Naturopaths in Ontario operate in a dynamic professional environment where clinical practice and business considerations frequently intersect. Whether collaborating with other health providers, referring patients, or selling products, naturopaths must carefully navigate potential conflicts of interest to maintain professional integrity and compliance with the College of Naturopaths of Ontario (CNO) standards and policies.
This article outlines some key principles from the Naturopathy Act, 2007 (NA), its regulations, and CNO guidance on how naturopaths can structure compliant business arrangements and avoid conflict-of-interest situations.
1. Collaboration and Professional Relationships
The CNO expects naturopaths to work collaboratively with other health professionals when it benefits the patient’s health. Regulations require that naturopaths make reasonable efforts to collaborate with a patient’s other relevant healthcare providers when such collaboration is necessary for patient well-being—unless the patient refuses consent (O. Reg. 17/14).
Failure to do so may constitute professional misconduct. Collaboration should be documented in the patient’s record, and naturopaths should always seek patient consent before sharing information with another provider.
2. Understanding Conflicts of Interest
The Professional Standard
Under Ontario’s professional conduct regulations, it is professional misconduct for a naturopath to act in a conflict of interest.
The CNO’s conflict of interest guidelines require that naturopaths not place themselves in a position where a patient, or other person, might reasonably conclude that their professional expertise or judgment may be influenced by personal interest, or that their personal interest may conflict with the best interests of the naturopath’s patients.
Thus, any reasonable appearance of conflict needs to be addressed, even if it does not actually exist.
Types of Conflicts
The CNO recognizes three main categories of conflict:
- Actual (real) conflict. When a naturopath’s personal or financial interest, which they are aware of, is connected to their professional responsibilities, and would reasonably influence the ability to objectively carry out their duties, regardless of whether there is subjective influence or personal benefit obtained.
- Perceived (apparent) conflict: When a neutral and informed person would reasonably conclude that the naturopath has been improperly influenced in how they carry out their duties, even if they are not actually so influenced.
- Potential conflict. Where a neutral and informed person would reasonably conclude that the naturopath may fail to fulfill their professional obligation to act in the patient’s best interests due to outside influences.
In all cases, naturopaths must take proactive steps to identify, disclose, and, where possible, avoid conflicts of interest.
3. Referrals and Self-Referrals
Referral Benefits
A conflict-of-interest situation arises when a naturopath—or someone closely associated with them—offers, requests, or accepts a benefit in exchange for a referral.
This includes any form of financial or material advantage, such as discounts, commissions, or gifts. Naturopaths must not:
- Pay for referrals;
- Receive compensation for referring patients to specific individuals or businesses; or
- Permit anyone to offer benefits on their behalf.
Self-Referrals
A self-referral occurs when a naturopath refers a patient to another business or service in which they have a personal or financial interest.
For example, if a naturopath also works as a personal trainer at a fitness centre and refers patients there, a conflict of interest may exist. The key question is whether the naturopath gains financially or personally from the referral. If so, the situation must be disclosed and, in some cases, avoided altogether.
4. Rent, Lease, and Space-Sharing Arrangements
A conflict of interest may arise when a naturopath rents or leases space at below market value in exchange for referrals or other implicit obligations.
For example, a naturopath renting space from a pharmacy at a discounted rate—with the understanding that patients will be referred to the pharmacy—would likely be viewed as being in a conflict of interest.
All rental and lease agreements should:
- Be made at fair market value;
- Clearly separate financial arrangements from patient referrals; and
- Be documented in writing.
Naturopaths should retain copies of all agreements and avoid arrangements that could be interpreted as contingent upon referrals or sales.
5. Fee-Splitting and Revenue-Sharing Arrangements
Fee-splitting occurs when a naturopath shares fees or income with another person or business. Certain arrangements can create conflicts of interest, especially when they give a non-registrant influence over clinical or professional matters.
Examples of problematic fee-splitting include:
- Allowing a clinic owner to determine treatment fees or scheduling;
- Agreeing to percentage-based rent or revenue sharing that pressures naturopaths to upsell services; or
- Relinquishing control of billing or patient communications.
Generally, fee-splitting arrangements are acceptable only if:
- The naturopath retains control over all professional and clinical decisions;
- The terms are transparent and documented in writing; and
- The arrangement does not compromise patient care or professional independence.
6. Advertising, Endorsements, and Product Promotion
Conflicts of interest can arise from endorsements or product sales when a naturopath benefits personally or financially.
A naturopath may be employed by or consult for a manufacturer or supplier of natural health products, provided that:
- The naturopath is compensated by salary or fee-for-service, not by commission; and
- The naturopath’s identity is not used in advertising or promotional materials.
Two disciplinary cases illustrate the importance of these rules:
- DC20-01 (2020) – The naturopath was found guilty of professional misconduct for promoting products from a company with which he was employed.
- DC21-02 (2022) – The naturopath was found guilty of misconduct for selling her own branded products through her clinic’s website.
These cases demonstrate that even indirect personal benefit from endorsements or product promotion can breach professional standards.
7. Avoiding Conflicts of Interest
The CNO advises that the best way to manage conflicts is to avoid them entirely. Disclosure alone may not be sufficient, particularly when the conflict involves close family members, significant financial benefit, or personal relationships.
Examples of conflicts that should be completely avoided include:
- Providing services to a family member or to someone who has caused harm to a family member;
- Accepting or offering substantial benefits for patient referrals; and
- Entering into agreements that financially reward referrals.
When avoidance is not possible, naturopaths should apply the DORM principle.
8. Addressing Conflicts Using the DORM Principle
The CNO’s DORM model—Disclosure, Options, Reassurance, and Modification—provides a structured framework for addressing conflicts of interest that cannot be completely avoided.
- Disclosure: The naturopath should disclose the nature of any benefit or relationship to the patient.
- Options: The naturopath should offer alternatives, such as another provider or a comparable product.
- Reassurance: The patient should be reassured that their decision will not affect the professional relationship.
- Modification: The naturopath should take reasonable steps to reduce or eliminate the benefit or influence.
In any case, following the first three steps—disclosure, options, and reassurance—may be sufficient to mitigate risk. However, some situations may require modification or referral to another naturopath.
9. Conflicts Arising from Products or Services
When conflicts relate to the sale of products or provision of services, naturopaths should, at a minimum:
- Disclose the nature of the conflict before providing the product or service;
- Inform patients about comparable alternatives, including at least one similar product or provider when possible;
- Assure patients that their care will not be affected by their choice; and
- Respect the patient’s decision regarding which product or service to purchase.
All communications regarding potential conflicts, disclosures, and patient decisions should be documented in the patient’s record.
10. Practical Recommendations for Compliance
- Document all arrangements — including leases, referral agreements, and fee-sharing terms — to demonstrate compliance.
- Establish written policies for managing conflicts of interest, especially regarding product sales or referrals.
- Review clinic contracts regularly to ensure that patient care decisions remain independent of business interests.
- Train staff and associates to recognize and disclose conflicts early.
- Seek legal advice before entering new business relationships or financial arrangements.
Conflicts of interest can arise in many forms—through financial arrangements, personal relationships, or dual business roles. Naturopaths can protect themselves and their patients by identifying potential risks early, maintaining professional independence, and following the CNO’s DORM framework.
Naturopaths should consider speaking to a lawyer to review their business arrangements and contractual agreements to ensure that their practice is compliant and builds patient trust.
Thank you to Ephraim Barrera for his contribution to this article. The contents of this article are not to be construed as legal advice. Contact Emerge Law’s lawyers for legal assistance.