before the next client receives a hot stone massage. One reason for this is that an undetected pathogen from one client may be transferred to the hot stones during a hot stone massage and possibly transferred to the next client who receives a hot stone massage if the same stones and water are used. It would be a clear violation of a therapist’s “do no harm” ethos to allow this happen, regardless of the employer’s standards of cleanliness. Ethically speaking, the therapist should consider educating the employer about the fundamentals principles of infection prevention as outlined by the Centers for Disease Control.
Where the law is applicable, sheets, towels, table surfaces, and other relevant items or materials must be cleaned according to all legal health and safety requirements. Where the law is lacking in comparison to a code of ethics or standards of practice a massage therapist may accept, therapists may have to take it upon themselves to protect themselves and their clients from potential safety hazards. In establishments where hot stones are used, for example, the standard of practice is such that hot stones should be scrubbed with hot water and soap between clients, and the water in the hot stone caddy exchanged for clean water
PATIENT AUTONOMY, INFORMED CONSENT, AND RIGHT TO REFUSE
to obtain adequate informed consent renders a healthcare professional liable for negligence or battery and constitutes medical malpractice (AMBP, 2022). While informed consent is a well-established practice, it often fails to meet its stated purpose. Recent research findings strongly suggest that procedures to obtain informed consent may not adequately promote the patient’s comprehension of the information provided, rendering the consent not truly informed. Studies suggest that a majority of patients do not read a consent form before signing it, and less than half of the U.S. population understands commonly used medical terms. Additionally, clients with limited reading ability are at increased risk for medical errors, due to problems reading medication bottles, appointment slips, self-care instructions, and health education brochures. These clients are also likely to have trouble reading materials intended to aid in obtaining informed consent (Sohnen-Moe, 2022). Several methods to improve informed consent have been suggested, and the following outlines best practices for increasing comprehension of informational materials and informed consent forms (Sohnen-Moe, 2022): ● All materials must be presented at each client’s reading level. ● All materials must be in the client’s preferred language. ● Written health-care materials, such as consent forms, should be written with simple sentence structure and vocabulary, making it easier to comprehend. ● The materials’ format may include visual clues, white spaces, and less information on the page to encourage thorough reading. Many poor readers will not attempt a full, single-spaced form if they feel it will take too much time and effort to read. ● Use a structure that promotes the main idea and supporting details in bullet or list form rather than using long, complicated paragraphs. ● Always provide materials in a format to accommodate client disabilities. ● Ask if the client needs an interpreter or if he or she prefers to bring a family member or friend to assist in the discussion process, as long as confidentiality can be maintained. ● Provide written information to clients regarding purpose of treatment, treatments methods, and other information to support discussions leading to informed consent decisions. The client can refer back to the information to support comprehension. Some practitioners provide clients with written information and consent forms weeks before the initial session to give them time to review the material. ● Always encourage questions, and give adequate time for discussion. ● Assess comprehension by informal methods such as observing facial expression, body language, tone, and rate or frequency of speech.
Informed consent refers to patients’ right to understand their condition(s) and participate in decisions regarding care of that condition. The patient or patient’s guardian is required to sign a written statement acknowledging agreement to proposed treatment terms and awareness of the known risk factors associated with them (Sohnen-Moe, 2022). Through this process, a healthcare practitioner informs a patient about the risks and benefits of a proposed therapy and allows the patient to decide whether the therapy will be undertaken. It is based on the moral and legal premise of patient autonomy and is the formal application of clients’ rights to make decisions about their own healthcare. Autonomy (self-rule) is based on the principle of respect for persons, which holds that individual persons have the right to make their own choices and develop their own life plan. In a healthcare setting, the principle of autonomy translates into the principle of informed consent: Therapists shall not treat clients without their informed consent. In order to affirm autonomy, every effort must be made to discuss treatment preferences with clients and to document them in written records (Sohnen-Moe, 2022). In massage therapy, informed consent usually takes the form of an agreement between the practitioner and client that states their shared objectives, the proposed treatment plan, expected outcome(s), and the anticipated time frame for results. It may also refer to the client’s medical history, asserting that the client has informed the practitioner about all known physical or medical conditions and current medications and will inform the practitioner if any of these conditions change (Sohnen-Moe, 2022). Informed consent in massage therapy typically includes a statement explaining the role of massage therapy in pain and stress reduction, other specified purposes, and its limitations (Sohnen-Moe, 2022). For example: ● Massage therapy does not take the place of medical examinations, care, or treatment. ● The therapist is not a doctor and does not diagnose medical conditions or prescribe medication. ● Clients should continue to consult their primary caregivers or other specialists for ongoing healthcare and medical conditions. ● Clients should consult their primary caregiver to review healthcare recommendations before making significant changes in their health and exercise regimen or diet. In addition to being an ethical obligation of caregivers, including therapists, AMBP requires that clients be informed of all important aspects of a treatment and/or procedure, although the details of these laws and statutes differ greatly. General guidelines require clients to be informed of the nature of their condition and the proposed treatment or procedure, its purpose, risks and benefits and their probability, risks and benefits of alternatives, and risks and benefits of not receiving the treatment. Failure
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