Background
A conflict-of-interest exists when a member is in any arrangement or relationship where a reasonable person could conclude that the exercise of the member’s professional expertise or judgment may be compromised by, or be influenced inappropriately by, the arrangement or relationship. A conflict-of-interest may be actual, potential or perceived.
Recognizing and preventing conflicts-of-interest
RPs are expected to be alert to any circumstance where a conflict-of-interest may develop or may be perceived by others, and respond by taking appropriate action. Most conflicts of interest are preventable if the situation is avoided at the outset.
Managing conflict-of-interest
Not all conflicts-of-interest are of equal concern. Some situations may be very serious and must be avoided entirely. There are other situations where a conflict-of-interest may develop, but is unavoidable, or not in the best interest of the client to avoid. These situations must be managed carefully.
An example of the latter could include working in a small or isolated community where a member may be the only person who can provide psychotherapy services to local residents. As a result, the member may provide psychotherapy to someone who is also his/her mechanic, hairdresser, lawyer, doctor, etc.
The following are some examples of situations that place a member in a conflict-of-interest:
1. Accepting a benefit for referring a client to any other person.
A benefit is any advantage or gain, whether direct or indirect, and whether or not it is monetary in nature. A conflict may exist even if the benefit is not to the member directly, but to a related person or related corporation. A related person is someone connected with the member by blood, marriage, common-law, or adoption. A related corporation is a corporation that the member or a related person wholly or substantially owns.A member should refer a client to another service provider only if the client requires or requests the service. The member should choose the place of referral solely on the basis of merit and benefit to the client, and not because the member hopes to receive a benefit as a result of that referral.
2. Offering a benefit for receiving a referral.
This situation is the inverse of the previous one. Referral recommendations must be made solely for the benefit of the client. Referrals for the benefit of the member can promote unnecessary services.
3. Offering a benefit to a client where the member’s services are being paid for by a third party.
Where a third party pays for the service (e.g. an insurance company), it is inappropriate to give the client expensive gifts to encourage him/her to continue therapy. Inducing a client to come in for a service paid for by a third party through gift-giving promotes unnecessary treatment and could involve fraud. The giving of a small, health-promoting product is acceptable (e.g. a free stress ball).
4. Accepting materials or equipment.
A member should not accept a benefit in the form of materials or equipment in return for using or recommending a supplier’s product or service. The member’s choice of product or service should be based solely on quality for the client. This does not preclude acceptance of nominal gifts (e.g. a small number of free sample stress balls).
5. Using premises or equipment without reasonable payment.
This example is given to prevent members from placing themselves in a conflict-of-interest with a landlord or supplier (e.g. obtaining the use of a free or low cost office from someone who could benefit from a member’s recommendations to clients).Members pay for all premises and equipment at a reasonable, market rate. Otherwise, there is at least an appearance that the member will favour the landlord or supplier in the member’s recommendations.
6. Entering into an agreement or arrangement that interferes with the member’s ability to properly exercise his/her professional judgment.
A member may not enter into an agreement or arrangement, or coerce another member into an agreement or arrangement, which prevents the member from placing the needs of clients first. For example, an agreement that a member will provide a certain treatment to all clients is improper because decisions must be based on an assessment of each client’s individual needs. Avoiding this type of conflict reassures the public that, despite any contractual obligations, the member will always place the needs of his/her clients first. Members may describe this rule when negotiating agreements with other parties.
7. Engaging in any form of revenue sharing except in specific circumstances as set out below.
In some practice arrangements, a member might not receive the entire fee paid by the client or a third party for providing professional services, but may share it with others within the organization or practice. In order to avoid a conflict-of-interest, members may share revenue only with one or more of the following: i. another member of the College; ii. a member of another regulated health profession; iii. a health professional corporation; iv. a social worker or social service worker or a professional corporation for a social worker or a social service worker; or v. any other person if there is a written contract with the person stating that the member will have control over, and be responsible for, his/her own professional decisions, and for maintaining professional standards.
8. Selling a product to a client or recommending a product that is sold in any premises associated with the member, without first advising the client that s/he may purchase the product elsewhere without affecting the client-practitioner relationship.
A member may not pressure the client into purchasing products from the member’s practice or the member’s landlord. Avoiding this type of conduct assures the public that any sale or recommendation made by the member is in the client’s interest only. It also gives the client the opportunity to obtain products elsewhere, perhaps at a lower price or at a more convenient location.If recommending a product to a client that is sold in any premises associated with the member, the member also issues a written description of the product. In addition, the member advises the client that s/he may purchase the product elsewhere without affecting the client-practitioner relationship.
The Standard: Conflict-of-interest
Members remain alert to potential, actual or perceived conflicts-of-interest, and take measures to prevent these situations from arising. Members take action to effectively manage and mitigate any conflicts-of-interest that may arise.
Demonstrating the Standard
A member demonstrates compliance with the standard by, for example:
- being aware of, and avoiding, situations that may place the member in a conflict-of-interest;
- carefully managing conflicts-of-interest by appropriately disclosing the conflict, and ensuring that suitable safeguards are established and documented;
- seeking advice from peers or the College, when in doubt.
See also:
Standard 1.7 Dual or Multiple Relationships
Standard 1.8 Undue Influence and Abuse
Standard 1.9 Referral
Professional Misconduct Regulation, provision 16
Note: College publications containing practice standards, guidelines or directives should be considered by all members in the care of their clients and in the practice of the profession. College publications are developed in consultation with the profession and describe current professional expectations. It is important to note that these College publications may be used by the College or other bodies in determining whether appropriate standards of practice and professional responsibilities have been maintained.