in such a manner as to maintain or elevate the esteem of the profession.

 

Advisory Opinion

1. A dentist who becomes ill from any disease or impaired in any way shall, with consultation and advice from a qualified physician or other authority, limit the activities of practice to those areas that do not endanger the patients or members of the dental staff.

1-D. Emergency Service.

Dentists shall be obliged to make reasonable arrangements for the emergency care of their patients of record. Dentists shall be obliged when consulted in an emergency by patients not of record to make reasonable arrangements for emergency care. If treatment is provided, the dentist, upon completion of such treatment, is obliged to return the patient to his or her regular dentist unless the patient expressly reveals a different preference.

1-E. Consultation and Referral.

Dentists shall be obliged to seek consultation, if possible, whenever the welfare of patients will be safeguarded or advanced by utilizing those who have special skills, knowledge, and experience. When patients visit or are referred to specialists or consulting dentists for consultation:

1. The specialists or consulting dentists upon completion of their care shall return the patient, unless the patient expressly reveals a different preference, to the referring dentist, or if none, to the dentist of record for future care.
2. The specialists shall be obliged when there is no referring dentist and upon a completion of their treatment to inform patients when there is a need for further dental care.

Advisory Opinion

1. A dentist who has a patient referred by a third party for a "second opinion" regarding a diagnosis or treatment plan recommended by the patient's treating dentist should render the requested second opinion in accordance with this Code of Ethics.

2. In the interest of the patient being afforded quality care, the dentist rendering the second opinion should not have a vested interest in the ensuing recommendation.

1-F. Child Abuse.

Dentists shall be obliged to become familiar with the perioral signs of child abuse and to report suspected cases to the proper authorities consistent with state laws.

1-G. Use of Auxiliary Personnel.

Dentists shall be obliged to protect the health of their patient by only assigning to qualified auxiliaries those duties which can be legally delegated. Dentists shall be further obliged to prescribe and supervise the patient care provided by all auxiliary personnel working under their direction.

1-H. Justifiable Criticism.

Dentists shall be obliged to report to the appropriate reviewing agency as determined by the local component or constituent society instances of gross or continual faulty treatment by other dentists. Patients should be informed of their present oral health status without disparaging comment about prior services. Dentists issuing a public statement with respect to the profession shall have a reasonable basis to believe that the comments made are true.

Advisory Opinion

1. A dentist's duty to the public imposes a responsibility to report instances of gross or continual faulty treatment. However, the heading of this section is "Justifiable Criticism." Therefore, when informing a patient of the status of his or her oral health, the dentist should exercise care that the comments made are justifiable. For example, a difference of opinion as to preferred treatment should not be communicated to the patient in a manner which would imply mistreatment. There will necessarily be cases where it will be difficult to determine whether the comments made are justifiable. Therefore, this section is phrased to address the discretion of dentists and advises against disparaging statements against another dentist. However, it should be noted that where comments are made which are obviously not supportable and therefore unjustified, such comments can be the basis for the institution of a disciplinary proceeding against the dentist making such statements.

1-I. Expert Testimony.

Dentists may provide expert testimony when that testimony is essential to a just and fair disposition of a judicial or administrative action.

Advisory Opinion

1. It is unethical for a dentist to agree to a fee contingent upon the favorable outcome of the litigation in exchange for testifying as a dental expert.

1-J. Rebate and Split Fees.

Dentists shall not accept or tender "rebates" or "split fees."

1-K. Representation of Care.

Dentists shall not represent the care being rendered to their patients in a false or misleading manner.

Advisory Opinions

1. Based on available scientific data the ADA has determined through the adoption of Resolution 42H-1986 (Trans. 1986:536) that the removal of amalgam restorations from the non-allergic patient for the alleged purpose of removing toxic substances from the body, when such treatment is performed solely at the recommendation or suggestion of the dentist, is improper and unethical. The Council reminds constituent and component societies that before a dentist can be found to have breached any ethical obligation the dentist is entitled to a fair hearing.
2. A dentist who represents that dental treatment recommended or performed by the dentist has the capacity to cure or alleviate diseases, infections or other conditions, when such representations are not based upon accepted scientific knowledge or research, is acting unethically.

