HPCSA Key 2026 Ethical Rule Changes

Health Professions Council of South Africa Key 2026 Ethical Rule Changes:

The HPCSA has introduced significant ethical rule changes effective in late 2025 and 2026,
focusing on Artificial Intelligence (AI) in healthcare, end-of-life decisions, and corporate
employment of practitioners.

Key updates include new guidelines for AI use (Booklet 20), revised rules for withholding
treatment (Booklet 7), and strict pre-approval requirements for unregistered employers (Rule
18).

• Booklet 20 – Artificial Intelligence (AI) in Health Care (New, 2025/2026): Establishes
  ethical guidelines for using AI, emphasizing that accountability remains with the
  practitioner, not the technology. It requires transparency with patients regarding AI tools
  in their care, data privacy adherence, and ethical training for practitioners.
  • • Accountability: Explicitly states that AI cannot replace professional clinical
      judgment; practitioners remain ultimately responsible for all clinical decisions
      and interpretations of AI output.
  • • Transparency: Patients must be informed if AI tools are being used to inform
      their care.
  • • Validation: Only AI systems validated for reliability and cultural appropriateness
      in South Africa should be used, aligning with SAHPRA regulatory requirements

• Booklet 7 – Withholding/Withdrawing Treatment (Updated): Strengthens patient
  autonomy, requiring consultation with patients or their representatives on end-of-life
  decisions. It now codifies a “hierarchy of consent” for when patients cannot make
  decisions themselves and allows for withdrawing treatment if it brings little benefit, even
  if family requests it.
  • Patient Representatives: Formally recognises a person nominated by the
    patient to make healthcare decisions if the patient loses capacity.
  • Hierarchy of Consent: Provides a clear order of authority for decision-making
    (e.g., spouse first, then parent, etc.) if no representative was appointed.
  • Futility and Best Interests: Reaffirms that practitioners may withhold or
    withdraw treatment they deem futile, provided the decision is grounded in the
    patient’s best interests and dignity.

• Amended Rule 18 – Employment of Practitioners (Effective early 2026): Reintroduces the requirement that registered practitioners must have HPCSA approval to be employed by unregistered corporate entities. Practitioners have until 31 May 2027 to comply with this, ensuring clinical independence in corporate environments. This rule was amended in late 2025 via Board Notice 856. It now mandates that practitioners may only accept employment from unregistered corporate entities (like private companies or schools) if that employer has been formally approved by the HPCSA.
  • Compliance Deadline: A grace period has been granted, requiring all affected practitioners to ensure compliance by 31 May 2027.
  • Continuing Professional Development (CPD): The HPCSA has discontinued the random sampling of practitioners for CPD verification. Instead, all practitioners must ensure ongoing compliance, and recognized service providers will now integrate attendance data directly into the HPCSA’s systems.
• Updates to Other Booklets (2025/2026): Changes have been made to guidelines regarding the management of chronic diseases, healthcare waste, and ethical billing practices.

Significant Rule & Procedural Changes

Other Recent Updates
Other booklets that received updates leading into this period include:

• Booklet 16: New guidelines on the usage of Social Media, emphasizing digital professionalism and the prohibition of posting patient photos or derogatory comments.
• Booklet 11: Updated guidelines regarding Over-servicing and Perverse Incentives.

You can download the full, current versions of these booklets directly from the HPCSA Ethics page.