Ethics Boundaries & Dilemmas

Ethics Boundaries & Dilemmas

RI AMTA Conference

October 21-23 , 2016

DWNEST01

DowneastSchool of Massage

Nancy W. Dail, BA, LMT, NCTMB

PO Box 24

99 Moose Meadow Lane

Waldoboro, ME04572

207-832-5531

The contents of this presentation are solely for instructional purposes only at the RI AMTA Conference in October 2016 and as such may not be reprinted or copied in any way without prior written permission from the Downeast School of Massage and from Nancy W. Dail, BA, LMT, NCTMB.

Boundaries and Dilemmas

Presented by Nancy Dail

Ethics concerns relationship. It is about the inner relationships of our values to actions. It is interaction between one belief and another, one desire and another, one fear and another. Ethics is the process by which we sort out what best creates inner and outer harmony in our lives. Kylea Taylor from The Ethics of Caring

Each practitioner upon entering a profession is invested with the responsibility to adhere to the standards of ethical practice and conduct set by the profession. Ethics is a part of philosophy which deals with systematic approaches to moral issues and problems.

Boundaries are the outside edges that as therapists we must uphold; boundaries give us the freedom to work in a clear atmosphere of scope of practice, utilizing our code of ethics, education, and often good sense. Ethics evolve with its profession and therefore need to be continually explored, discussed, and defined. The reality of practice is that ethical dilemmas often are unexpected and absolutely do happen. Bring your dilemma or ethical issue to this 3 hour lecture and group session where we will discuss boundaries and real dilemmas in the massage therapy practice.

Course Description

Lecture includes the philosophy and science of ethics, as well as its relationship to massage therapy, clients, and other health professionals. Class participation includes solving ethical dilemmas for entire class benefit.

Course Objectives

Participants should be able to understand the influence of ethics in professional practice.
Participants should be able to identify ethical dimensions involved in the everyday practice of their profession.
Participants should be able to recognize ethical situations and problems that are unique to massage therapy, in contrast to those shared by other health professionals.
Participants should be able to apply principles of problem solving in ethical decision-making.

Learning Objectives:

Students should be able to define Ethics.
Students should be able to talk about the characteristics of a profession.
Students should be able to define Technical and Ethical Competence.
Students should be able to explain the role and purpose of a code of ethics.
Students should be able to talk about the AMTA Code of Ethics.
Students should be able to identify the role and purpose of Standards of Practice specific to massage therapy and bodywork.
Students should be able to identify ethical situations in massage therapy/bodywork and processes by which to effectively resolve ethical issues.
Students should be able to describe avenues of complaints.
Students should be able to talk about massage therapy as an advocacy profession.
Students should be able to talk about the importance of a professional peer group.

11. Participants should be able to talk about various ethical dilemmas based on the group discussions on ethical situations in this class. Class structure will be experiential, in groups solving ethical situations and bringing answers back to the entire class.

Explore a checklist for keeping the Value of Ethics in our practice.

Class Schedule: October 21-23, 2016 - One class at 6:30pm-9:30PM and one at 2-5PM

Recommended Texts and Sources

Business Mastery, by Cherie Sohnen-Moe, SMA

Coding Out: Reviving Ethical Behavior in Fatal Cultures by Melissa Parisot, Institute for Global Ethics, Newsletter Ethical Connections Volume 6, Number 1, Spring 2004

Ethical Dimensions in the Health Professions, by Ruth Purtilo, W. B. Saunders Co.

Fundamentals of Therapeutic Massage, by Sandy Fritz, Mosby.

The Educated Heart: Professional Guidelines for Massage Therapists, Bodyworkers, and Movement Teachers, N. McIntosh, Decatur Bainbridge Press

Massage Mastery from Student to Professional by Anne Williams, Lippincott, Williams & Wilkins

Professional Foundations for Massage Therapists by Patricia Benjamin, Pearson/Prentice Hall

The Ethics of Caring, by Kylea Taylor, Hanford Mead

The Ethics of Touch, by Ben Benjamin and Cherie Sohnen-Moe, Tucson, AZ: SMA.

