Codes of Ethics and Professional Conduct

To achieve high standards of a profession it is the dedication of its Members in performing service to humanity that helps define them. In becoming a Member (as defined in the by-laws) of the Manitoba Association of Osteopathic Manual Therapists (MAOMT) (the "Association"), an individual assumes obligations and responsibilities to act in accordance with the ideals and standards within the Osteopathy profession. These principles, standards and ideals are set forth in the by-laws of the Association (the "by-laws"), the Standard of practice, the MAOMT Policies and Procedures, and the Code of Ethics.

Each Member of the Association must adhere to the highest standards of conduct at all times when dealing with the public. The Association embraces the belief that the principles, standards and ideals contained in the previously named documents must be adhered to by each Member.

While a Code of Ethics describes the ideals behaviour that each members strive for. If that behaviour is not met, not every failure to achieve perfection will result in disciplinary action. The Association also needs a set of minimum standards that each Member must comply. This Standards of Practice is the professional standard by which a Member’s behaviour is judged in the complaints and discipline process.

The Code of Ethics sets out the goals which members attempt to strive for. The Standards of Practice specifies the rules that must be achieved to avoid possible disciplinary action. The Code of Ethics can help interpret any uncertainty in the application of the Standards of Practice to a particular situation. Members whom strive to follow Code of Ethics as part of their culture of practice will have no fear of not meeting the Standards of Practice.

Code of Ethics

Introduction
This code outlines the expected standards of behaviour for all members of the Manitoba Association of Osteopathic Manual Therapists (MAOMT). It is to be read in conjunction with the MAOMT’s Standards of Practice and other relevant documents as well as the applicable federal and provincial legislation.

Nothing in this Code shall be construed as permitting breach of any law or interpreted in any way that would discourage a member from complying with their legal obligations (statute and common law).

The Code provides guidance for thinking about ethical issues; it cannot provide a final answer to all ethical questions that may arise during professional practice. Failure to specify any particular responsibility or practice in this Code does not negate the existence of these responsibilities or practices.

Members aim to attain the following ideals:

