How we show up.
Every time. For everyone.
Eight principles that govern the professional conduct of every IAHC member, regardless of their artistic tradition, training background, or the clinical setting in which they work.
A note before the principles
A code of ethics is not a list of rules imposed from above. It is a shared statement of who we are and how we choose to practise. The principles below were developed by drawing on the ethical frameworks of established allied health professional associations, including the North American Federation of Healthcare Clown Organizations (NAFHCO), Therapeutic Clowns Canada, the North American Drama Therapy Association (NADTA), and the World Federation of Music Therapy (WFMT), and by asking what those frameworks share, where they fall short, and what a truly global, model-neutral code would need to say that they do not.
The most important addition is Principle 05. Most existing codes are written from within a single tradition and implicitly assume that tradition as the standard. IAHC is being built on the explicit premise that no single model of healthcare clowning is the correct one. The red-nose tradition, ensemble models, solo practice, community-based approaches, and every other form this work takes are all legitimate expressions of the same fundamental commitment: to bring presence, play, and human connection to people in healthcare settings. This code is written to serve all of them.
This code is proposed. It will be formally reviewed and ratified by the IAHC board and Standards and Ethics Committee once those bodies are constituted. Members and practitioners are invited to engage with it, challenge it, and help make it better.
The Patient Comes First
The wellbeing, dignity, and autonomy of the patient are the primary consideration in every encounter, above all other interests.
Healthcare clowning exists in service of the patient. Every decision made in a clinical encounter, from whether to enter a room to when to leave it, must be guided by what is in the best interest of the person receiving care.
Practitioners must be attentive to verbal and non-verbal cues that indicate a patient's willingness to engage, and must withdraw without hesitation when engagement is not welcome. The patient's right to refuse is absolute and requires no explanation.
This principle applies regardless of the practitioner's artistic tradition, training model, or character. The clown serves the patient. The patient does not serve the clown.
Protect Dignity at All Times
Every patient, family member, and colleague is treated with unconditional respect. Humour is never used at the expense of a person's dignity.
The therapeutic power of healthcare clowning rests on the quality of the relationship between practitioner and patient. That relationship is only possible when the patient feels genuinely safe, seen, and respected.
Practitioners must never use humour, play, or performance in ways that demean, embarrass, or diminish a patient or family member, even unintentionally. Cultural sensitivity, awareness of power dynamics, and attentiveness to the patient's emotional state are not optional refinements; they are core clinical competencies.
Dignity extends to colleagues. Healthcare clowning practitioners are guests in clinical environments and must conduct themselves accordingly, treating all members of the care team with the same respect they bring to the bedside.
Maintain Confidentiality
Information encountered in the course of clinical practice is held in strict confidence and shared only as required by the care team or by law.
Practitioners will inevitably encounter sensitive information about patients and families: diagnoses, prognoses, family circumstances, emotional states. This information is encountered in a position of trust and must be treated accordingly.
Clinical observations relevant to patient care should be communicated to the appropriate member of the care team through established channels. They must not be shared outside the clinical context, including in professional development discussions, without appropriate anonymisation.
This principle applies to all forms of communication, including social media, public presentations, and informal conversation. The fact that a patient was visited, let alone the details of that visit, is confidential information.
Know and Respect Your Scope
Practitioners work within the boundaries of their training, their role, and the clinical environment. They do not practise beyond their competence or assume the functions of other disciplines.
Healthcare clowning is a distinct discipline with its own scope of practice. It is not a substitute for psychotherapy, child life, music therapy, social work, or any other allied health profession, even when it shares some of their therapeutic territory.
Practitioners must be clear about what they are and what they are not. When a patient's needs fall outside the scope of healthcare clowning, the appropriate response is to acknowledge that and, where possible, facilitate a referral to the right member of the care team.
This principle also requires practitioners to be honest about the limits of their own individual training and experience. Encountering a clinical situation that exceeds your competence is not a failure; failing to recognise it is.
Honour Every Model and Tradition
IAHC recognises and respects the full diversity of healthcare clowning practice. No single artistic tradition, training model, or organisational approach is privileged above others.