1-L. Representation of Fees.

Dentists shall not represent the fees being charged for providing care in a false or misleading manner.

Advisory Opinions

1. A dentist who accepts a third party* payment under a copayment plan as payment in full without disclosing to the third party* that the patient's payment portion will not be collected, is engaged in overbilling. The essence of this ethical impropriety is deception and misrepresentation; an overbilling dentist makes it appear to the third party* that the charge to the patient for services rendered is higher than it actually is.
2. It is unethical for a dentist to increase a fee to a patient solely because the patient has insurance.
3. Payments accepted by a dentist under a governmentally funded program, a component or constituent dental society sponsored access program, or a participating agreement entered into under a program of a third party* shall not be considered as evidence of overbilling in determining whether a charge to a patient, or to another third party* in behalf of a patient not covered under any of the aforecited programs constitutes overbilling under this section of the Code.
4. A dentist who submits a claim form to a third party* reporting incorrect treatment dates for the purpose of assisting a patient in obtaining benefits under a dental plan, which benefits would otherwise be disallowed, is engaged in making an unethical, false, or misleading representation to such third party.
5. A dentist who incorrectly describes on a third party* claim form a dental procedure in order to receive a greater payment or reimbursement or incorrectly makes a non-covered procedure appear to be a covered procedure on such a claim form is engaged in making an unethical, false, or misleading representation to such third party.
6. A dentist who recommends and performs unnecessary dental services or procedures is engaged in unethical conduct.

*A third party is any party to a dental prepayment contract that may collect premiums, assume financial risks, pay claims, and/or provide administrative services.

1-M. Patient Involvement.

The dentist should inform the patient of the proposed treatment, and any reasonable alternatives, in a manner that allows the patient to become involved in treatment decisions.

1-N. Chemical Dependency.

It is unethical for a dentist to practice while abusing controlled substances, alcohol or other chemical agents which impair the ability to practice. All dentists have an ethical obligation to urge impaired colleagues to seek treatment. Dentists with first-hand knowledge that a colleague is practicing dentistry when so impaired have an ethical responsibility to report such evidence to the professional assistance committee of a dental society.

 

Principle- Section 2:
Education

The privilege of dentists to be accorded professional status rests primarily in the knowledge, skill, and experience with which they serve their patients and society. All dentists, therefore, have the obligation of keeping their knowledge and skill current.

2-A. Disclosure of Conflict of Interest

A dentist who presents educational or scientific information in an article, seminar or other program shall disclose to the readers or participants any monetary or other special interest the dentist may have with a company whose products are promoted or endorsed in the presentation. Disclosure shall be made in any promotional material and in the presentation itself.

 

Principle- Section 3:
Government of a Profession

Every profession owes society the responsibility to regulate itself. Such regulation is achieved largely through the influence of the professional societies. All dentists, therefore, have the dual obligation of making themselves a part of a professional society and of observing its rules of ethics.

 

Principle- Section 4:
Research and Development

Dentists have the obligation of making the results and benefits of their investigative efforts available to all when they are useful in safeguarding or promoting the health of the public.

4-A. Devices and Therapeutic Methods.

Except for formal investigative studies, dentists shall be obliged to prescribe, dispense, or promote only those devices, drugs, and other agents whose complete formulae are available to the dental profession. Dentists shall have the further obligation of not holding out as exclusive any device, agent, method, or technique if that representation would be false or misleading in any material respect.

