to suppress the pain. Is it better to control the pain or for the patient to be more alert? ● Having to go into a neighborhood recognized as dangerous in order to provide home care for a patient. The massage and bodywork professional will not be directly involved in the decision making process to address the issues above. They will be directly and closely involved with the client as the family and healthcare team carry out these decisions. The therapist may witness procedures that conflict with their values, beliefs, and in some cases, their interpretation of ethical standards. The therapist must thoroughly understand the scope of the end of life and hospice care before they commit to accepting clients into their care. NCBTMB Standard V: Roles and Boundaries Adhere to ethical boundaries and perform the professional roles designed to protect both the client and the practitioner, and safeguard the therapeutic value of the relationship (NCBTMB2009). NHPCO related principle Provide clients and their families with the highest possible level of quality end-of-life care and services, while maintaining professional boundaries that respect their rights and privacy (National Hospice and Palliative Care Organization Ethics Committee, 2006). Considerations for the massage therapist: 1. Respect client privacy and personal boundaries and do not enter into the client’s family life and affairs any further than is required to meet the goals of the care plan. Becoming overly involved in family dynamics or trying to “help” in ways outside of the professional role actually weakens ability to serve because it places the therapist within the family dynamic. 2. Respect cultural, ethnic, and religious beliefs of the client and family and do not impose beliefs or values. We live in a multi-cultural society with diverse beliefs about death and dying, rituals, and approaches to care giving. Remain open and sensitive to individual differences and see it as an opportunity to see things from a broader perspective. 3. Recognize the care team’s influential position with the client/ family and do not exploit the relationship for personal or other gain. In private practice the therapist may offer products or other complementary approaches, for example nutritional supplements, essential oils or guided imagery techniques. When working within a health care organization the therapist must be clear about their scope of service is and utilize proper channels to get approval to offer a modality that falls outside of that scope. For example, the therapist feels the client would really benefit from an aromatherapy treatment or herbal supplement for symptom relief. It is not appropriate to introduce it to the client or family. All practices must be discussed with members of the interdisciplinary team and, most likely, the attending physician would need to approve it. 4. It would also be inappropriate to solicit the client’s family or friends to make appointments for massage. The therapist must recognize and limit the impact of transference and counter-transference among the patient or family and boundary issues occur when professional and personal lives collide. All people are affected by subtle influences of personal history and emotional responses to the experiences 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.
In order to assist the massage and bodywork therapist to identify, analyze, and determine appropriate action in cases of ethical conflict, it is necessary to compare standards of practice established by the National Certification Board for Therapeutic Massage & Bodywork and related ethical principle from the National Hospice and Palliative Care Organization (NHPCO) (NCBTMB, 2009; Carlin, 2016). This will assist the therapist to increase their knowledge base concerning the basis for end or life procedures, determine their role in client care, and resolve ethical issues that impact their delivery of massage services in hospice care.
ROLES, BOUNDARIES & PRINCIPLE
around them. Katz (2006) states: “If we can distinguish what belongs to us, what belongs to the patient, and what these responses might indicate about our interactions, our patients benefit in that we come to more deeply ‘know’ them without acting out our own issues.” 5. Avoid dual or multidimensional relationships that could impair professional judgment or result in exploitation of the patient/family or co-workers by allowing another skilled practitioner take the professional role in these cases. 6. Acknowledge and respect the client’s freedom of choice and right to refuse any part of the therapeutic session because services are permission-based and require informed consent. It is important to recognize that a patient’s situation and tolerance of massage or even touch may fluctuate especially in advanced stages of disease or injury (Carlin, 2016). 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.” 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.
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
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