The HPCSA’s Ethical Rules are enforceable professional standards, not optional guidance. The greatest compliance risk is often not ignorance of a single rule, but a practice model whose marketing, incentives, delegation or record systems make misconduct predictable.
Approximate article length: 1,455 words
Why the Ethical Rules matter
The Ethical Rules of Conduct for Practitioners Registered under the Health Professions Act were originally published under Government Notice R717 of 4 August 2006 and have been amended over time. They operate within the framework of the Health Professions Act and provide a basis on which a professional board may investigate and discipline conduct. Importantly, the rules are not an exhaustive catalogue of every form of unprofessional conduct. A practitioner cannot defend harmful or dishonest conduct merely by arguing that the exact behaviour is not named in a particular rule.
The rules should be read together with the Health Professions Act, profession-specific scopes of practice, HPCSA ethical booklets, the National Health Act, the Medicines and Related Substances Act, the Protection of Personal Information Act and other applicable legislation. Policies issued by an employer, hospital or funder may add operational requirements, but they cannot authorise conduct that conflicts with law or professional standards.
For practice owners, the rules are not only personal obligations. They should shape how the business recruits staff, advertises services, structures incentives, delegates work, communicates fees, stores records and responds to impairment or complaints. A commercially successful model can still be professionally indefensible.
Advertising without canvassing or deception
A practitioner may advertise professional services, but the communication must not be unprofessional, untruthful, deceptive or misleading, and it should not create unwarranted anxiety about a health condition. Advertising should allow the public to make an informed choice; it should not exploit fear, vulnerability or unrealistic expectations.
The distinction between legitimate advertising and canvassing or touting is critical. Advertising provides factual information about available services. Canvassing or touting involves active conduct aimed at improperly drawing patients to a practitioner, often through pressure, inducements, unsolicited approaches or paid recommendations. The format has changed in the digital era, but the ethical problem has not. A referral fee, paid patient lead, disguised influencer endorsement or commission linked to patient conversion can create the same risk as traditional touting.
Claims about outcomes must be supportable and appropriately qualified. Statements such as ‘guaranteed cure’, ‘risk-free treatment’ or ‘the best specialist in South Africa’ are difficult to justify and may mislead the public. Before-and-after images and patient testimonials create additional consent, confidentiality and representativeness risks. Even where a patient consents, the practitioner remains responsible for ensuring that the content is not misleading or exploitative.
Professional stationery, websites and profiles should accurately state the practitioner’s name, registered profession or category, recognised qualifications, registration details, practice information and any speciality or field that may lawfully be represented. The safest rule is accuracy without embellishment. A course certificate should not be presented as a registered specialist qualification.
Scope, competence and delegation
Ethical rule 21 expresses a central boundary: except in an emergency, a practitioner should perform only professional acts for which they are adequately educated, trained and sufficiently experienced, and under proper conditions and in appropriate surroundings. Scope is not determined by confidence, patient demand, commercial opportunity or the fact that a device appears easy to use.
Competence is dynamic. A practitioner who was trained years ago may require updated education before adopting a new technique. A newly qualified practitioner may be registered but still lack the experience to perform a complex intervention without supervision. The environment also matters. A procedure that is appropriate in a properly equipped facility may be unsafe in an office without emergency support, infection-control systems or suitable monitoring.
Delegation does not remove accountability. Tasks should be delegated only to people who are legally permitted, appropriately trained and properly supervised. The practitioner should define the task, provide adequate instructions, verify competence and ensure escalation when the patient’s condition changes. Administrative staff should not give clinical advice merely because they have heard the practitioner answer similar questions before.
Telehealth, artificial intelligence and remote monitoring do not create exemptions from scope or competence requirements. The practitioner remains responsible for deciding whether the technology is appropriate, understanding its limitations, verifying material outputs and ensuring that the patient can receive safe follow-up or emergency care.
Medicines, devices and conflicts of interest
Rules governing medicines and medical devices are designed to prevent professional judgement from being distorted by financial benefit. A practitioner should not recommend a product merely because the practitioner, practice or related entity earns a margin, commission or other advantage. The clinical indication, evidence, patient-specific needs, available alternatives and cost-effectiveness remain central.