The Psychology of the Body, by Elliot Greene and Barbara Goodrich-Dunn, Lippincott Williams & Wilkins.

What is the Value of Ethics, Suzanne Ross, St. James Ethics Centre,

Reach Nancy at:

Downeast School of Massage, PO Box 24, 99 Moose Meadow Lane, Waldoboro, ME 04572, 207-832-5531

Handouts

Ethics Outline

Great and Small – Thomas Merton

Code of Ethics, Standards of Practice, AMTA

Are You In Trouble With A Client, Estelle Disch, Ph.D.

Protocol for Processing Scenarios

Ethical Dilemmas

Practitioner Checklist

Attendance

Attendance and participation are mandatory for this short course.

Ethics

An ethic of care involves a morality grounded in relationship and response

Rita C. Manning

Each practitioner upon entering a profession is invested with the responsibility to adhere to the standards of ethical practice and conduct set by the profession.

Definition of Ethics: Ethics is a part of philosophy which deals with systematic approaches to moral issues and problems. Refers to the rules or principles which govern right conduct. Ethics is the study of morality.

The first rule of ethics is to DO NO HARM! Hippocrates

Greek Origins: Socrates, Plato and Aristotle

Character Traits, Values and Cardinal Virtues

Ethical Behavior

A. Golden Rule - Do unto others as you would have them do unto you. Jesus

B. Buddhist concept of right relationship - view how intentions and actions effect the other and in turn realize the rippling effect of outward motion.

C. Ethical behavior is reverence for life demonstrated by right relationship to another.

Ethicist - Philosopher or theologian who study ethics.

A. Metaethics - tries to discover the underlying reasons given for making moral

judgments

B. Normative ethics - asks concrete questions; what types of acts are morally

right or wrong, etc.

What is a profession

A. Defining one’s role is important to all who seek meaning and self-respect in their work. If one’s professional identity is unclear the work is more stressful and less satisfying, and ethical dilemmas are more frequent and more difficult to resolve. Ethical Dimensions in the Health Professions by Purtilo & Cassel, W. B. Saunders Co.

B. Characteristics of a profession

1. Members of a profession claim maximal competence and or knowledge in a specific area.

2. A profession offers a service which is of some significant social value.

3. A profession has the most distinctive aspect of its right to control its own work - it has legitimate, socially recognized autonomy.

VI Technical Competence - Unethical to practice if one is incompetent

A. Reach technical competence through education

B. Promote technical competence through professional goals; Natl Cert and continuing education.

C. Professions have codes of ethics which are specific to technical competence

Ethical Competence

A. Includes technical competence

B. Honesty with colleagues and clients

C. Sense of goals of one’s work

D. Sense of duty to uphold standards

E. Act on behalf of the client

A. Ethics goes beyond law and guidelines

B. Legally an action may be within the law, but unethical in performance as

demonstrated by an ethical code defined by the profession.

Codes of Ethics

A. AMTA code of ethics - handout

B. National Certification Board for Therapeutic Massage and Bodywork code of ethics

C. Discussion of additional codes

D. Codes of ethics are living documents

Four Step Process of Moral Judgment and Action

A. Gather relevant information

B. Identify the dilemma

C. Decide what to do

D. Complete the Action

Governing Mechanisms for Massage Therapists

A. AMTA professional chapter

B. Natl Grievance Committee

C. Licensing bureau - registration, certification, Advisory committee

D. Police and law

XII Advocates - one who works on behalf of another

A. Massage therapists are advocates

B. Assist client to understand situation in relevant context

C. Assist other decision makers in understanding client point of view

D. The professional advocate

E. AMA Principles of Medical Ethics “ A physician should practice a method of healing founded on a scientific basis and he should not voluntarily associate professionally with anyone who violates this principle.”