Patient values, beliefs, goals and rights
1. Members shall listen to their patients and show respect for their values, beliefs and goals.
2. Members shall respect the moral and legal rights of their patients, and shall act to ensure that these rights are respected by all staff in their employ.
Patient-professional Relationship
3. Members shall value the well-being of patients over their personal interests.
4. Members shall take all reasonable steps to minimize risk to patients and to prevent harm. Members shall appropriately manage any harm that arises.
5. If an emergency arises during treatment, members shall provide appropriate assistance.
6. Members shall maintain appropriate patient-professional boundaries.
7. Members shall not discriminate against any patient on grounds of age, ancestry, place of origin, colour, ethnic origin, citizenship, creed (religion), disability, family status, gender, gender identity, gender expression, marital status, medical condition, national or ethnic origin, physical or mental disability, political affiliation, race religion, sexual orientation or socioeconomic status.
8. Once a patient is accepted into the practice, members shall provide professional services until: a) they are not longer required; b) the patient declines further treatment; c) another osteopathic manual practitioner or health care professional has assumed responsibility; or d) until the patient has been given reasonable notice of the member’s intent to terminate the relationship.
Informed Decision-making
9. Members shall provide all necessary and sufficient information about osteopathy treatment in a manner the patient can understand, doing their best to answer questions as completely as possible. Information shall be transparent, accurate, complete, and evidence-based where possible.
10. Members shall respect the right of capable patients to give or refuse consent.
11. Members shall guide substitute decision makers in making decisions in accordance withe the accepted substitute decision-making standards.
12. Members shall be attentive to unrealistic expectations, explaining to patients what can and cannot be reasonably expected from treatment.
13. Members shall not misuse the power imbalance to influence decision making. They shall inform their patients when their personal values influence their recommendations.
14. Members shall respect requests for a second opinion from a colleague or health professional.
Privacy
15. Members shall protect the emotional and physical privacy of their patients.
Confidentiality
16. Members shall protect all personal and health information.
17. Members shall respect that patients own their own health care information.
18. Members shall only disclose health information to third parties with the patient’s consent.
19. Members may share information with other health are professionals who are, have or will be providing health care to a patient, taking care to disclose necessary information only and to ensure information is not inadvertently conveyed to unintended parties.
Fees, Renumeration
20. Members shall charge fees that are reasonable for services rendered.
21. Members shall refrain from any action that permits renumeration for referral services.
22. Members shall provide a fee schedule before initiating treatment.
23. Members shall ask for payment only after service has been rendered.
Practice
24. Members shall practice within the limits of their knowledge and skill.
25. Members shall recognize their limitations and make appropriate and timely referrals for the well-being of their patients.
26. Members shall maintain complete and accurate clinical records.
27. Members shall engage in lifelong learning to maintain their clinical skills.
Accountability
28. Members shall be accountable for their decisions, whether they result in action or inaction.
Abuse, Harassment
29. Members shall refrain from behaviour that may be construed as harassment or abuse of patients, associates or employees. They shall ensure a professional environment free of intimidation and hostility.
30. Members shall refrain from use of their authority to coerce patients, associates or employees.
Advertising
31. Members shall not engage in any activity, including advertising or speech, that could mislead a reasonable person.
32. Members shall not use patient testimonials to promote their practice.
Unethical Behaviour
33. Members shall intervene promptly if any member of their practice provides incompetent care.
34. Members shall take reasonable steps to address unethical conduct by colleagues and other health care professionals.
Members charged with criminal acts shall report the charges as well as the courts findings to the MAOMT.
Collaboration
35. Members shall work collaboratively with other professionals in planning and implementation of care.
36. Members shall respect other members of the health care team, notwithstanding any philosophical differences regarding treatment, and share information with other professionals in the circle of care.
Research
37. Members shall utilize osteopathic research that contributes to improving patient outcomes and improving care.
38. Members shall support current research standards.
Conflict of Interest
Members are responsible for recognizing a conflict of interest before it arises. Once they are aware of a conflict or potential conflict of interest, members shall manage it promptly and appropriately in the best interest of the patient.
Integrity
39. Members shall practice in an honest and upright manner.
40. Members shall uphold the reputation of their profession and act to preserve public trust.
41. Members shall refrain from practicing while impaired in any way.
42. Members shall clearly and accurately represent themselves, never overstaying or embellishing their abilities, education, experience or qualifications.

Standards of Practice

Introduction

Members of the Manitoba Association of Osteopathic Manual Therapists (MAOMT) hold themselves to high standards of professionalism in their practice. They have extensive education and training in osteopathic practice that meet or exceed the benchmark standards published by the World Health Organization(1) and are dedicated to promoting safe and

effective osteopathic assessment and treatment.

The MAOMT has developed standards, which are intended to ensure that clients of MAOMT members receive safe and effective care, provided in an ethical manner. As Osteopathic Manual Therapists are not currently self-regulated in Manitoba, these

standards apply to MAOMT members only. These standards are not set in regulation as they would in the the case of a self-regulated profession in Manitoba. The MAOMT has developed these standards for the benefit of members and their clients. Some members of the MAOMT may be registrants with a regulatory college of colleges and would therefore be subject to the standards set by that college or colleges.

This document sets out the acceptable professional standards that all Osteopathic Manual Therapists, who have been accepted as members of the MAOMT, are expected to follow. Standards of practice provide a shared understanding of how members of a profession are expected to conduct themselves. Members of the MAOMT are expected to consistently adhere to these standards in their osteopathic practice.

It is anticipated that this document will continue to evolve and that it will be revised periodically to reflect changes in the health care sector or clinical setting and to address emerging issues. In the event that any statement in this document conflicts with existing

legislation, the legislation shall prevail.

One of the pre-requisites of becoming an MAOMT member is to first be accepted as an affiliate member of the Ontario Association of Osteopathic Manual Practitioners (OAO). When the MAOMT was established in 2016, the intention was to align our standards and ethics with those of the OAO. With the OAO’s expressed written authorization and permission, much of this document has been taken directly from the OAO’s Standards of Practice Document, with edits being made accordingly to reflect Manitoba’s Personal Health Information Act and laws.

