Tuesday, May 19, 2009

Fundamentals Blog: Task 4: The ethics of professional practice. Due date: May 20th 2009
Barbara Newton

Ethics are a set of principle or system of moral values with respect to their rightness and wrongness of certain action ( Dictionary Reference), defined as rules or standards, of expected conduct governing the conduct of an individual, groups, or members of a profession ( Merriam Webster, McQuillan ( 2009) and Salvo (2007).
For the purposes of our study the ethical considerations for massage therapy fall into four main categories: client orientated care; therapeutic relationship; scope of practice; and ethical decision making. Here in New Zealand for registered therapists and members these are mapped out by the Massage New Zealand ( MNZ) Code of Ethics.

1) Client orientated care“ A practitioner shall endeavor to serve the best interests of their client at all times and to provide the highest quality service possible”( MNZ, Code of ethics)
Treatment must first and fore mostly focus on the best interests of the client: according to their goals, be undertaken with respect, and ensuring all communications are clear and understood especially when denoting clear boundaries with regard to role, responsibilities, expectations and limitations to the client, and that this is done with compassion and awareness of power differentials.

2) Therapeutic relationship
The therapeutic relationship between the therapist and client is all about trust, integrity, experience and whether or not he client feels comfortable in all aspects of the treatment by the therapist. This is probably the most important category and consists of two areas: professionalism and informed consent.

a) Professionalism is conveyed to the client through image and behaviour.
As the massage industry is an emerging one it must differentiate from itself from other health providers by, at least meeting expectations but preferably exceeding them, in the therapists presentation, appearance, attitude and behaviour.
Image: clean, hygienic, tidy therapist and premises.
Behaviour: From the MNZ Code of Ethics: respect for client, refraining from being under the influence of any mind altering drugs or alcohol during treatments, and “a practitioner shall not enter into an intimate or sexual relationship with a patient while the patient is under their care”. This is easier said than done however as adjudged by breaches to other health professional code of ethics reported in the media.

As part of professionalism the therapist must avoid at all costs any conflict of interest, and personalization of the relationship by either transference or countertransference as they must be above reproach in this area.

b) Informed consent
The client should be informed on every aspect of their treatment session:
· of the process: such as clinical procedure, scope of practice, terms of payment, likely effects of massage etc
· their rights as per the Privacy, Health & Safety, Consumer Guarantee and Health & Disability Acts
· right to be informed of initial proceedings, feed back systems, sensitive body area and subsequent treatment plan
· Their right of refusal
· Right of confidentiality
· Clients personal privacy/space.
· Complaints procedure.
· Power differentials: Because the therapist is in both a physical and psychological advantageous position over the client, the aspect of informed consent is of paramount importance and cannot be stressed enough to ensure any power differentials are kept to a manageable level.

The importance of a therapeutic relationship is that it keeps the client not only safe, but happy, building belief and trust in what you are and what you are doing which will in turn relaxes the client. If the client believes and trusts the therapist, and your treatment then more positive outcomes are more likely,
(McQuillan, 2009 (Moerman, 2002)).

3) Scope of practice“A practitioner shall acknowledge the limitations of their skills and, when necessary, refer clients to the appropriate qualified health care professional” (MNZ, Code of Ethics)
This is about what you do and don’t do with relation to your training, experience, competency and qualifications. It is worth noting that training does not automatically mean competency, as this comes with experience.
It is important that others are aware of exactly what we do, not what they think we do, and whether or not it is appropriate, so it is necessary to have well defined communicated boundaries not only for client safety but so that they are aware of your capabilities.
Examples: As defined by MNZ i) A Certified massage therapist (CMT)) as a relaxation massage therapist as one who can manipulate soft tissue for pleasure and stress related reduction and management, and a
ii) Registered massage therapist (RMT) a therapist who can manipulate soft tissue for pleasure, stress reduction/ management, pain relief, injury management and limited exercise prescription.
It is worth keeping in mind the nonmaleficence of client centered care which is to “First do no harm” as massage therapy should benefit the client or “to help, or at least do no harm”! If treatment is not within your scope of practice then the client needs to be referred to someone who is practiced in the required skills.

4) Ethical decision making

Ethical decision making is based on all of the aforementioned. Should you ever be in the predicament of potentially putting your own interests before that of the client, have any doubts what so ever about its ethical status then you must ask yourself if this is in the clients’ best interest. If it is not then it is unethical. Treat every client as you would like to be treated yourself.

In order to provide the best possible massage experience for each and every client every time the therapist must have a thorough understanding of what
client orientated, professional therapeutic care, based on mutual respect, within well defined boundaries, and practiced within the therapists capabilities in a professional manner by informed consent actually is. Ethics help us define these parameters.

Class notes
Text books


Dictionary Reference. Ethics. Retrieved May 18, 2009 from http://dictionary.reference.com/browse/ethics

Fritz, S., (2009), Mosby’s fundamentals of therapeutic Massage, 4th ed., Missouri: Mosby Elsevier.

McQuillan, D. (2009). Ethics. Retrieved May 17, 2009 from http://elluminate.tekotago.ac.nz/play_recording_confirmation.html
Merriam Webster Dictionary. Ethics. Retrieved May19, 2009 from http://www.merriam-webster.com/dictionary/ethics
Salvo, S., (2007), Massage therapy, principles and practice, 3rd ed., Missouri: Saunders Elsevier.
Velasquez, M, Andre, C., Shanks, S., & Meyer, M., What is ethics?. Retrieved May 17 from http://www.scu.edu/ethics/practicing/decision/whatisethics.html

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