F. Holistic care on the rise

G. Patients rights movement

XIII. Support among Professional Peers

A. AMTA

B. Burn-out and self-care

C. Get massage, go to meetings, support profession

XIV. Group discussions - additional handouts for problem solving

XV.. Keeping the Value of Ethics – Practitioner Checklist

XVI.. The Value of Ethics

Modeling
Enforcement
Communication
Transparency
Oversight
Education
Prevention

XVII. Questions and Summary

Great And Small

The Way of Chuang Tzu

By Thomas Merton

When we look at things in the light of Tao,

Nothing is best, nothing is worst.

Each thing, seen in its own light,

Stands out in its own way.

It can seem to be “better”

Than what is compared with it

On its own terms.

But seen in terms of the whole,

No one thing stands out as “better”.

If you measure differences,

What is greater than something else is “great,”

Therefore there is nothing that is not “great”;

What is smaller than something else is “small,”

Therefore there is nothing that is not “small,”

So the whole cosmos is a grain of rice,

And the tip of a hair

Is as big as a mountain-

Such is the relative view.

You can break down walls with battering rams,

But you cannot stop holes with them.

All things have different uses.

Fine horses can travel a hundred miles a day,

But they cannot catch mice

Like terriers or weasels:

All creatures have gifts of their own.

The white horned owl can catch fleas at midnight

And distinguish the tip of a hair,

But in bright day it stares, helpless,

And cannot even see a mountain.

All things have varying capacities.

Consequently: he who wants to have right without wrong,

Order with disorder,

Does not understand the principles

Of heaven and earth.

He does not know how

Things hang together.

Can a man cling only to heaven

And know nothing of earth?

They are correlative: to know one

Is to know the other.

To refuse one

Is to refuse both.

Can a man cling to the positive

Without any negative

In contrast to which it is seen

To be positive?

If he claims to do so

He is a rogue or a madman.

Code of Ethics

This Code of Ethics is a summary statement of the standards of conduct that define ethical behavior for the massage therapist. Adherence to the Code is a prerequisite for admission to and continued membership in the American Massage Therapy Association (AMTA).

Principles of Ethics. The Principles of Ethics form the first part of the Code of Ethics. They are aspirational and inspirational model standards of exemplary professional conduct for all members of the association. These Principles should not be regarded as limitations or restrictions, but as goals for which members should constantly strive.

Massage therapists/practitioners shall:

Demonstrate commitment to provide the highest quality massage therapy/bodywork to those who seek their professional service.
Acknowledge the inherent worth and individuality of each person by not discriminating or behaving in any prejudicial manner with clients and/or colleagues.
Demonstrate professional excellence through regular self-assessment of strengths, limitations, and effectiveness by continued education and training.
Acknowledge the confidential nature of the professional relationship with clients and respect each client’s right to privacy within the constraints of the law.
Project a professional image and uphold the highest standards of professionalism.
Accept responsibility to do no harm to the physical, mental and emotional well-being of self, clients, and associates.

Rules of Ethics. The Rules of Ethics are mandatory and direct specific standards of minimally-acceptable professional conduct for all members of the association. The Rules of Ethics are enforceable for all association members, and any members who violate this Code shall be subject to disciplinary action.

Massage therapists/practitioners shall:

Conduct all business and professional activities within their scope of practice and all applicable legal and regulatory requirements.
Refrain from engaging in any sexual conduct or sexual activities involving their clients in the course of a massage therapy session.
Be truthful in advertising and marketing, and refrain from misrepresenting his or her services, charges for services, credentials, training, experience, ability or results.
Refrain from using AMTA membership, including the AMTA name, logo or other intellectual property, or the member’s position, in any way that is unauthorized, improper or misleading.
Refrain from engaging in any activity which would violate confidentiality commitments and/or proprietary rights of AMTA or any other person or organization.

Effective Date May 1, 2010

Standards of Practice

Purpose Statement: These American Massage Therapy Association (AMTA) Standards of Practice were developed to assist the professional massage therapist to:

provide safe, consistent care
determine the quality of care provided
provide a common base to develop a practice
support/preserve the basic rights of the client and professional massage therapist
assist the public to understand what to expect from a professional massage therapist

This document allows the professional massage therapist to evaluate and adapt performance in his/her massage/bodywork practice. The professional massage therapist can evaluate the quality of his/her practice by utilizing the Standards of Practice in conjunction with the Code of Ethics, the Bylaws and Policies ofAMTA, and precedents set by the AMTA Grievance, Standards, and Bylaws Committees.

