C-16, r. 5 - Code of ethics of chiropractors

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chapter C-16, r. 5
Code of ethics of chiropractors
CHIROPRACTORS — CODE OF ETHNICS
Chiropractic Act
(chapter C-16, s. 3).
C-16
Professional Code
(chapter C-26, s. 87).
C-26
April 4 2013
Replaced, O.C. 163-2013, 2013 G.O. 2, 671; eff. 2013-04-04; see chapter C-16, r. 5.1.
DIVISION I
DEFINITIONS AND INTERPRETATION
1.01. In this Regulation, unless the context indicates otherwise,
(a)  “Order” means the Ordre des chiropraticiens du Québec;
(b)  “chiropractor” means whosoever is entered on the roll of the Order.
R.R.Q., 1981, c. C-16, r. 2, s. 1.01.
1.02. The Interpretation Act (chapter I-16) applies to this Regulation.
R.R.Q., 1981, c. C-16, r. 2, s. 1.02.
DIVISION II
DUTIES AND OBLIGATIONS TOWARDS THE PUBLIC
2.01. The chiropractor must, except for valid reasons, support every measure likely to improve the quality and availability of professional services in the field in which he practises.
R.R.Q., 1981, c. C-16, r. 2, s. 2.01.
2.02. In the practice of his profession, the chiropractor must take into account the foreseeable general consequences which his research and work may have on society.
R.R.Q., 1981, c. C-16, r. 2, s. 2.02.
2.03. The chiropractor must promote measures of education and information in the field in which he practises. He must also, in the practice of his profession, except for valid reasons, perform the necessary acts to ensure such education and information.
R.R.Q., 1981, c. C-16, r. 2, s. 2.03.
DIVISION III
DUTIES AND OBLIGATIONS TOWARDS PATIENTS
§ 1.  — General provisions
3.01.01. The chiropractor must practise his profession in a manner which respects the life, dignity and liberty of his patient.
R.R.Q., 1981, c. C-16, r. 2, s. 3.01.01.
3.01.02. The chiropractor must practise his profession in accordance with the principles recognized by the chiropractic science.
R.R.Q., 1981, c. C-16, r. 2, s. 3.01.02.
3.01.03. Before accepting a mandate, the chiropractor must take into consideration the extent of his aptitudes, proficiency and the means at his disposal. He must not, in particular, undertake treatment for which he is not sufficiently prepared without obtaining the necessary assistance.
R.R.Q., 1981, c. C-16, r. 2, s. 3.01.03.
3.01.04. The chiropractor must at all times acknowledge the right of the patient to consult a colleague, a member of another professional order or another competent person.
R.R.Q., 1981, c. C-16, r. 2, s. 3.01.04.
3.01.05. The chiropractor must not practise his profession under conditions or circumstances or at any place, private or public, likely to impair the quality of his services.
R.R.Q., 1981, c. C-16, r. 2, s. 3.01.05.
3.01.05.1. Screening clinics or examinations shall be located or carried out in places that allow for their proper execution such as chiropractor’s offices, schools, sports facilities and the workplace, excluding shopping centre malls and other similar places.
An examination must be carried out in a closed area so as to respect confidentiality.
O.C. 154-85, s. 1.
3.01.05.2. A screening clinic examination must be capable of determining the need for further chiropractic examinations or treatments and include a questionnaire.
O.C. 154-85, s. 1.
3.01.06. The chiropractor must try to establish a relationship of mutual confidence between himself and his patient. For that purpose, he must, in particular:
(a)  refrain from practising his profession in an impersonal manner;
(b)  give his interviews in such a way as to respect his patient’s scale of values and personal convictions, where the latter informs him thereof.
R.R.Q., 1981, c. C-16, r. 2, s. 3.01.06.
3.01.07. The chiropractor must refrain from intervening in the personal affairs of his patient on subjects which are not under the generally acknowledged competence of the profession, so as not to unduly restrict his patient’s autonomy.
R.R.Q., 1981, c. C-16, r. 2, s. 3.01.07.
3.01.08. Subject to Subdivision 6 respecting professional secrecy, the chiropractor must collaborate with his patient or the patient’s relatives or with any other person in the interest of that patient.
R.R.Q., 1981, c. C-16, r. 2, s. 3.01.08.
§ 2.  — Integrity
3.02.01. A chiropractor must carry out his professional obligations with integrity.
R.R.Q., 1981, c. C-16, r. 2, s. 3.02.01.
