● Add a phrase such as, “All Are Welcome Here,” or “Welcoming Practice,” to your marketing materials. This way, people will know the practice is supportive of diversity and will be more comfortable visiting the practice. ● Invite back each client that receives care or contacts the practice for information and be sure to address the mental and physical benefits of the practice. Ethical considerations of hospice massage Massage and bodywork professionals follow ethical standards and guidelines within their scope of practice. If that includes working with clients in hospice care the practitioner must be prepared to face ethical issues that may lead to dilemmas related to hospice end-of-life care. As massage therapy is increasingly integrated into all phases of modern day health care from infancy to gerontology, the practitioner may be called upon to work with clients in hospice or other forms of end of life care. Advances in medical treatment, technology, and changes in attitudes, and legislation about care for the terminally ill presents ethical dilemmas and conflict for the family and all care givers. Dr. Richard Fife, an ethicist, states: “In hospice care, staff members are constantly faced with the possibilities and realities of ethical dilemmas” (Fife, 2005). He reports findings from a two- year study of ethical dilemmas faced by hospice staff. Some of the most common issues included Fife notes are as follows: ● Working with clients who have been admitted without a do- not-resuscitate (DNR) order. ● Withdrawal or withholding of nutrition/hydration. ● Patient autonomy versus patient safety and physical needs. ● Conflicts with the patient’s family or significant others. ● Conflict over whether to follow a patient’s wish to be discharged from a hospice unit when the staff member feels that the primary caregiver is incompetent to take care of the patient. ● Pain medication and respiratory distress/consciousness. The question here being whether the pain is so great that 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
● Keep an open mind and conduct self-assessment to evaluate beliefs and values. By examining those values and keeping an open mind practitioners grow and change. As the great Maya Angelo said, “I did then what I knew how to do. Now that I know better, I do better.”
it is necessary to adversely affect consciousness and cause some respiratory distress by the higher use of medications 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. 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
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 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).
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