Advisory Opinions

1. A dentist who suspects the occurrence of an adverse reaction to a drug or dental device has an obligation to communicate that information to the broader medical and dental community, including, in the case of a serious adverse event, the Food and Drug Administration (FDA).
2. Dentists who engage in the sale of dental products to their patients must take care not to exploit the trust inherent in dentist-patient relationship for their own financial gain. Dentists should not induce their patients to buy a dental product by misrepresenting the product's therapeutic value. It is not enough for the dentist to rely on the manufacturer's representations about a product's safety and efficacy. The dentist has an independent obligation to enquire into the truth and accuracy of the manufacturer's claims and verify that they are founded on accepted scientific knowledge or research. Dentists should disclose to their patients all relevant information the patient needs to make an informed purchase decision, including whether the product is available elsewhere.

4-B. Patents and Copyrights.

Patents and copyrights may be secured by dentists provided that such patents and copyrights shall not be used to restrict research or practice.

 

Principle- Section 5:
Professional Announcement

In order to properly serve the public, dentists should represent themselves in a manner that contributes to the esteem of the profession. Dentists should not misrepresent their training and competence in any way that would be false or misleading in any material respect.

 

5-A. Advertising.

Although any dentist may advertise, no dentist shall advertise or solicit patients in any form of communication in a manner that is false or misleading in any material respect.

Advisory Opinions

1. If a dental health article, message, or newsletter is published under a dentist's byline to the public without making truthful disclosure of the source and authorship or is designed to give rise to questionable expectations for the purpose of inducing the public to utilize the services of the sponsoring dentist, the dentist is engaged in making a false or misleading representation to the public in a material respect.
2. The Council on Ethics, Bylaws and Judicial Affairs believes it would be of service to the members to provide some insight into the meaning of the term "false or misleading in a material respect." Therefore, the following examples are set forth. These examples are not meant to be all-inclusive. Rather, by restating the concept in alternative language and giving general examples, it is hoped that the membership will gain a better understanding of the term. With this in mind, statements shall be avoided which would: a) contain a material misrepresentation of fact, b) omit a fact necessary to make the statement considered as a whole not materially misleading, c) be intended or be likely to create an unjustified expectation about results the dentist can achieve, and d) contain a material, objective representation, whether express or implied, that the advertised services are superior in quality to those of other dentists, if that representation is not subject to reasonable substantiation.

   Subjective statements about the quality of dental services can also raise ethical concerns. In particular, statements of opinion may be misleading if they are not honestly held, if they misrepresent the qualifications of the holder, or the basis of the opinion, or if the patient reasonably interprets them as implied statements of fact. Such statements will be evaluated on a case by case basis, considering how patients are likely to respond to the impression made by the advertisement as a whole. The fundamental issue is whether the advertisement, taken as a whole, is false or misleading in a material respect.

3. The use of an unearned or non-health degree in any general announcements to the public by a dentist may be a representation to the public which is false or misleading in a material respect. A dentist may use the title Doctor, Dentist, DDS, or DMD, or any additional earned advanced degrees in health service areas. The use of unearned or non-health degrees could be misleading because of the likelihood that it will indicate to the public the attainment of a specialty or diplomats status.

   For purposes of this advisory opinion, an unearned academic degree is one which is awarded by an educational institution not accredited by a generally recognized accrediting body or is an honorary degree. Generally, the use of honorary degrees or non-health degrees should be limited to scientific papers and curriculum vitae. In all instances state law should be consulted. In any review by the council of the use of non-health degrees or honorary degrees, the council will apply the standard of whether the use of such is false or misleading in a material respect.

4. A dentist using the attainment of a fellowship in a direct advertisement to the general public may be making a representation to the public which is false or misleading in a material respect. Such use of a fellowship status may be misleading because of the likelihood that it will indicate to the dental consumer the attainment of a specialty status. However, when such use does not conflict with state law, the attainment of fellowship status may be indicated in scientific papers, curriculum vitae, third party payment forms, and letterhead and stationery which is not used for the direct solicitation of patients. In any review by the council of the use of the attainment of fellowship status, the council will apply the standard of whether the use of such is false or misleading in a material respect.
5. There are two basic types of referral services for dental care: not-for-profit and the commercial.