Where a practitioner has a financial interest in a product, facility or service, the interest should be disclosed clearly and managed. Disclosure alone does not cure an arrangement that is inherently improper. A recommendation must remain scientifically and clinically defensible, and the patient should not be steered away from a reasonable alternative solely to increase revenue.
Prescribing and supplying medicines must comply with the practitioner’s statutory authority, scope of practice and the current requirements of the Medicines and Related Substances Act and its regulations. Because prescription-format and electronic-prescribing requirements may be amended, practices should not rely on old templates or summaries. They should periodically verify that prescription systems, signatures, authentication, scheduling controls and record retention meet current law and professional-board requirements.
A prescription should be based on an adequate clinical assessment or other lawful clinical basis, be clinically indicated, account for contraindications and interactions, and be documented. Repeat prescribing without appropriate review can become unsafe even where the medicine was initially justified.
Fees, commissions and perverse incentives
A practitioner should not pay or accept commission or material consideration for recommending patients, purchasing or supplying professional goods, or acting in a manner that is not scientifically, professionally or medically indicated. The ethical concern is not limited to cash. Free equipment, marketing support, travel, rebates, ownership interests, targets and volume-based bonuses can all affect judgement.
Practices should stress-test every commercial arrangement by asking four questions: Is the payment connected to a patient referral or clinical decision? Could it encourage over-servicing, under-servicing or selection of a more profitable option? Has the financial interest been disclosed? Would the arrangement remain defensible if the patient, professional board and public saw the full contract? A weak answer to any of these questions requires review.
Fee transparency is also part of ethical conduct. Patients should know the material charges before fee-generating services begin and should be told when the plan changes in a way that creates additional cost. A signature on a broad financial consent form does not excuse a practice from explaining an unexpected or significant charge.
Impairment, misconduct and the duty to act
The rules address impairment because an impaired practitioner may endanger patients while being unable to assess their own performance accurately. Practitioners and trainees may have duties to report their own impairment or the impairment of another person in circumstances specified by the rules and professional-board processes. The purpose should be patient protection and appropriate intervention, not punishment or gossip.
Similarly, serious unprofessional, illegal or unethical conduct cannot always be handled as a private disagreement. The practitioner should preserve relevant facts, follow lawful reporting channels and avoid reckless accusations. Where immediate patient safety is at risk, escalation should not be delayed merely to protect a colleague or the reputation of an institution.
Practice owners need a written pathway for impairment, complaints, adverse events and whistleblowing. Staff should know whom to contact, how confidentiality will be managed, how urgent risks will be contained and when external reporting may be required.
A practical compliance framework
An annual ethics review should examine the practice as a system rather than testing individual memory. Review all public-facing claims; confirm registration and scope; audit delegation and supervision; inspect medicine and device arrangements; identify referral-linked payments; test billing transparency; assess consent and record keeping; update social-media controls; and verify incident-reporting procedures.
Contracts with locums, associates, marketers, laboratories, device suppliers and management companies should be reviewed for clauses that could create fee sharing, referral inducements, improper control of clinical decisions or uncertainty about records and patient communication. The practitioner cannot contract out of professional accountability.
The strongest defence is not a policy folder that no one uses. It is a practice in which commercial arrangements, staff incentives and workflows are designed so that ethical conduct is the easiest conduct. Where revenue depends on exaggeration, unnecessary treatment or hidden financial relationships, misconduct is not an isolated risk; it is built into the model.
The Ethical Rules should therefore be treated as an operating standard. They protect patients, but they also protect practitioners by forcing clarity before a complaint, adverse event or regulatory inquiry exposes weaknesses that should have been corrected earlier.
Disclaimer: While every reasonable effort has been made to ensure the accuracy, completeness and currency of the information contained in this document, Genoa Underwriting Managers (Pty) Ltd makes no representations or warranties, whether express or implied, regarding the correctness, reliability or suitability of such information. The contents of this document are provided for general informational purposes only and do not constitute legal, medical, financial, insurance or professional advice. Readers should seek appropriate professional advice specific to their circumstances before acting on any information contained herein. To the fullest extent permitted by law, Genoa Underwriting Managers (Pty) Ltd, its employees, representatives and affiliates shall not be liable for any loss, damage, liability or expense arising directly or indirectly from reliance on or use of the information contained in this document.