(1) World Health Organization, 2010, Benchmarks for Training in Osteopathy
(2) CSA Z16686:20 Osteopathic healthcare provision (Adopted CEN EN 16686:2015, first edition, 2015-07, with Canadian deviations)

The MAOMT member shall:

Section 1 - Professional Conduct

Responsibility to comply with legislation

1.1 Comply with all federal, provincial/territorial and municipal laws and regulations relevant to the member’s practice as an MAOMT Osteopathic Manual Therapist.

Individual Responsibilities

1.2 Practice within the limits of personal knowledge and skills in the field of osteopathy

1.3 Be accountable for the member’s own actions.

1.4 Represent all professional qualifications, designations and affiliations honestly and correct misinterpretations of credentials by others immediately.

1.5 Refrain from osteopathic practice while impaired in any way.

1.6 Refer the client to other healthcare providers, including other Osteopathic Manual Therapists, when it is in the best interest of the client.

1.7 Maintain professional boundaries with clients, students and other healthcare professionals.

Responsibilities to clients

1.8 Provide treatment only when there is a reasonable expectation of therapeutic benefit and continue treatment when there is a reasonable expectation of continuing benefit.

1.9 Practice in a manner that respects and promotes the diversity and equity of clients.

1.10 Advocate on behalf of clients for appropriate healthcare services.

1.11 Report actions or behaviours of an MAOMT member that pose a risk of harm to clients.

Responsibilities to other members and/or other healthcare professionals

1.12 Ensure comments about other Osteopathic Manual Therapists or healthcare professionals are accurate and relevant.

Responsibilities to ensure an appropriate clinical setting

1.13 Provide a clinical setting that is safe and allows for the dignified provision of culturally appropriate care.

1.14 Ensure that Standard Precautions, including minimum infection prevention practices, are in place in the clinical setting.

1.15 Maintain professional liability insurance as required by the MAOMT.

Section 2 - Record Keeping

2.1 Ensure accurate record keeping of the provision of client care.

2.2 Ensure the secure maintenance of all documentation of the provision of client care.

2.3 Ensure the appropriate transfer or disposal of client documentation.

Section 3 - Business Management

3.1 Maintain accurate and up-to-date financial records, contracts, appointment records and receipts

3.2 Promote his/her business with integrity and avoid situations that lead to conflict of interest.

3.3 Not accept a significant benefit (such as a rebate, gift or other compensation) from a supplier of healthcare products/services or from another healthcare professional to whom the member refers clients, as this is a conflict of interest.

3.4 Provide written notice to clients, and comply with all relevant legislation, if the member closes, sells or relocates a practice.

3.5 Refrain from using their place of employment and/or institutional affiliation to recruit clients for their private practice.

Section 4 - Informed Consent

4.1 Obtain informed consent from the client (or legal guardian or substitute decision maker) prior to commencing treatment.

4.2 Recognize and respect the client’s right to refuse part, or all, of the proposed treatment plan.

4.3 Obtain consent from clients (or their legal guardian or substitute decision maker) prior to allowing the therapeutic session to be observed or electronically recorded.

4.4 Provide explanations to clients (or their legal guardian or substitute decision maker) prior to treatment about the nature and purpose of assessments and the specific use of the results.

Section 5 - Client Centered Care

5.1 Use effective oral and written interpersonal communication skills.

5.2 Seek feedback and respond appropriately.

5.3 Educate clients and/or their caregivers to facilitate continued progress.

5.4 Facilitate teamwork and inter professional collaboration in the provision of client centered care.

5.5 Contribute osteopathic expertise, as a member of the inter professional team, to provide collaborative client centered care.

Section 6 - Ongoing Professional Competence

6.1 Maintain awareness of relevant developments in osteopathic practice and related requirements.

6.2 Draw upon the expertise of others to enhance osteopathic practice and personal proficiency.

6.3 Regularly self-assess knowledge and skills to develop a plan for professional development needs.

Section 7 - Clinical Supervison and Research

7.1 If offered, train and educate students and other healthcare professionals only in areas for which they are competent.