   The not-for-profit is commonly organized by dental societies or community services. It is open to all qualified practitioners in the area served. A fee is sometimes charged the practitioner to be listed with the service. A fee for such referral services is for the purpose of covering the expenses of the service and has no relation to the number of patients referred.

   In contrast, some commercial referral services restrict access to the referral service to a limited number of dentists in a particular geographic area. Prospective patients calling the service may be referred to a single subscribing dentist in the geographic area and the respective dentist billed for each patient referred. Commercial referral services often advertise to the public stressing that there is no charge for use of the service and the patient may not be informed of the referral fee paid by the dentist. There is a connotation to such advertisements that the referral that is being made is in the nature of a public service.

   A dentist is allowed to pay for any advertising permitted by the Code, but is generally not permitted to make payments to another person or entity for the referral of a patient for professional services. While the particular facts and circumstances relating to an individual commercial referral service will vary, the council believes that the aspects outlined above for commercial referral services violate the Code in that it constitutes advertising which is false or misleading in a material respect and violate the prohibitions in the Code against fee splitting.

6. An advertisement or other communication intended to solicit patients which omits a material fact or facts necessary to put the information conveyed in the advertisement in a proper context can be misleading in a material respect. An advertisement to the public of HIV negative test results, without conveying additional information that will clarify the scientific significance of this fact, is an example of a misleading omission. A dental practice should not seek to attract patients on the basis of partial truths which create a false impression.

5-B. Name of Practice.

Since the name under which a dentist conducts his or her practice may be a factor in the selection process of the patient, the use of a trade name or an assumed name that is false or misleading in any material respect is unethical.

Use of the name of a dentist no longer actively associated with the practice may be continued for a period not to exceed one year.

Advisory Opinion

1. Dentists leaving a practice who authorize continued use of their names should receive competent advice on the legal implications of this action. With permission of a departing dentist, his or her name may be used for more than one year, if, after the one year grace period has expired, prominent notice is provided to the public through such mediums as a sign at the office and a short statement on stationery and business cards that the departing dentist has retired from the practice.

5-C. Announcement of Specialization and Limitation of Practice.

This section and Section 5-D are designed to help the public make an informed selection between the practitioner who has completed an accredited program beyond the dental degree and a practitioner who has not completed such a program.

The special areas of dental practice approved by the American Dental Association and the designation for ethical specialty announcement and limitation of practice are: dental public health, endodontics, oral and maxillofacial pathology, oral and maxillofacial surgery, orthodontics and dentofacial orthopedics, pediatric dentistry, periodontics and prosthodontics.

Dentists who choose to announce specialization should use "specialist in" or "practice limited to" and shall limit their practice exclusively to the announced special area(s) of dental practice, provided at the time of the announcement such dentists have met in each approved specialty for which they announce the existing educational requirements and standards set forth by the American Dental Association.

Dentists who use their eligibility to announce as specialists to make the public believe that specialty services rendered in the dental office are being rendered by qualified specialists when such is not the case are engaged in unethical conduct. The burden of responsibility is on specialists to avoid any inference that general practitioners who are associated with specialists are qualified to announce themselves as specialists.

General Standards.

The following are included within the standards of the American Dental Association for determining the education, experience, and other appropriate requirements for announcing specialization and limitation of practice:

1. The special area(s) of dental practice and an appropriate certifying board must be approved by the American Dental Association.
2. Dentists who announce as specialists must have successfully completed an educational program accredited by the Commission on Dental Accreditation, two or more years in length, as specified by the Council on Dental Education, or be diplomates of an American Dental Association recognized certifying board. The scope of the individual specialist's practice shall be governed by the educational standards for the specialty in which the specialist is announcing.
3. The practice carried on by dentists who announce as specialists shall be limited exclusively to the special area(s) of dental practices announced by the dentist.

Standards for Multiple-Specialty Announcements.

