Legal, Professional, and
Ethical Issues in
Complementary and
Alternative Medicine
Linda Diane Feldt RPP, NCTMB
Herbalist and Holistic Health Practitioner
Understanding
Regulatory Terms and Levels
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Licensure
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Certification
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Practice acts
Title registration
Governmental “state certified”
Private certification (no inherent legal status)
Certification by Reference (govt. accepts private standards)
Approval of Certifying Agencies
 The National Council of Certifying Agencies
 The National Commission for Health Certifying Agencies
Registration
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Frequently used only to allow for use of a title or to identify members of
a professional group
Frequently has the most flexible standards
Can be done privately (by associations, schools, etc.) or by states
Legal, Professional and Ethical Issues
in Complementary and Alternative
Medicine
Levels of Regulation and
Authorization
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Licensing
 local or state level government
Certification
 by state
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by certifying agency (“big C”)
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standards may be developed by the profession and referenced by the state
commonly include eligibility, exam, CE, recertification
by professional association (grey area)
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may include standards, ethics, CE,
may include permission to use trademarked title or name
by individual school or modality (“small c”)
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most often a certificate of completion
may include permission to use trademarked title or name
Registration
 Members of a group or profession must register with state or local
agency to use title Legal, Professional and Ethical Issues
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in Complementary and Alternative
Medicine
Current Examples
of groups using a National
Certification Program
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American Herbalist Guild
Midwives Association of North America
American Organization for Bodywork
Therapies of Asia
The National Certification Board for
Therapeutic Massage and Bodywork
Legal, Professional and Ethical Issues
in Complementary and Alternative
Medicine
Components of a Profession
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Standards for Practice
Standards for Education (training)
Ethics
Scope of Practice
Continuing Education
Membership in a Professional Association
Complaint process
Legal, Professional and Ethical Issues
in Complementary and Alternative
Medicine
Professional Associations
While the exact activities of each association will
vary, they may:
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Sets standards for education
Set standards for practitioners
Create and enforce ethics guidelines
Determine scope of practice
May own and defend trademark
Provide initial and/or continuing education
(continued next slide)
Legal, Professional and Ethical Issues
in Complementary and Alternative
Medicine
Professional Associations
(cont.)
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Be proactive in safeguarding the right to practice for
members
Offer professional liability insurance
Encourage research
Provide a professional journal or newsletter
Provide a practitioner locator service
Provide PR and practice development support
Network with other professional associations
Legal, Professional and Ethical Issues
in Complementary and Alternative
Medicine
Professional Associations
a few of the challenges related to regulation
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Many members have entered the professions part time,
or as an adjunct to another type of practice
Members may not be willing or able to pay high
membership fees, especially if membership is not
required to practice in their locale
Significant resources are being used to protect the right
to practice
Many of these associations are 501 (c ) (3) IRS
designated educational organizations and are restricted
in the resources they can use to affect legislation, and
therefore regulation.
Legal, Professional and Ethical Issues
in Complementary and Alternative
Medicine
Regulation Options and
Realities
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Initiated to address public safety concerns?
Enacted at the local, state, or national level?
Driven by economic opportunity or goals?
Self defined by members of the profession?
Defined by other professions?
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Exclusion
Umbrella provisions
Response to scope of practice/right to practice
concerns
Legal, Professional and Ethical Issues
in Complementary and Alternative
Medicine
Innovative Routes to
Regulation
The Federation of Therapeutic Massage, Bodywork and Somatic Practice Organizations
has produced a consensus document on developing legislation.This document can
be downloaded from www.federationmbs.org
Consumers and Practitioners are promoting legislation to ensure access to alternative
therapies through “Health Freedom” bills. www.nynaturalhealthproject.org
www.californiahealthfreedom.org
www.naturalhealth.org
The World Health Organization is involved in integrating traditional and conventional
medicine www.polity.org.za/html/govdocs/ reports/who/wtms_ch3.pdf
Legal, Professional and Ethical Issues
in Complementary and Alternative
Medicine
Larger Challenges
There are many challenges to regulation of CAM therapies. These include:
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There is no one profession, but hundreds
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More than 200 “hands-on” therapies exist
Unlike most other health care professions, many of the
modalities are trademarked
Consumer right to access to CAM therapies must be
safeguarded
CAM practices often attract renegades
There are exploding opportunities for commercial
exploitation
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Few professions have been subject to such demand and
commercialization before becoming established as professions
Legal, Professional and Ethical Issues
in Complementary and Alternative
Medicine
Additional Challenges
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Some CAM therapies have a religious or spiritual
component, which is not appropriate for regulation
Traditional therapies may have cultural or religious
aspects not easily understood or appropriate for
legislation or even the formality of a professional
association
There is still significant lack of information and
misunderstanding about many CAM therapies
As a “fringe” profession that has become more
mainstream, we still have within our ranks those
practitioners who may lead the next paradigm shift
Legal, Professional and Ethical Issues
in Complementary and Alternative
Medicine
Ethics - just the beginning
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As alternative therapies move from “fringe” to “mainstream” the ethics of
how we practice must also be reviewed and more widely adopted.
