Belgium | Cam-Regulation

Belgium

Summary of the country's general legislation of CAM.

Go directly to legislation of specific CAM therapies in Belgium:
Acupuncture – Anthroposophic medicine – Ayurveda – Chiropractic – Herbal medicine/Phytotherapy –
Homeopathy – Massage – Naprapathy – Naturopathy – Neural therapy – Osteopathy – Traditional Chinese Medicine (TCM) – Other treatments

Belgium was a founding member of the European Union in 1952 (11) and a founding member of the Council of Europe since 5 May 1949 (12).

The legal and regulatory status of CAM and CAM practices

The practice of health care professionals in Belgium is regulated by the practice of health care professions act, the Royal Decree No. 78 of 10 November 1967 (36). The act includes physicians, dentists, physiotherapists, pharmacists, nurses, midwives and paramedical practitioners (37).

According to Article 2 of this act, making a diagnosis and establishing the treatment of a physical or mental disorder are reserved for the holders of a medical diploma approved by the competent medical commission (38). Consequently only physicians, dentists or midwives are entitled to make a diagnosis and to prescribe treatment, and only these professions may practise CAM treatments (37).

The rights and duties of physicians and patients are regulated in the law on the rights of patients of 22 August 2002 (39, 40). Doctors can recommend CAM to their patients (or practise CAM themselves), and a number of CAM treatments may be dispensed legally by physiotherapists on medical prescription (41).

Professional exercise of a non-conventional practice by a non-doctor is a punishable offence. In real life, however, many non-doctors practise one or another non-conventional treatment.

In order to regulate the practice of non-conventional systems, and give the population a freedom of choice concerning therapeutic treatments, the act on non-conventional practices (the “Law of minister Colla”) was adopted by the Belgian Parliament in 1999 (42,43). The Colla Act was published in the Belgisch Staatsblad/Moniteur Belge (Official Journal) on 1999-06-24 (45). Four chambers were to be installed for acupuncture, chiropractic, homeopathy and osteopathy, and the number of non-conventional practices could be extended by the government (37).

Practitioners of non-conventional medicine, as defined in the Act of 29 April 1999, are also health professionals (39). The law should take effect after a series of implementing orders had been engaged (43). The Colla act 1999, article 3, established that a joint commission should advise the government on the practice of CAM, particularly registration of practitioners, membership in recognized professional organizations and restrictions on medical acts (44). This should be ensured mainly by a dual registration system for both non-conventional practices and registers for individual practitioners (for which both should satisfy certain conditions)(38). 

So far, only the use of the title of homeopath has been regulated by law while the work on the royal decrees concerning the practice of the three other non-conventional practices is still ongoing. The Belgian Council of Ministers passed new regulation on homeopathy on 12 July 2013 which was made official by a Royal Decree published on 12 May 2014 by the Ministry of Health.

Homeopathy is now a medical act and only medical doctors, dentists and midwives are entitled to practise homeopathy (dentists and midwives only within their competence). The Royal Decree lays down requirements for registration of homeopathic doctors: the practitioners must have a degree in homeopathy from an official college or university, and the national teaching centres will have to comply with the European/national CEN quality standards which are about to be formulated. Transitional provisions will be developed for doctors who have already been practicing as homeopaths but do not comply with the new requirements.  Practitioners already practicing who do not have a medical, dentistry or midwifery diploma can continue their activities under a temporary measure until they fulfil the new requirements. Practice of homeopathy by non-medical qualified practitioners will be illegal in Belgium.

In Article 9 of the Colla act of 1999, CAM practitioners who are not also conventional physicians must obtain a recent physician’s diagnosis from their patient prior to commencing treatment (44). If patients choose not to consult a physician before seeing CAM, they must put their wishes in writing. Registered CAM practitioners must take precautions to ensure that patients are not deprived of conventional treatment. As a result, CAM practitioners who are not also physicians must keep physicians informed of the health of their patients. With a patient’s consent, CAM practitioners are permitted to seek the advice of other CAM practitioners who are not conventional physicians (44).

Since the Colla law is not fully in effect, the practice of CAM by a non-physician is still illegal. Several non-medical practitioners of CAM have been sentenced for this offence (38). In the autumn of 2010 a trial against a physiotherapist practising acupuncture was won by the prosecuted physiotherapist. An appeal in 2010 confirmed the acquittal because the physiotherapist complied with the prerequisite of medical prescription. The judge reserved the diagnosis for the prescribing doctor (47).

In conclusion, when the Colla law is fully executed, Belgium will still restrict the practice of medicine to doctors, with the exception of certain treatments such as those provided by the above mentioned non-conventional medicines (38).

The governmental supervision of CAM Practices

The conduct of medical doctors in Belgium is supervised by the Order of Physicians (47) in application of existing laws. The Order is not legislative nor a governmental institution. It serves as an exclusive tribunal for the conduct of doctors only, directly if (even anonymous) complaint against one doctor is received by the Order, or indirectly, but systematically, after a civil- or criminal court already has convicted a doctor (so a doctor is always convicted twice, once by the regular court and after that by the Order of Physicians (47).
The code of professional ethics contains the rules concerning continuity of care, medical secrecy, handing over of medical data to colleagues and the individual relations between a physician and patients, colleagues, dentists, pharmacists and allied health professionals (48). A doctor risks a fine (under Article 11) or suspension or withdrawal of his/her licence to practise (under Article 8) if the law is trespassed. The Order of Physicians does not preside over paramedical professions.
The Order discourages the practice of any alternative medicine (irrespective of whether the therapist is a doctor or not), as long as the proof of working mechanisms or clinical evidence remain insufficient (47).
According to the code, physicians are expected to practise medicine according to the current knowledge of scientific medicine. On the other hand, physicians have a freedom of therapy, so they can freely practise CAM if they bring no harm to their patients (45).