7.2 Ensure students have knowledge of the learning objectives and are are aware of the methods of evaluation prior to commencing their supervised clinical education and training.

7.3 Provide timely and specific feedback to students under their supervision.

7.4 Be responsible and accountable for the actions of students while under their supervision.

7.5 Recognize and acknowledge students’ and other healthcare professionals’ contributions

to a member’s research efforts.

7.6 Ensure and ethical process is used to evaluate research design including the eligibility

and recruitment of study subjects, data collection methods and use of results.

Section 8 - Advertising

8.1 Advertise professional services accurately and honestly.

8.2 Ensure that the member does not refer to their self in advertisements as an Osteopathic Manual Therapist with an osteopathic speciality, expertise or certification.

8.3 Only use the MAOMT logo with the express written permission of the MAOMT

8.4 Promote the member’s business with integrity and avoid situations leading to conflict of interest.

Standards of Practice - Sexual Boundaries

Introduction

These standards are not set in regulation as they would in the the case of a self-regulated profession in Manitoba. The MAOMT has developed these standards for the benefit of members and their clients. Some members of the MAOMT may be registrants with a regulatory college of colleges and would therefore be subject to the standards set by that college or colleges.

Section 1 - Purpose

1.a. sets out the members shall establish and maintain appropriate boundaries with their patients, former patients and persons who are interdependent with their patients;

1.b. prohibits sexual contact and sexualized interactions of any kind between members and their patients;

1.c. identifies the spectrum of conduct of behaviours which are considered to be a sexual contact, sexual harassment and sexual interactions;

1.d. strictly limits sexual interactions and sexual contact with patients, former patients and persons who are interdependent with a member’s patient;

1.e. provides important context for understanding what is appropriate of members to maintain strict sexual boundaries with their patients, former patients, and persons who are interdependent with their patients; and

1.f. complements all other applicable to MAOMT’s standards of practice, policies and code of ethics.

Section 2 - Foundation of the relationship

2.a. The relationship between a member and their patient must be understood in the context of the following ethical pillars of member’s expected standards of behaviour as reflected in the MAOMT code of ethics:

2.a.(i). Members shall respect the moral and legal rights of their patients, and shall act to ensure that these rights are respected by all staff in their employ.

2.a.(ii). Members shall value the well-being of patients over their personal interests.

2.a.(iii). Members shall maintain appropriate patient-professional boundaries.

2.a.(iv). Members shall not misuse the power imbalance to influence decision making. They shall inform their patients when their personal values influence their recommendations.

2.a.(v). Members shall be accountable for their decisions, whether they result in action or inaction.

2.a.(vi). Members shall refrain from behaviour that may be construed as harassment or abuse of patients, associates or employees. They shall ensure a professional environment free of intimidation and hostility.

2.a.(vii). Members shall refrain from use of their authority to coerce patients, associates or employees.

2.a.(viii). Members shall uphold the reputation of their profession and act to preserve public trust.

2.b. The relationship between a member and their patient is a professional relationship founded in trust and defined by a power inequality which extends beyond the termination of the relationship.

2.c. When seeking therapeutic care patients are by definition vulnerable because:

2.c.(i). they rely on the specialized training and knowledge of members to get a clinical impression and treat them; and

2.c.(ii). clinical impression and treatment needs for patients to allow members to touch parts of their body and access their personal information due to the member’s training to provide them with the osteopathic therapeutic care they seek.

In this context, members must not use their position of power and trust to exploit patients physically, sexually, psychologically or emotionally.

2.d. The boundaries of a relationship between a member and their patient are defined by the limits of appropriate clinical, therapeutic or professional conduct which is focused on the best interests of the patient. They require keeping an appropriate emotional and physical distance, the confines of which are defined by the nature and scope of osteopathic services that are sought and provided.

2.d.(i). the boundaries also include members and persons who are interdependent with a member’s patient as they are subject to the same power inequalities as with member and patient such that appropriate sexual boundaries with interdependent persons must also be maintained.

2.e. Patients who seek osteopathic care who also have mental health issues are particularly vulnerable and the power inequality is enhanced.