3.02.02. The chiropractor must avoid any misrepresentation with respect to his level of competence or to the efficiency of his own services and of those generally provided by the members of his profession. If the good of the patient so requires, he must send the latter to another chiropractor, a member of another professional order or another competent person.
R.R.Q., 1981, c. C-16, r. 2, s. 3.02.02.
3.02.03. The chiropractor must inform his patient as soon as possible of the extent and terms and conditions of the mandate entrusted to him by the latter and obtain his agreement in this respect.
R.R.Q., 1981, c. C-16, r. 2, s. 3.02.03.
3.02.04. The chiropractor must reveal to his client in a complete and objective manner the nature and scope of the problem which, in his opinion, results from the aggregate facts brought to his attention.
R.R.Q., 1981, c. C-16, r. 2, s. 3.02.04.
3.02.05. A chiropractor must not express his opinion or give contradictory or incomplete advice. To that end, he must try to know all the facts before giving an opinion or counsel.
R.R.Q., 1981, c. C-16, r. 2, s. 3.02.05.
3.02.06. A chiropractor must inform his patient as early as possible of any error that might cause the latter prejudice and which cannot be easily rectified made by him while rendering a professional service to that patient.
R.R.Q., 1981, c. C-16, r. 2, s. 3.02.06.
§ 3.  — Availability and diligence
3.03.01. In the practice of his profession, the chiropractor must display reasonable availability and diligence.
R.R.Q., 1981, c. C-16, r. 2, s. 3.03.01.
3.03.02. In addition to opinion and counsel, the chiropractor must furnish his patient with any explanations necessary to the understanding and appreciation of the services he provides him.
R.R.Q., 1981, c. C-16, r. 2, s. 3.03.02.
3.03.03. The chiropractor must be objective and impartial when persons other than his patients ask him for information.
R.R.Q., 1981, c. C-16, r. 2, s. 3.03.03.
3.03.04. Unless he has just and reasonable grounds for so doing, a chiropractor shall not cease to act for the account of a patient. The following shall, in particular, constitute just and reasonable grounds:
(a)  loss of the patient’s confidence;
(b)  the fact that the chiropractor is placed in a situation of conflict of interest or in a circumstance whereby his professional independence could be called in question;
(c)  inducement by the patient to perform illegal, unfair or fraudulent acts.
R.R.Q., 1981, c. C-16, r. 2, s. 3.03.04.
3.03.05. Before he ceases to exercise his functions for the account of a patient, the chiropractor must forward a notice within a reasonable time and ensure that such termination of service is not prejudicial to his patient.
R.R.Q., 1981, c. C-16, r. 2, s. 3.03.05.
§ 4.  — Liability
3.04.01. The chiropractor must, in the practice of his profession, completely bind his personal civil liability. He is thus prohibited from inserting in a contract of professional services any clause directly or indirectly excluding, in whole or in part, the said liability.
R.R.Q., 1981, c. C-16, r. 2, s. 3.04.01.
§ 5.  — Independence and impartiality
3.05.01. The chiropractor must subordinate his personal interest to that of his patient.
R.R.Q., 1981, c. C-16, r. 2, s. 3.05.01.
3.05.02. A chiropractor must ignore any intervention by a third party which could influence the performance of his professional duties to the detriment of his patient.
R.R.Q., 1981, c. C-16, r. 2, s. 3.05.02.
3.05.03. A chiropractor must safeguard his professional independence at all times and avoid any situation which would put him in conflict of interest. Without restricting the generality of the foregoing, a chiropractor is:
(a)  in conflict of interest when the interests concerned are such that he may be influenced to favour certain of them to those of his patient or whereby his judgment and loyalty towards the latter may be unfavourably affected;
(b)  no longer an independent adviser in respect of a given act if he finds a personal advantage, direct or indirect, real or possible, therein.
R.R.Q., 1981, c. C-16, r. 2, s. 3.05.03.
3.05.04. As soon as he ascertains that he is in a situation of conflict of interest, the chiropractor must notify his patient thereof and ask his authorization to continue his mandate.
R.R.Q., 1981, c. C-16, r. 2, s. 3.05.04.
3.05.05. The chiropractor must refrain from sharing his fees with a person who is not a member of the Order or from remitting such fees to him.
R.R.Q., 1981, c. C-16, r. 2, s. 3.05.05.
3.05.06. The chiropractor may share his fees with a colleague only to the extent that such sharing corresponds to a distribution of services and responsibilities.
R.R.Q., 1981, c. C-16, r. 2, s. 3.05.06.
3.05.07. Save for the remuneration to which he is entitled, a chiropractor shall refrain from receiving, paying or agreeing to pay any benefit, rebate or commission in respect of the practice of his profession.
