Reflection question What is the ethical dilemma here? What would have been an appropriate course of action for Kim? Anyone who chooses to serve those in hospice care recognizes that it is a privilege to do this profound work. Caring for the dying through the medium of touch can be an experience that forever alters the therapist’s worldview of death and dying. Therapists will be forced to examine thoughts, feelings and behavior in this profoundly important professional work. By accepting the responsibility to explore the impact of massage and bodywork on end-of-life care, the therapist will be better equipped to uphold the highest ethical standards of their professional role. Is there a minimum age a client must be to receive massage therapy? With the multitude of studies that have been done concerning the effectiveness of massage therapy for younger populations, particularly infants, working on minors is perfectly acceptable. See the previous section on massage for minors. Can I refuse to treat a client? Yes, and you should when the situation warrants severing the professional relationship. Keep the reason concise, do not get personal or emotional with the client, and keep the explanation as general possible. For example, simply say you do not believe you can provide what the client wants or needs, and leave it at that. It is suggested that you do not want to say or suggest anything that might be perceived as discriminatory in terms of race, age, sex, gender or religious affiliations. In all instances, do not engage in a debate with the individual. Contact the supervisor, employing agency, professional organization, or legal council for additional questions or assistance. Where should I look for information concerning whether a modality is within the scope of practice? The first, and perhaps best, place to look is the statute of the particular jurisdiction in which you practice. A list of the state practice laws and state massage therapy regulatory board contact information is located on the state website. It should include a definition and provide the scope of practice. The state of Illinois, for example, defines massage therapy this way: “A system of structured palpation or movement of the soft tissue of the body. The system may include, but is not limited to, techniques such as effleurage or stroking and gliding, petrissage or kneading, tapotement or percussion, friction, vibration, compression, and stretching activities as they pertain to massage therapy. These techniques may be applied by a licensed massage therapist with or without aid of lubricants, salt, or herbal preparations, hydromassage, thermal massage, or a massage device that mimics or enhances the actions possible by human hands.” Most statutes will also illuminate what is prohibited, which in Illinois includes the diagnosis of a specific pathology or those acts of physical therapy or corrective measures that are outside the scope of massage therapy as defined. Along with how the state defines scope of practice, practitioners should also be familiar with what their insurance covers and what practices are excluded in the policy.
Case example Kim, a massage therapist, who was working as an independent contractor for a local hospice organization was asked by the hospice nurse to see a woman with advanced Parkinson’s disease. The massage therapist saw the patient for weekly sessions. In addition, Kim had been hired by the family as a personal care attendant and was essentially “on-call” to run errands, drive the patient to doctor’s appointments and stay with her in the home when the family needed to be away. Kim complained that the hospice had let her go because they saw her actions as inappropriate. She also complained that the family was calling on her more and more and had not paid her in some time. She stated that she couldn’t bring herself to discontinue her service because the patient “needs me so much.” Protecting the practice and profession Whether the professional is a veteran or novice, questions will arise in a practice that could have serious implications for the practice and the profession. It is up to the professional to seek answers to their questions from the appropriate source and suspend their practice until they have resolved the situation and can be confident that they are providing the best care for the client based on the foundations of ethical practice. Professionals meet the education, training, licensure and/ or certification requirements in their state of practice and must review these frequently for legislative changes. It is also prudent to join a professional organization that will provide education and training materials, websites for current information, networking sites, resources on current topics and contacts to get assistance in answering ethical or legal questions pertaining to practice. Richard Armstrong has summarized some of the most frequently asked questions that are summarized below (Armstrong, 2012): What is the difference between an independent contractor and an employee? The Internal Revenue Service implications are different for each of these employment classifications. If the practitioner is an employee, the employer must generally withhold income taxes, as well as pay Social Security and Medicare taxes. If the employer controls work hours, books clients, handles the financial transactions, then the practitioner is normally an employee. If, on the other hand, the practitioner controls the appointments and book their own clients, they are most likely an independent contractor. How can I minimize the potential for legal action to be taken against my practice or myself? The single best way to avoid problems is to really know the client and to be very clear with your intentions and actions. Doing so will build trust, which is a key component in a good professional relationship. Clear communication coupled with always obtaining informed consent from clients, can virtually eliminate the risk of litigation. Of course the practitioner must have a working knowledge of ethical standards and codes of conduct that is applied to every aspect of practice. From a client satisfaction perspective, make sure you employ ethically sound practices, set clear policies and enforce firm boundaries, and when possible, give clients accommodate client requests as long as they are legal and ethical.
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Book Code: MPA0825
EliteLearning.com/Massage-Therapy
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