Belgium

NewsNew regulation found after the CAMbrella deliveries:

13.05.2015
The Belgian Council of Ministers has on 12 July 2013 passed new regulation on homeopathy. This was made official by a Royal Decree published 12 May 2014 by the Ministry of Health.
In Belgium 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 decision fully implement The Colla law on non-conventional practices (acupuncture, chiropractic, homeopathy and osteopathy) adopted by the Belgian Parliament in 1999 (42). 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.


Notice! All text below is copied from the CAMbrella report – delivered Dec 31, 2012

In this summary, you will find:

  • Direct links to the legislation of specific CAM therapies in Belgium
  • The legal and regulatory status of CAM and CAM practices in Belgium 
  • The governmental supervision of CAM practices in Belgium 
  • The reimbursement status of CAM practices and medicinal products in Belgium 
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 (3940). 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). 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). However, since this joint commission has still not been established (January 2011), it cannot play its key role and consequently the law cannot be fully executed (38). The Colla Act was published in the Belgisch Staatsblad/Moniteur Belge (Official Journal) on 1999-06-24 (45).

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 consent, CAM practitioners are permitted to seek the advice of other CAM
practitioners who are not conventional physicians (44).

“At the request of two associations representing osteopaths, the Brussels court of first
instance ordered the Belgian state on 22 January 2010 to set up the joint commission. The government appealed but the judgement was for immediate execution”(38). The
practitioner members of the joint commission must be appointed by the chambers, which
must be established, with one chamber per non-conventional medicine referred to in the
Colla law”(38).

The Belgian Parliament approved by a Royal Decree of 6 April 2010 the recognition of 13
professional organizations of medical and non-medical practitioners of non-conventional
medicine (283846). The 13 associations are within the field of the 4 “recognized” CAM
treatments, some are only representing physicians, some only non-physicians and some are mixed (45).

These organizations nominate members of the Chambers”(28). The act says that every royal decree on the recognition of the professionals’ organizations or their members must be agreed by the parliament. The decree was not approved by the Parliament within sixth months after its publication in the Belgian Official Journal. “The members of the professional association that will be recognized in the future therefore have no legal guarantee as to the delays in which their ‘Royal Decree of recognition’ would be confirmed by law” (38). Since the Colla law is not fully in effect, the practice of a CAM by a non-doctor 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 four 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).