2.f. Good communication is essential to this fiduciary relationship. Clear professional communication by a member with their patient as to what to expect during a treatment session, including the clothing preferred for treatments, the history taking, the assessment and the physical osteopathic treatment. This is the most effective way to avoid and misunderstandings as to the purpose and scope of the osteopathic therapeutic encounter.

2.g. Failure to communicate properly or keep appropriate boundaries, especially sexual boundaries, prevents a member from providing objective therapeutic care to a patient and thus results in harm to the patient.

Section 3 - Scope of this Standards of Practice: Sexual Boundaries

3.a. To whom and what circumstances does this apply to?

3.a.(i). This Standard applies to all members: active, inactive, research and students.

3.a.(ii). The requirements of this Standard include all encounters with patients, former patients and persons who are interdependent with a member’s patient in any setting. This includes in person, telephone as well as through electronic communication and is not limited to encounters of the purpose of providing therapeutic osteopathic care.

3.b. Who is considered a patient for the purposes of this Standard?

3.b.(i). A patient includes any person to whom a member provides osteopathic care regardless of the setting in which that care is provided and may include former patient as described below

3.b.(ii). A member provides osteopathic care to a person when the member engage in one or more of the following activities in relation to that person:

3.b.(ii).(a) gathering therapeutic/clinical information to assess the person;

3.b.(ii).(b). providing a clinical impression

3.b.(ii).(c). providing osteopathic advice or osteopathic treatment;

3.b.(ii).(d) providing or contributing to a clinical chart (record);

3.b.(ii).(e) providing any type of waiver for treatment; and

3.b.(ii).(f). charging or receiving payment for providing osteopathic care;

3.b.(iii). A person is considered a patient of the member for the duration of any single intervention which any osteopathic care is provided to that person by the member. That person remains a patient for a reasonable period of time after the conclusion of the osteopathic care, including in between and following multiple therapeutic interventions. What is considered a reasonable period of time depends on the circumstances of, and surrounding the therapeutic osteopathic intervention(s), the patient and the member. In determining what is a reasonable period of time is, the following factors are relevant:

3.b.(iii).(a). osteopathic intervention includes: assessment, health history taking, mentoring, student interaction, any hands on treatments or care (which also includes any promotional osteopathic interventions)

3.b.(iii).(b). the number of osteopathic interventions (treatments);

3.b.(iii).(c). whether there was a reasonable expectation that care would extend beyond a single intervention;

3.b.(iii).(d). the length of time over which the therapeutic intervention(s) occurred;

3.b.(iii).(e). the length of time in between therapeutic interventions;

3.b.(iii)(f). the duration of the therapeutic intervention(s);

3.b.(iii).(g). the extent to which the therapeutic intervention(s) involved what could be considered intimate assessments and treatments (which are considered any palpation or therapeutic interventions near any body part that could be considered intimate or personal in nature) and/or the exchange of sensitive information;

3.b.(iii).(h). whether continued osteopathic care has been transferred to the care of another member or another health professional;

3.b.(iii).(i). the nature and extent of the patient’s vulnerabilities in relation to the member;

3.b.(iii).(j). the nature of extent of care sought from or provided by the member;

3.b.(iii).(k). the understanding of the patient in terms of the member’s role in their osteopathic therapeutic care;

3.b.(iii).(l). the situations that led to the termination of the patient-member osteopathic therapeutic relationship (fiduciary) following on or more interventions, including whether the sexual contact between the member and the patient was contemplated by either of them before the therapeutic relationship ended;

3.b.(iv). The criteria set out above is for the purposes on establishing who is considered a patient of the member for this Standard and may not apply to other circumstances.

Section 4 - Sexual Boundary Violations - the Spectrum of Prohibited Conduct

4.a. Member-Patient Sexual Contact

4.a.(i). Any form of sexual contact between a member and their patient is strictly prohibited, regardless of the circumstances or setting, and the onus is on the member to ensure that appropriate boundaries are maintained at all times.

