Physiotherapists may be in circumstances where they must decide whether it is appropriate to provide assessment and treatment to whānau, family members and others close to them. This includes self-treatment. In these situations, it is important to consider and reflect on the physiotherapy ethical and professional obligations.
All patients are entitled to a good standard of care from a physiotherapist, and lack of objectivity can be a problem when providing physiotherapy to whānau, family members, those you work with and close friends. Other problems include:
- the physiotherapist’s professional judgment may be impaired due to the personal nature of the relationship and can impact on diagnosis and treatment
- the power dynamics present with whānau, family members, colleagues and those close to you
- might make it difficult for the patient to give an informed consent or consider an alternative provider and/or make a complaint
- might make it difficult for the physiotherapist to refuse to provide care.
(ref Informed consent standard)
It is not good practice for physiotherapists to assess and treat their whānau, family members and others close to them unless there is no other available and appropriately qualified physiotherapist. Physiotherapists should exercise great discretion in carrying out any such therapy and if they have any doubt seek independent verification or consult with a respected colleague.
For the purpose of this statement, the Physiotherapy Board has defined the following key terms:
This is generally described as a collective of people connected through a common ancestor (whakapapa) or as the result of a common purpose (kaupapa).
Whakapapa and kaupapa are not mutually exclusive. Whakapapa whānau will regularly pursue kaupapa or goals. Whereas kaupapa whānau may or may not have whakapapa connections. Whakapapa whānau and kaupapa whānau are social constructs and as such can be located along a continuum depending on the function and intent. 
An individual with whom you have both a familial connection and a personal or close relationship such that the relationship could reasonably be expected to affect your professional and objective judgement. A family member includes, but is not limited to, your spouse or partner, parent, child, sibling, members of your whānau or extended family, or your spouse or partner’s extended whānau or family.
Those close to you:
Any other individuals who have a personal or close relationship with you, whether familial or not, where the relationship is of such a nature that it could reasonably be expected to affect your professional and objective judgement such as work colleagues in some circumstances.
New Zealand law
The relevant legal document pertaining to this standard is:
- The Code of Health and Disability Services Consumers’ Rights 1996. This states that Health Consumers have a ‘Right to Freedom from Discrimination, Coercion, Harassment, and Exploitation.’ (Right 2)
1. Treatment of whānau, family members and others close to you
1.1. Physiotherapists should avoid treating whānau, family members and others close to you due to the lack of objectivity and the potential power imbalance.
1.2. Some exceptions exist, including:
- in emergency situations where the patient will suffer further harm if care is not provided, or
- in geographically isolated settings where there is no other suitably qualified provider is available, or
- where exceptions exist, there should be a process in place, which allows for independent verification to cover the need for assessment and treatment and any related This could include a consultation with a respected colleague or a General Practitioner referral.
1.3. The treatment of colleagues is only acceptable where power dynamics or other issues have been considered and do not impair objectivity or breach the Aotearoa New Zealand Code of Ethics and Professional Conduct.
1.4. Professional documentation is required for any assessment and treatment of whānau, family members, or others close to you. (ref: Physiotherapy health records standard)
2. Insurers and third-party payers
2.1. Physiotherapists must understand and abide by the policies or recommendations of insurers or third-party payers regarding remuneration for the assessment and treatment of whānau, family members and others close to them. If you are unsure of the insurers or third-party payer policy in this regard, you should contact them prior to undertaking any assessment and treatment and submitting a claim.
Aotearoa New Zealand Code of Ethics and Professional Conduct (2018) Principle 5.7, 6, 10.2 and 10.7
Involvement of an additional person during a consultation standard
This statement is scheduled for review in 2023. Legislative changes may make this statement obsolete before this review date.
This document has relied heavily on the Dental Council and Medical Council of New Zealand’s Standards and resources sexual boundaries as these Health Professionals face similar issues. We acknowledge The Medical Council of New Zealand and the Dental Council for their generosity in allowing us to use and appropriately amend their document.