R.R.Q., 1981, c. C-16, r. 2, s. 3.05.07.
3.05.08. For a given service, the chiropractor must only accept fees from a single source, unless explicitly agreed otherwise by all the parties concerned. He shall accept payment of these fees only from his patient or the latter’s representative.
R.R.Q., 1981, c. C-16, r. 2, s. 3.05.08.
3.05.09. The chiropractor shall generally act, in the same matter, for only one of the parties in question. If his professional duties require that he act otherwise, the chiropractor must specify the nature of his responsibilities and must keep all the interested parties informed that he will cease to act if the situation becomes irreconcilable with his duty of impartiality.
R.R.Q., 1981, c. C-16, r. 2, s. 3.05.09.
§ 6.  — Professional secrecy
3.06.01. A chiropractor must respect the secrecy of all confidential information obtained in the practice of his profession.
R.R.Q., 1981, c. C-16, r. 2, s. 3.06.01.
3.06.02. The chiropractor shall be released from professional secrecy only with the authorization of his patient or whenever so ordered by law.
R.R.Q., 1981, c. C-16, r. 2, s. 3.06.02.
3.06.02.01. In addition to the cases provided for in section 3.06.02, a chiropractor may communicate information that is protected by professional secrecy to prevent an act of violence, including a suicide, where the chiropractor has reasonable cause to believe that there is an imminent danger of death or serious bodily injury to a person or an identifiable group of persons.
However, the chiropractor may only communicate the information to the person exposed to the danger or that person’s representative, and to the persons who can come to that person’s aid.
The chiropractor may only communicate such information as is necessary to achieve the purposes for which the information is communicated.
O.C. 1279-2005, s. 1.
3.06.02.02. A chiropractor who communicates information pursuant to section 3.06.02.01 must do so without delay.
For each communication, the chiropractor must also enter the following particulars in the patient’s record:
(1)  the date and time of the communication;
(2)  the name of the person or group of persons exposed to the danger;
(3)  the name of the person to whom the communication was given, specifying, as the case may be, if it was given to the person exposed to the danger, the person’s representative or the persons who can come to that person’s aid;
(4)  the act of violence the chiropractor intended to prevent;
(5)  the danger the chiropractor identified;
(6)  the imminence of the danger the chiropractor identified; and
(7)  the information communicated.
O.C. 1279-2005, s. 1.
3.06.03. A chiropractor must not disclose a request for his service made by a person unless the nature of the case so requires.
R.R.Q., 1981, c. C-16, r. 2, s. 3.06.03.
3.06.04. A chiropractor must avoid indiscreet conversation concerning a patient and the services rendered him.
R.R.Q., 1981, c. C-16, r. 2, s. 3.06.04.
3.06.05. A chiropractor shall not make use of confidential information to the prejudice of a patient or with a view to obtaining, directly or indirectly, a benefit for himself or for another person.
R.R.Q., 1981, c. C-16, r. 2, s. 3.06.05.
§ 7.  — Accessibility of records
3.07.01. A chiropractor must respect the right of his patient to take cognizance of the documents which concern him in any record constituted on his behalf and to obtain a copy of such documents.
R.R.Q., 1981, c. C-16, r. 2, s. 3.07.01.
§ 8.  — Determination and payment of fees
3.08.01. A chiropractor must charge and accept fair and reasonable fees.
R.R.Q., 1981, c. C-16, r. 2, s. 3.08.01.
3.08.02. Fees are fair and reasonable if they are justified by circumstances and are in proportion to the services rendered. The chiropractor must, in particular, take into account the following factors when fixing his fees:
(a)  the time given to the carrying out of the professional service;
(b)  the difficulty and magnitude of the service;
(c)  the performance of unusual services or services requiring exceptional competence or celerity.
R.R.Q., 1981, c. C-16, r. 2, s. 3.08.02.
3.08.03. A chiropractor must provide his patient with all the explanations required for the understanding of his statement of fees and for the terms and conditions of payment.
R.R.Q., 1981, c. C-16, r. 2, s. 3.08.03.
3.08.04. A chiropractor must refrain from demanding advance payment for his services; he must on the other hand, notify his patient of the approximate cost of his services.
R.R.Q., 1981, c. C-16, r. 2, s. 3.08.04.
3.08.05. The chiropractor may collect interest on outstanding accounts only after having duly notified his patient thereof. The interest so charged must be at a reasonable rate.
R.R.Q., 1981, c. C-16, r. 2, s. 3.08.05.