4.a.(ii). Member-patient sexual contact includes but is not limited to the following contact between the member and their patient, regardless of whether the member believes that the patient has consented to the sexual contact or the setting in which the sexual contact occurs:

4.a.(ii).(a). sexual intercourse;

4.a.(ii).(b). genital to genital, genital to anal, oral to genital, or oral to anal contact;

4.a.(ii).(c). masturbation of a member by, or in the presence of a patient;

4.a.(ii).(d). masturbation of a member’s patient by, or in the presence of a patient;

4.a.(ii).(e). encouraging a member’s patient to masturbate in the presence of that member;

4.a.(ii).(f) the member fondling or sexually touching of any part of the patient’s body, including the genitals, anus, buttocks, or breasts of the patient. This does not include performing an appropriate techniques of these body parts that are therapeutically indicated and the member has gotten consent to do the technique of the purpose of providing a specific osteopathic treatment or technique to the patient;

4.a.(ii).(g) kissing of a romantic or sexual nature with a patient;

4.a.(ii).(h) sexual acts by the member in the presence of the patient.

4.a.(iii). Internal osteopathic techniques and treatments are prohibited and outside of the scope of practice of Osteopathy in Manitoba and are considered one of the regulated acts as part of the The Regulated Health Professionals Act (C.C.S.M. c. R117).

4.b. Sexual Interactions

4.b.(i). Sexualized interactions between a member and their patient is a boundary violation and is prohibited.

4.b.(ii). What constitutes as a sexual interaction with a patient must be viewed from the perspective of the patient. The prohibited act can occur in the context of any intervention with a patient, whether the intervention is a clinical one for the purpose of providing therapeutic osteopathic care or an intentional or chance encounter outside of a clinical setting. It includes an encounter over the phone, or over social media, or other forms of digital communication.

4.b.(iii). Appropriate therapeutic osteopathic care will at times require the member to ask relevant questions of a personal nature, including questions about sexual health, or involve the member conducting a treatment to be near a patient’s breasts, buttocks, pelvic floor (external palpation only). These require appropriate explanations and are needing consent in the form of verbal and/or writing with provisions for privacy and if are conducted appropriately are not sexualized interactions and are not prohibited.

4.b.(iv). Sexualized interactions include any incident or repeated incidents of objectionable or unwelcome conduct, behaviour or remarks of a sexual nature by a member towards a patient and that the member knows or out reasonably to know will or would cause offence or humiliation to the patient or adversely affect the patient’s health and well-being. It includes but not exhaustive to: sharing images, or remarks through social media or other digital communication, remarks about fantasies or dreams. It does not include conduct that is professional and clinically indicated as part of a therapeutic intervention of the purpose of providing osteopathic care to the patient.

4.b.(v). In the context of a therapeutic intervention for the purposes of obtaining osteopathic care, the patient is in a vulnerable situation having put their trust in the member to limit the interaction during that intervention to what is reasonably expected to provide the osteopathic care that they are seeking. A member must limit their osteopathic therapeutic interventions to only which the patient has provided their consent for.

4.b.(vi). Depending on the circumstances, prohibited conduct may include, but is not limited to one or more of the following:

4.b.(vi).(a) not providing privacy while the patient is undressing or dressing;

4.b.(vi)(b) assisting with undressing or dressing, unless the patient is having difficult and expressly consents to such assistance;

4.b.(vi).(c) providing inadequate draping;

4.b.(vi).(d) member undressing;

4.b.(vi).(e) making remarks about a patient’s sexual orientation, gender identity or activities that could reasonably be perceived as judgmental or discriminatory;

4.b.(vi).(f) making comments or gestures that could reasonably be perceived as flirtatious, seductive or sexual by a patient, including reference to a patient’t appearance or clothing;

4.b.(vi).(g) requesting details of the sexual history or sexual behaviour of a patient when not therapeutically indicated or without explaining why it is relevant to their therapeutic osteopathic care;

4.b.(vi).(h) discussing a member’s own or others sexual preferences or activities with a patient;

4.b.(vi). (i) not explaining the scope or need for intimate or sensitive information or techniques or treatments or not obtaining informed consent before conducting sensitive osteopathic techniques or treatments to the areas near the breasts buttocks and pelvic floor.