Educational criteria for announcement by dentists in additional recognized specialty areas are the successful completion of an educational program accredited by the Commission on Dental Accreditation in each area for which the dentist wishes to announce.

 

Dentists who completed their advanced education in programs listed by the Council on Dental Education prior to the initiation of the accreditation process in 1967 and who are currently ethically announcing as specialists in a recognized area may announce in additional areas provided they are educationally qualified or are certified diplomates in each area for which they wish to announce. Documentation of successful completion of the educational program(s) must be submitted to the appropriate constituent society. The documentation must assure that the duration of the program(s) is a minimum of two years except for oral and maxillofacial surgery which must have been a minimum of three years in duration

 

Advisory Opinion

1. A dentist who announces in any means of communication with patients or the general public that he or she is certified or a diplomats in an area of dentistry not recognized by the American Dental Association or the law of the jurisdiction where the dentist practices as a specialty area of dentistry is engaged in making a false or misleading representation to the public in a material respect.

5-D. General Practitioner Announcement of Services.

General dentists who wish to announce the services available in their practices are permitted to announce the availability of those services so long as they avoid any communications that express or imply specialization. General dentists shall also state that the services are being provided by general dentists. No dentist shall announce available services in any way that would be false or misleading in any material respect.

 

*Advertising, solicitation of patients or business, or other promotional activities by dentists or dental care delivery organizations shall not be considered unethical or improper, except for those promotional activities which are false or misleading in any material respect. Notwithstanding any ADA Principles of Ethics and Code of Professional Conduct or other standards of dentist conduct which may be differently worded, this shall be the sole standard for determining the ethical propriety of such promotional activities. Any provision of an ADA constituent or component society's code of ethics or other standard of dentist conduct relating to dentists' or dental care delivery organizations' advertising, solicitation, or other promotional activities which is worded differently from the above standard shall be deemed to be in conflict with the ADA Principles of Ethics and Code of Professional Conduct.

Interpretation and Application of Principles of Ethics and Code of Professional Conduct

 

The preceding statements constitute the Principles of Ethics and Code of Professional Conduct of the American Dental Association. The purpose of the Principles and Code is to uphold and strengthen dentistry as a member of the learned professions. The constituent and component societies may adopt additional provisions or interpretations not in conflict with these Principles of Ethics and Code of Professional Conduct which would enable them to serve more faithfully the traditions, customs, and desires of the members of these societies.

 

Problems involving questions of ethics should be solved at the local level within the broad boundaries established in these Principles of Ethics and Code of Professional Conduct and within the interpretation by the component and/or constituent society of their respective codes of ethics. If a satisfactory decision cannot be reached, the question should be referred on appeal to the constituent society and the Council on Ethics, Bylaws and judicial Affairs of the American Dental Association, as provided in Chapter XII of the Bylaws of the American Dental Association. Members found guilty of unethical conduct as prescribed in the American Dental Association Code of Professional Conduct or codes of ethics of the constituent and component societies are subject to the penalties set forth in Chapter XII of the American Dental Association Bylaws.

 

It shall be the ideal, resolve, and duty of all optometrists:

TO KEEP their patients' eye, vision, and general health paramount at all times;

 

TO RESPECT the rights and dignity of patients regarding their health care decisions;

 

TO ADVISE their patients whenever consultation with, or referral to another optometrist or other health professional is appropriate;

 

TO ENSURE confidentiality and privacy of patients' protected health and other personal information;

 

TO STRIVE to ensure that all persons have access to eye, vision, and general health care;

 

TO ADVANCE their professional knowledge and proficiency to maintain and expand competence to benefit their patients;

TO MAINTAIN their practices in accordance with professional health care standards;

 

TO PROMOTE ethical and cordial relationships with all members of the health care community;

 

TO RECOGNIZE their obligation to protect the health and welfare of society; and

 

TO CONDUCT themselves as exemplary citizens and professionals with honesty, integrity, fairness, kindness and compassion.