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. 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 Case study 1 A massage therapist and client have had a professional relationship for five months. During this time, the client has received a massage once per month. There has not been any inappropriate activity during this time, and there has not been any non-professional contact outside of the massage
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. What is a non-compete clause? When a practitioner work for another massage therapist or is employed by a practice or spa as an employee, they may be asked to sign a non-compete agreement or a non-compete clause may be a standard part of an employment contract. These clauses prohibit an employee from competing against their employer for a specified length of time and in a specific, limited geographical area. Reasonable terms might include a time frame of as three years or less and a geographic area that is small and specific, like a town or city. The non-compete clause may vary according to the state of licensure or certification. California, for example, does not allow non-compete agreements at all. Also, today’s tough economy may cause courts to look closely at contract provisions that are overreaching, unfair or prevent the practitioner from earning a living. What should I know about contracts? The answer to this is fairly easy: find a good local lawyer to advise before signing any important contract, including leases, purchase contracts and employment. Practitioners need to understand the parties involved, the terms, all information and what kinds of penalties exist in case of breach. Unfortunately, wading through this information alone without legal counsel can be overwhelming, and erring on the side of caution can save time and money in the end. Can I operate my massage therapy practice out of my home? Check the local municipal jurisdiction, zoning office, state regulations of practice along with specific rules of the building or association. The key is the protection of the residential character of the home or apartment. Local zoning ordinances regarding traffic and parking must be considered. Before starting, take a trip down to city hall and ask the appropriate questions such as the need for permits, licenses, or health permits or requirements needed to conduct business. Is my massage license portable, meaning that I can move from state to state without requalification? The license to practice is state-given so license issued allows practice in a particular state. Some states do have special provisions recognizing the fact that an individual moves into the jurisdiction holding a current license from another jurisdiction. In this case, special provisions apply to the individual, though they must still follow the requirements to qualify and get a new license. There simply is no national, universally recognized licensing or certification program that provides for individuals to move from one state to another and have a license recognized. When preparing to move, understand that a new license or certification will be needed for that state, and there may be other legal requirements to practice.
CASE STUDIES: ETHICAL ISSUES IN PRACTICE
sessions. Lately, however, the client has been scheduling weekly massages. Moreover, the appointments have been at the home of the client, and the conversations during a massage appointment have typically been personal in nature, often speaking freely. Although it is unspoken, both the client and the
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