Typically Canadian chiropractic provincial divisions or regulatory bodies have advertising regulations that prohibit professional advertising unless it meets certain criteria. The Canadian Chiropractic Association has ethical rulings on advertising in its Code of Ethics.
Many of the existing provincial regulations on advertising by chiropractors and other health professionals are only partly enforceable following the 1990 judgement of the Supreme Court of Canada in the Royal College of Dental Surgeons v Rocket and Price. In this case the Supreme Court struck down the RCDS's regulation governing advertising by dentists in Ontario for violation of the Charter of Rights and Freedoms.
The court held that commercial expression, including advertising by dentists, fell within the scope of Section 2 of the Charter which grants fundamental freedoms, including freedom of expression. The fundamental freedoms are not absolute. They are subject to Section 1 of the Charter which provides:
The Canadian Charter of Rights and Freedoms guarantees the rights and freedoms set out in it subject only to such reasonable limits prescribed by law as can be demonstrably justified in a free and democratic society.
The court held that the dental regulation in question, which proceeded on the basis of an overall ban on advertising subject to allowable exceptions, did not meet the test of reasonable limits appearing in Section 1.
The court looked in some depth at what prohibitions on advertising by health professionals might meet the reasonable-limits test of Section 1 of the Charter. It held that prohibitions aimed at misleading, deceptive or unprofessional advertising would not infringe the Charter, providing a practitioner's freedom of expression was not unduly restricted and the public was not deprived of relevant information.
It will be apparent from this that the legal position is subtle rather than black and white. For example, a regulation that prohibits unprofessional advertising and is not unduly restrictive will be legal, but what exactly is unprofessional, and what is unduly restrictive? Should regulations prescribe what is unprofessional, or should that be left to the rulings of regulatory bodies pursuant to a regulation that covers but does not seek to define unprofessional conduct? Apart from the legal position, advertising is an area in which there are ethical and professional responsibilities and for which professional guidelines are most appropriate.
For advertising to be both legal and professional the following principle should apply in all media. The message should be:
- truthful, because consumers often lack the knowledge to evaluate potentially misleading advertising claims;
- clear, because consumers often lack the knowledge to evaluate potentially misleading claims;
- complete, because consumers may lack the knowledge to detect omissions necessary to make informed choices;
- professional, as consumers should have confidence in the health providers they choose, and professionalism in all aspects of practice is important in creating and sustaining that confidence. In addition each chiropractor owes it to his/her colleagues to maintain united professional standards; and
- responsible, consistent with provincial division legislation and the Canadian Chiropractic Association's Code of Ethics.
To conform to the above criteria on professionalism and responsibility, advertising claims should not:
- claim professional superiority over other chiropractors, in respect of individuals or generally;
- be offensively critical respecting other health care practitioners' services, or their products;
- guarantee results or in other ways create unjustified expectations;
- refer to products or services that are not subsequently provided as promised;
- violate the confidentiality of the doctor-patient relationship;
- contain self-congratulatory statements;
- state a number of years in practice or in practice in a given community;
- include patient testimonials; and
- offer free examination, diagnostic or treatment services.