The reimbursement status of CAM practices and medicinal products

CAM is not reimbursed by compulsory health insurance, organized by the National Institute for Health and Disability Insurance (RIZIV-INAMI), but several health insurance funds incorporate CAM partially in their voluntary health insurance (37).

Sources

11. EUROPA. Gateway to the European Union; member countries. Brussels EUROPA
Communication department of the European Commission; 2011 [cited 2011 November 3]; Available from: http://europa.eu/about-eu/countries/index_en.htm.

12. Council of Europe. Council of Europe. Strasbourg: Council of Europe; 2011 [cited 2011
November 7]; Available from: http://www.coe.int/lportal/web/coe-portal.

28. ECH (European Committee for Homeopathy). ECH in European Countries. Brussels: ECH; 2011 [cited 2011 September 12]; Available from: http://www.homeopathyeurope.org/countries.

36. The practice of health care professions act of 10 November 1967 (Belgium Statute Book of 14 November 1967), The Parliament of Belgium(1967).

37. Corens D, WHO. Health Systems in Transition: Belgium: Health System Review. In: Merkur S, Jemiai N, Palm W, editors. Copenhagen: WHO Regional Office for Europe, on behalf of the European Observatory on Health Systems and Policies; 2007.

38. Goossens M HG, Léonard C, Mertens R, Piérart J, Robays J, Roberfroid D, Schmitz O, Van den Bruel A, Vinck I, Kohn L. Acupuncture: State of affairs in Belgium. Synthesis. Health Services Research (HSR). Brussels: Belgian Health Care Knowledge Centre (KCE). 2011. KCE Reports 153C. D/2011/10.273/22. 2011.

39. The Centre for Biomedical Ethics and Law of the Catholic University of Leuven Belgium. National Patient Rights Legislation – Belgium. Leuven: Katholieke Universiteit Leuven; 2012 [cited 2012 February 7, ]; Available from: http://europatientrights.eu/countries/not_ratified_not_signed/belgium/belgium.html.

40. The patients rights act of 22 August 2002 (Belgian Statute Book of 26 September 2002), The Parliament of Belgium(2002).

41. ECHAMP. Homeopathy and anthroposophic medicine in the EU: Facts and Figures 2011 (Third edition). In: European Coalition on Homeopathic and Anthroposophic Medical Products, editor. Third ed. Brussels: ECHAMP E.E.I.G.; 2011.

42. Non-conventional practices act of 29 April 1999 (Belgian Statute Book of 24 June 1999). Loi du 29 avril 1999 relative aux pratiques non conventionnelles dans les domaines de l’art médical, de l’art pharmaceutique, de la kinésithérapie, de l’art infirmier et des professions médicales. Moniteur Beige,24 June 1999, 169. , The Belgian Parliament(1999). http://www.ejustice.just.fgov.be/cgi_loi/change_lg.pl?language=fr&la=F&cn=1999042968&table_name=loi

43. Ersdal G, CAM-CANCER consortium. How are European patients safeguarded when using complementary and alternative medicine (CAM)? Jurisdiction, supervision and reimbursement status in the EEA area (EU and EFTA) and Switzerland. Tromsø: NAFKAM, University of Tromsø 2005 28 October Report No.: Report CAM 21.11.05-1.doc.

44. Legal Status of Traditional Medicine and Complementary/Alternative Medicine : A Worldwide Review [database on the Internet]. World Health Organization. 2001 [cited 9 March 2010]. Available from: http://whqlibdoc.who.int/hq/2001/WHO_EDM_TRM_2001.2.pdf, http://hinfo.humaninfo.ro/gsdl/whohss/1.00.0000/en/d/Jh2943e/.

45. Marnix Schaubroek Belgian IVAA-Representative. Email: CAM legislation in Belgium. 2012.

46. Fait au nom de la commission des affaires sociales par M. du Bus de Warnaffe et Mme Franssen. 5 – 407/2 Session de 2010-2011, 9 Novembre 2010 Projet de loi portant confirmation de l’arrêté royal du 6 avril 2010 portant reconnaissance des organisations professionnelles de praticiens d’une pratique non conventionnelle ou d’une pratique susceptible d’être qualifiée de non conventionnelle reconnues. SÉNAT DE BELGIQUE; 2010 [cited 2012 February 7, ]; Available from: http://www.homeopathyeurope.org/regulatory-status/national-regulations/belgium-statutoryregulation-documents/BelgianSenateDecision.pdf.

47. Fossion JP. Email: Some questions about Belgium. 2010.

48. Time.lex, European Commission Directorate General Information Society. SMART 2007/0059Study on Legal Framework of Interoperable eHealth in Europe- National profile Belgium. Brussels: EUROPA; 2007 [cited 2012 February 7,]; Available from: http://ec.europa.eu/information_society/activities/health/docs/studies/legal-fw-interop/ehealthlegal-country-profile_belgium.pdf.

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