There are conflicting ethical standards between professions, and many
CAM practitioners practice a variety of work.
The widespread use of multi level marketing for alternative therapies is an
additional ethical challenge.
The growing use of trademarked movements, therapies, terms, and
teachings has an effect on alternative therapies and who can do and teach
what.
Much of the consumer information on CAM is obtained from ads, popular
press articles, the internet, and other non-professional sources. Ethical
considerations will usually not be included in and promoted by those
sources.
Some of the ways that CAM is practiced would naturally challenge
conventional ethical boundaries.
Legal, Professional and Ethical Issues
in Complementary and Alternative
Medicine
Resources
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http://www.nccaom.org/ has chart of certification and state regulation for asian
therapies
http://www.americanherbalistsguild.com/ links to AHG Certification and Legislative
Issues
http://www.somatic.com/ccsp/certchrt.pdf chart of training requirements for many
modalities
http://www.federationmbs.org Legislative Packet
http://www.ncbtmb.com National Certification Board for Therapeutic Massage and
Bodywork
http://www.ncbtmb.com/handbook/code_of_ethics.htm National Certification Board for
Therapeutic Massage and Bodywork Ethics
http://www.noca.org/ National Organization of Certifying Agencies
http://www.noca.org/ncca/accreditation.htm National Organization of Certifying
Agencies Accreditation Information
http://www.mana.org/ Midwives Association of North America
http://narm.org/ North American Registry of Midwives
http://www.holisticwisdom.org/aaordinance Information opposing Ann Arbor’s
proposed regulation of massage and bodywork
Legal, Professional and Ethical Issues
in Complementary and Alternative
Medicine
Resources
NCCA's Mission
The NCCA helps to ensure the health, welfare, and safety of the public through the
accreditation of a variety of certification programs/organizations that assess
professional competency. The NCCA uses a peer review process to:
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Establish accreditation standards;
Evaluate compliance with the standards;
Recognize organizations/programs which demonstrate compliance; and
Serve as a resource on quality certification.
NCCA's Vision
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The NCCA will be an administratively independent resource recognized as the
authority on accreditation standards for professional certification
organizations/programs. Based on sound principles, NCCA standards will be
optimal and comprehensive criteria for organizational process and performance.
They will be broadly recognized, objective, and current benchmarks for certifying
bodies to achieve and by which they operate.
Legal, Professional and Ethical Issues
in Complementary and Alternative
Medicine
Resources
Pages 40-41 of Essentials of Complementary and
Alternative Medicine for chart of licensing status
of CAM professions by states
Coursepack: Advising Patients Who Seek
Alternative Medical Therapies, Eisenberg -- list
of associations, journals, and more at the end of
this article.
Legal, Professional and Ethical Issues
in Complementary and Alternative
Medicine
Resources (NCCAOM)
NATIONAL CERTIFICATION COMMISSION FOR ACUPUNCTURE AND ORIENTAL MEDICINE
Code of Ethics (Revised May 2001)
All practitioners certified by the National Certification Commission for Acupuncture and Oriental Medicine must be committed to responsible and ethical
practice, to the growth of the profession’s role in the broad spectrum of American health care, and to their own professional growth. Candidates
seeking certification agree to be bound by the NCCAOM Code of Ethics.