Healthcare clowning has developed independently across many countries, cultures, and clinical contexts. The result is a rich and varied field: from the red-nose hospital clown tradition of North America and Europe, to ensemble-based models, to solo practitioners working in palliative and geriatric settings, to community-based approaches in low-resource environments.
IAHC's ethical framework is built to serve all of these traditions equally. The standards we set describe what all models share: a commitment to the patient, a therapeutic relationship, clinical awareness, and professional conduct. They do not prescribe how a practitioner must look, what character they must embody, or which artistic lineage they must belong to.
Practitioners and organisations are expected to extend this same respect to their peers. Disagreement about method is legitimate and healthy. Dismissal of another practitioner's tradition as less valid is not consistent with IAHC membership.
Commit to Reflective Practice
Practitioners engage in ongoing reflection on their practice, seek supervision, and remain open to learning throughout their career.
The clinical encounter is complex, emotionally demanding, and never fully predictable. Reflective practice, the habit of examining what happened, why, and what it means for future practice, is not a training exercise. It is a career-long professional responsibility.
Practitioners are expected to seek regular supervision or peer consultation, particularly when working in high-acuity settings such as paediatric oncology, palliative care, or trauma. Supervision is not a sign of inadequacy; it is a sign of professional seriousness.
This principle also requires practitioners to remain genuinely open to new evidence, new methods, and new perspectives, including perspectives that challenge their existing practice. The field is still developing. So are we all.
Practise with Honesty and Transparency
Practitioners represent their qualifications, experience, and the nature of their work accurately, and do not make claims that exceed the evidence.
Healthcare clowning has a genuine and growing evidence base. Practitioners should be familiar with it and represent it honestly, neither overstating what the research shows nor dismissing it. Overclaiming harms the field's credibility; underclaiming harms the field's standing.
Practitioners must represent their own qualifications accurately. Claiming credentials not yet held, or implying a level of clinical training not yet completed, is a breach of this code regardless of intent.
Organisations and practitioners are expected to be transparent about their funding, their affiliations, and any conflicts of interest that might affect their practice or their public statements about the field.
Advance the Field with Integrity
Practitioners act as ambassadors for healthcare clowning, conducting themselves in ways that strengthen the field's standing, its relationships with healthcare institutions, and its capacity to serve patients.
Every practitioner who enters a hospital carries the reputation of the entire field with them. Professional conduct, reliable communication with care teams, and consistent quality of practice are not just personal standards; they are contributions to the collective credibility of healthcare clowning as a recognised discipline.
Practitioners are encouraged to contribute to the field's development: through peer mentorship, participation in research, engagement with professional associations, and advocacy for the recognition of healthcare clowning within healthcare systems.
Where practitioners observe conduct that falls below the standards of this code, they have a responsibility to address it, first through direct conversation where appropriate, and through formal channels where necessary. The integrity of the field depends on practitioners holding each other accountable with the same care and respect they bring to the bedside.
How this code relates to the Standards of Practice
The IAHC Code of Ethics and the proposed Standards of Practice are distinct but inseparable. The Code of Ethics describes the values and commitments that underpin all IAHC membership. The Standards of Practice describe the specific competencies that IAHC certification requires.
SOP-4 (Ethical Practice and Professional Conduct) formally requires certified practitioners to uphold this Code. But the Code applies to all IAHC members, not only those seeking or holding certification. Membership in IAHC is an agreement to practise in accordance with these principles.
Where a practitioner's conduct is found to be inconsistent with this Code, the IAHC Standards and Ethics Committee, once constituted, will have the authority to investigate and, where necessary, to suspend or revoke membership or certification. The process for doing so will be defined in the IAHC bylaws and will include appropriate rights of response and appeal.
We want your response to this
This code was written by drawing on existing frameworks and on the founding principles of IAHC. It has not yet been reviewed by a broad community of practitioners. That review is exactly what we are inviting.
If something here does not reflect your experience of the field, if a principle is missing, if the language of a principle does not translate across your tradition or your healthcare system, we want to hear it. The code that gets ratified should be one the whole community recognises as its own.