4.b.(vi).(j) not providing the patient with an opportunity to question or refuse a sensitive osteopathic techniques or treatments to the areas near the breasts buttocks and pelvic floor, or to withdraw consent;

4.b.(vi) (k) using unorthodox assessment or treatment techniques including inappropriate touching of the breasts, genitalia, or anus;

4.b.(vi) (l) intentional touching of the breast, genitalia or anus during an otherwise clinically indicated therapeutic osteopathic intervention where the touching is not clinically indicated;

4.b.(vi).(m) sexualizing body contact, which can include hugging in some circumstances. This does not prohibit hugging in appropriate scenarios, where there is no sexual aspect to the physical contact; and

4.b.(vi).(n) necessarily scheduling appoints for treatments outside normal office hours for any reason not related to providing therapeutic osteopathic care.

4.b.(vii). In the context of therapeutic interventions between a member and their patients outside the clinical setting, sexual interactions also include:

4.b.(vii).(a) socializing with a patient or former patient in the contact of developing an intimate romantic or sexual relationship;

4.b.(vii).(b) responding sexually to advances made by a patient, former patient or persons who are interdependent with a member’s patient; and

4.b.(vii).(c) initiating and form of sexual advance toward a patient, former patient or persons who are interdependent with a member’s patient;

4.b.(vii).(d) sending sexually explicit emails, text messages, voicemails; and

4.b.(vii).(e) making inappropriate advances on social media.

These lists are provided as guidance and are not exhaustive to the above.

Section 5 - Persons Interdependent with the Patient

5.a. For the purpose of this Standard, an interdependent person can be anyone who has a close relationship with a registrant’s patient and is involved in their patient’s medical care, including, not limited to their parents’ spouse, children, legal guardian or caregiver.

5.b. A member must never use their professional relationship with the person who is interdependent with a member’s patient to establish or seek sexual contact with our sexual interactions with a person who is interdependent with a member’s patient is a boundary violation include bit are not limited to:

5.b.(i). the duration, frequency and type of care provided to the patient;

5.b.(ii). the degree of emotional dependence of the patient and or the interdependent person to the member;

5.b.(iii). the extent to which the member used any knowledge or influence obtained from providing therapeutic osteopathic care to the patient to establish or seek sexual contact with or sexualized interactions with the interdependent person; and

5.b.(iv). the extent to which the patient is reliant on the person who is interdependent with them.

Section 6 - Former Patients

6.a. The inherent power inequalities from a member-patient relationship can continue long after that therapeutic relationship ends. Any relationship or intervention between a member and their former patient which includes sexualized interactions or member-patient sexual contact is strongly discouraged for that reason.

6.b. The onus is on a member to satisfy the MAOMT that a ‘reasonable period’ has elapsed in accordance with section 3.b.(iii) above before engaging in what is otherwise prohibited conduct as defined in this Standard of Practice with a patient.

6.c. A member who is considering engaging in a sexual relationship with a former patient must first consider the risks and whether the contemplated contact or interactions would be considered prohibited contact. They should seek advice from the MAOMT board of directors, or legal counsel to ensure that the member fully understands the risks and potential consequences before having sexual contact or engaging in sexualized interactions with a former patient.

Consequence of Breaching this Standard of Practice

Violating sexual boundaries with a patient, former patient or a person who is interdependent with a patient is a very serious matter. Like the violations themselves, the nature and extent of the measures required to address them and the consequences to a member who has violated boundaries with a patient are best viewed as being on a continuum and determined by the unique circumstance of each specific case.

Serious violations will require formal disciplinary action and usually a loss of the member’s ability to maintain membership with the association. Less serious violations may require remedial and protective measures, including conditions on a member’s practice, but not necessarily result in formal disciplinary action.

Updated Feb. 20, 2023.

Limitations

The MAOMT may decline to proceed with a complaint against a Member, past or current after 5 years from the incident if the MAOMT concludes that there are insufficient reasons why the complaint was not brought earlier.

Codes of Ethics and Professional Conduct

Limitations

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