Commitment to the Patient
I will:
1.
Respect the rights, dignity, and person of each patient.
2.
Render to each patient the highest quality of care and make timely referrals to other Oriental medicine providers or health care professionals as may
be appropriate.
3.
Avoid treating patients when my judgment or competence is impaired by untreated chemical dependency or physical or mental incapacity reasonably
believed to be hazardous to the safety of the patient.
4.
Accept and treat all those seeking my services in a nondiscriminatory manner.
5.
Keep accurate records of history and treatment and respect the confidentiality of those records or any other personal information imparted by the
patient in accordance with law.
6.
Keep the patient informed by explaining treatments and outcomes and avoid making promises with regard to outcomes that will create inappropriate
expectations.
7.
Follow the U.S. Department of Health and Human Services regulations regarding the protection of human subjects in research studies and clinical
trials (45 CFR Part 46).
8.
Follow U.S. Public Health Service Policy on Humane Care and Use of Laboratory Animals (Office for Protection from Research Risks, National
Institutes of Health, Revised September 1986).
Legal, Professional and Ethical Issues
in Complementary and Alternative
Medicine
Resources (NCCAOM)
Commitment to the Profession
I will:
1.
2.
3.
Continue to work to raise the standards of the profession.
Use appropriate professional mechanisms to report ethical and professional practice violations.
Maintain the highest standard of ethical and professional practice to the benefit of my patients and the profession.
Commitment to the Public
I will:
1.
Provide accurate information regarding my education, training, experience, professional affiliations, and certification
status.
2.
Refrain from making public statements on the efficacy of Oriental medicine that are not supported by the generally
accepted experience of the profession.
3.
Respect the integrity of other forms of health care and other medical traditions and seek to develop collaborative
relationships to achieve the highest quality of care for individual patients.
4.
Refrain from any representation that NCCAOM certification implies licensure or a right to practice unless so
designated by the laws in the jurisdiction in which I practice.
5.
Use only the appropriate professional designations for my credentials.
Legal, Professional and Ethical Issues
in Complementary and Alternative
Medicine
Resources (NCCAOM)
NATIONAL CERTIFICATION COMMISSION FOR ACUPUNCTURE AND ORIENTAL MEDICINE
Grounds for Discipline (Revised May 2001)
Unethical Behavior
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Making false, misleading, or deceptive statements or providing false, misleading, or deceptive information in connection with an application for
NCCAOM certification or recertification or attempting to obtain certification by deceptive or fraudulent means.
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Misrepresenting one’s credentials (education, training, experience, level of competence, skills, and/or certification status).
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Engaging in false, misleading, or deceptive advertising.
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Obtaining or attempting to obtain compensation or reimbursement by fraud or deceit.
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Being the subject of final disciplinary action or being convicted of a felony for a violation of any federal, state, or local statute, regulation, or
ordinance that relates to the practice of acupuncture or Oriental medicine or another health care profession.
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Having a license to practice acupuncture or Oriental medicine or another health care profession limited, suspended, or revoked in any state or
jurisdiction of the United States or its territories and possessions.
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Having a sexual relationship with or engaging in sexual misconduct with a current patient or with a former patient within six months of the time
a professional relationship or treatment ended.
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Cheating or attempting to cheat on NCCAOM examinations.
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Otherwise violating the prevailing standards of the profession relating to the safe, ethical, proficient, and/or competent practice of acupuncture
and Oriental medicine.
Incompetence
Engaging in conduct that evidences a lack of knowledge of, or lack of ability or failure to apply, the prevailing principles and/or skills of the profession for
which the individual has been certified.
Impairment
Being unable to engage in the practice of acupuncture and/or Oriental medicine safely, proficiently, or competently as a result of substance abuse or physical
or psychological impairment. “Impairment” includes, but is not limited to:
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Engaging in the practice of acupuncture or Oriental medicine while one’s ability to practice is impaired by alcohol or other legal or illegal
drugs.
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Engaging in the practice of acupuncture or Oriental medicine while one’s ability to practice is impaired by a physical or mental condition or
disease reasonably believed to be a hazard to the safety of patients.
Legal, Professional and Ethical Issues
in Complementary and Alternative
Medicine