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This article is concerned with ethical guidelines for arts and health practice; it considers ethics as moral philosophy, medical ethics and the medical principle of ‘first, do no harm’ in the context of arts and health practice. The article proposes a framework for optimizing practice in arts and health by ensuring that ethical considerations are in place to safeguard best practice for both participants and practitioners/artists. These considerations include code of conduct, assessment of and briefing for participants, supervision for practitioners and documentation of outcomes. The article concludes that it is essential and ethical to develop guidelines to support and professionalize arts and health practice.