3.08.06. Before having recourse to legal proceedings, a chiropractor must have exhausted all other means at his disposal for obtaining payment of his fees.
R.R.Q., 1981, c. C-16, r. 2, s. 3.08.06.
3.08.07. A chiropractor must not sell his accounts, except to a colleague.
R.R.Q., 1981, c. C-16, r. 2, s. 3.08.07.
3.08.08. When a chiropractor appoints another person to collect his fees, he must ensure that the latter is accustomed to act with tact and moderation.
R.R.Q., 1981, c. C-16, r. 2, s. 3.08.08.
DIVISION IV
DUTIES AND OBLIGATIONS TOWARDS THE PROFESSION
§ 1.  — Incompatible offices and functions
4.01.01. The chiropractor must not hold any financial interest, direct or indirect, in a business whose object is the production or sale of apparatus or products which may be used for chiropractic treatment when the possession of such interest places the chiropractor in a situation of conflict of interest with respect to his patient.
R.R.Q., 1981, c. C-16, r. 2, s. 4.01.01.
§ 2.  — Derogatory acts
4.02.01. In addition to the derogatory acts referred to in sections 57 and 58 of the Professional Code (chapter C-26), the following are derogatory to the dignity of the profession:
(a)  pressing or repeated inducement to resort to his own professional services;
(b)  direct or indirect interference with the liberty of the patient to select his chiropractor;
(c)  administering treatment which is not required from a chiropractic point of view;
(d)  not administering all the treatment in his power and indicated under the circumstances, in accordance with the highest possible standards of present chiropractic practice;
(e)  using diagnostic means whose scientific value is not recognized;
(f)  consulting, collaborating or agreeing, in the treatment of a patient, with a person who does not have the appropriate scientific knowledge in the field in which he practises;
(g)  conducting himself, in the practice of his profession, in a reproachful manner towards his patient either on the physical level or on the psychological level;
(h)  obtaining or causing to be obtained for a patient an unjustifiable material benefit, in particular by falsifying a declaration, report or any document respecting the health of a patient or the care administered to the latter;
(i)  granting any kind of rebate to a patient;
(j)  guaranteeing, directly or indirectly, expressly or implicitly, the curing of an illness;
(k)  not notifying the Order that he has reason to believe that a candidate for the practice of chiropractor is unsuited to the practice of the profession or that a chiropractor does not abide by the code of ethics of a chiropractor;
(l)  carrying out a chiropractic act without first having made a basic examination consisting, in particular, of the following items:
i.  the appropriate history of the case;
ii.  sufficient research of any subjacent pathology and anomaly by the diagnostic methods indicated and in compliance with standards of actual practice;
iii.  an unequivocal indication of an appropriate chiropractic therapy.
R.R.Q., 1981, c. C-16, r. 2, s. 4.02.01.
§ 3.  — Relations with the Order and colleagues
4.03.01. A chiropractor whose participation in a council for the arbitration of accounts, a disciplinary council or a professional inspection committee is requested by the Order must accept that duty unless he has exceptional grounds for refusing.
R.R.Q., 1981, c. C-16, r. 2, s. 4.03.01.
4.03.02. A chiropractor must, as soon as possible, answer all correspondence addressed to him by the Order, the syndic, investigators or the members of the professional inspection committee.
R.R.Q., 1981, c. C-16, r. 2, s. 4.03.02.
4.03.03. A chiropractor must not abuse a colleague’s good faith or be guilty of breach of trust or disloyal practices towards him. He must not, in particular, take credit for the work of a colleague.
R.R.Q., 1981, c. C-16, r. 2, s. 4.03.03.
4.03.04. A chiropractor consulted by a colleague must provide the latter with his opinion and recommendations as soon as possible.
R.R.Q., 1981, c. C-16, r. 2, s. 4.03.04.
4.03.05. A chiropractor called upon to collaborate with a colleague must maintain his professional independence. If he is given a task contrary to his conscience or principles, he may ask to be excused from doing it.
R.R.Q., 1981, c. C-16, r. 2, s. 4.03.05.
§ 4.  — Contribution to the advancement of the profession
4.04.01. A chiropractor must, as far as he is able, contribute to the development of his profession by sharing his knowledge and experience with his colleagues and students, and by his participation in courses and continuing training periods.
R.R.Q., 1981, c. C-16, r. 2, s. 4.04.01.
REFERENCES
R.R.Q., 1981, c. C-16, r. 2
O.C. 154-85, 1985 G.O. 2, 934
O.C. 1279-2005, 2006 G.O. 2, 203
S.Q. 2008, c. 11, s. 212