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. 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
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 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). 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.
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