1. Conduct of the Professional Massage Therapist or Practitioner, hereinafter referred to as "Practitioner"
1.1 AMTA members must meet and maintain appropriate membership requirements.
1.2 Individual AMTA members who engage in the practice of professional massage/bodywork, shall adhere to standards of professional conduct, including the AMTA Code of Ethics.
1.3 The Practitioner follows consistent standards in all settings.

1.4 The Practitioner seeks professional supervision/consultation consistent with promoting and maintaining appropriate application of skills and knowledge.

2. Sanitation, Hygiene and Safety
2.1 Practitioner provides an environment consistent with accepted standards of sanitation, hygiene, safety and universal precautions.
2.2 Pathophysiology (Contraindications)
2.2.1 The Practitioner maintains current knowledge and skills of pathophysiology and the appropriate application of massage/bodywork.
2.2.2 The Practitioner monitors feedback from the client throughout a session.
2.2.3 The Practitioner makes appropriate referrals to other reputable healthcare providers.

3. Professional Relationships with Clients
3.1 The Practitioner relates to the client in a manner consistent with accepted standards and ethics.
3.2 The Practitioner maintains appropriate professional standards of confidentiality.
3.3 The Practitioner relates to the client in a manner which respects the integrity of the client and practitioner.
3.4 The Practitioner ensures that representations of his/her professional services, policies, and procedures are accurately communicated to the client prior to the initial application of massage/bodywork.
3.5 The Practitioner elicits participation and feedback from the client.

4. Professional Relationships with Other Professionals
4.1 The Practitioner relates to other reputable professionals with appropriate respect and within the parameters of accepted ethical standards.
4.2 The Practitioner's referrals to other professionals are only made in the interest of the client.
4.3 The Practitioner's communication with other professionals regarding clients is in compliance with accepted standards and ethics.
4.4 A Practitioner possessing knowledge that another practitioner:
(1) committed a criminal act that reflects adversely on the Practitioner's competence in massage therapy, trustworthiness or fitness to practice massage therapy in other respects;
2) engaged in an act or practice that significantly undermines the massage therapy profession; or
(3) engaged in conduct that creates a risk of serious harm for the physical or emotional well being of a recipient of massage therapy; shall report such knowledge to the appropriate AMTA committee if such information is not protected or restricted by a confidentiality law.

5. Records
5.1 Client Records
5.1.1 The Practitioner establishes and maintains appropriate client records.
5.2 Financial Records
5.2.1 The Practitioner establishes and maintains client financial accounts that follow accepted accounting practices.

6. Marketing
6.1 Marketing consists of, but is not limited to, advertising, public relations, promotion and publicity.
6.2 The Practitioner markets his/her practice in an accurate, truthful and ethical manner.

7. Legal Practice
7.1 American Massage Therapy Association members practice or collaborate with all others practicing professional massage/bodywork in a manner that is in compliance with national, state or local municipal law(s) pertaining to the practice of professional massage/bodywork.

8. Research
8.1 The Practitioner engaged in study and/or research is guided by the conventions and ethics of scholarly inquiry.
8.2 The Practitioner doing research avoids financial or political relationships that may limit objectivity or create conflict of interest.

Are You In Trouble With A Client?

Boston Associates to Stop Therapy Abuse

BASTA!

Estelle Disch, Ph.D.

528 Franklin Street

Cambridge, MA 02139

The purpose of this checklist is to alert you to boundary issues which might be interfering with your ability to work effectively with a particular client. Be particularly attentive if the situation persists even after you have attempted to change it.

Client’s initials or pseudonym______

1.______This client feels more like a friend than a client.

2.______I often tell my personal problems to this client.

3. ______I feel sexually aroused in response to this client.

4.______I want to be friends with this client when therapy ends.