Complete Your CE Test Online - Click Here front of the client, joke about sexual matters, make sexual remarks or jokes, or use sexual innuendo. Maintain a comfortable and professional environment. Avoid meeting new clients at unknown locations, at hotels, or in the client’s home, where your personal safety may be at greater risk. If you meet the client on-site, set up the massage table in a neutral location, rather than a bedroom. Encourage relaxation through your client’s visual, auditory, and olfactory senses, but keep the look and smell of your environment subdued and professional. Avoid creating an overly perfumed, romantic, or sensual atmosphere. Remember that a client may be allergic to certain odors, have strong negative reactions to certain smells, or associate a given odor with an unpleasant memory or incident. Music should also be soothing and subtle, and played only after you have asked your client about his or her preference for music or silence during the massage. Misconduct Misconduct has been a persistent and troubling issue in health care and medical professions since the early days of modern medicine. Written more than 2,000 years ago, the Hippocratic Oath urged members of the medical profession to refrain from “mischief, and in particular, sexual relationships with both female and male persons.”4 In recent years, accusations of misconduct in the health care and personal service industries have become increasingly common, due in part to formal regulation of the complaint process and greater awareness of the issue among the general public. Misconduct takes many different forms that vary considerably in type and degree of severity. The following examples of misconduct demonstrate the need for ethical vigilance in every aspect of business practice, from organizational matters, to billing, to social interactions. Even in cases where inappropriate behaviors are the unintended result of thoughtlessness, errors in judgment, or improper planning, they risk potentially serious repercussions for the client and heavy penalties for the practitioner. Victims may face emotional and physical scarring with lifelong implications, and allegations of misconduct – even false ones – wreak havoc with practitioners’ lives and livelihoods5 . Misconduct takes many forms. The following list provides some examples: ● ● Misrepresentation of educational status: Identifying yourself as a craniosacral therapist after taking a two-hour course. ● ● Substance abuse: Practicing under the influence of alcohol, drugs, or any illegal substances (with the exception of prescribed dosage of prescription medication which does not significantly impair the practitioner). ● ● Financial impropriety: Charging a cash-paying client a different fee than an insurance-paying client. ● ● Exploiting the power differential: Asking a stockbroker for financial tips during a treatment. ● ● Misleading claims of curative abilities: Telling a client you guarantee her pain will be gone in two sessions. ● ● Accessibility: Refusing to adapt your office (or making some reasonable accommodation) for those with physical challenges. ● ● Bigotry: Refusing to work with someone due to race, religion, size, or sexual orientation. ● ● Inappropriate advertising: Using a provocative picture in advertising; presenting misleading qualifications. ● ● Dual relationships: Dating a client. ● ● Violation of laws: Practicing out of your home, when it is not permitted by law. ● ● Confidentiality: Name-dropping famous clients; telling a spouse details about his partner’s session. ● ● Contraindications: Treating a client when you are sick/infectious; ignoring signs of conditions that preclude physical contact. ● ● Informed consent: Working on a minor without parental knowledge; treating someone’s injury without permission. ● ● Practicing beyond scope of practice: Doing spinal adjustments, massage or counseling without appropriate training. ● ● Sexual misconduct: Watching a client undress or hugging a client in a sexual way. Harassment Harassment is a specific kind of misconduct or boundary violation in which an individual of equal or greater authority is inappropriately familiar with a co-worker or junior employee. Harassment can manifest itself in abusive remarks or behavior, belittling statements and actions, and discussion or commentary of an overly personal or offensive nature. Sexual harassment is abuse of power, typically exercised within the context of work, containing a sexual or gender-specific component. The Equal Employment Opportunity Commission defines sexual harassment as any unwelcome advance, request, verbal statement, or physical conduct of a sexual nature, including visual displays, in which:6 ● ● Submission is made a condition of an individual’s employment, either explicitly or implicitly. ● ● Submission forms the basis for work-related evaluations, such as decisions regarding employment benefits or advancement. ● ● The individual is subject to intimidating, offensive, or hostile environmental elements that interfere with the individual’s ability to work effectively or productively. Sexual harassment, like sexual misconduct, is not defined by any specific sexual interaction between two individuals. Harassment may include the discussion of sexually explicit topics of conversation at a place of business, unnecessary or inappropriate references to specific body parts or functions, and visual depictions of a provocative or offensive nature, such as posters or calendars featuring photos of nude or scantily clad models. Sexual harassment can occur between men and women, women and women, men and men, or any other combination of sexual or gender identity. Sexual harassment may feel humiliating or shameful, making the victim reluctant to report the incident. Reporting misconduct If you believe another practitioner is acting unethically or illegally, you have a responsibility to report it. Contact your state board, the certifying organization (NCBTMB, AMTA, etc.), or the Agency for Healthcare Administration (AHCA) to file a complaint. The AHCA is responsible for analyzing complaints and reports involving potential misconduct and initiating investigations. The boards and councils within statewide organizations determine probable cause and disciplinary action. References 1. Hippocratic Oath translation discussed at http://www.geocities.com/ever wild7/noharm.html 2. MIA Professional and Ethics Seminar (Manitoba) June 9, 2002 3. The Ethics of Touch [Benjamin and Sohnen-Moe, 2003] 4. http://classics.mit.edu/Hippocrates/hippooath.html 5. The Ethics of Touch, Benjamin, Ben E. and Sohnen-Moe, Cheree, 2003] 6. http://www.eeoc.gov/types/sexual_harassment.html 7. www.doh.state.fl.us/mqa/massage/ma_home.html. Saturday, August 3, 2003 8. NCBTMB Consumer Survey. Harris Interactive, October 2001. Complete survey questions/results are available on line at http://wwwncbtmb.com/Press_releases/SurveyResults.html:citation at: www. massagetoday.com/archives/2001/12//02.html 9. www.cbsmalpractice.com/report/articles/ jul 1801.htm Monday, July 21, 2003 (CBS Malpractice Report: “Tips for Better Record Keeping”) 10. Quintrell, N 1994, Communication Skills: Pharmaceutical Society of Australia, Canberra. 11. http://www.ncbtmb.com/standards_of_practice.html 12. http://www.ethics.va.gov/ETHICS/docs/necrpts/NEC_Report_20030701_Ethical_Boundaries_Pt- Clinician_Relationship.pdf 13. http://www.hhs.gov/ohrp/humansubjects/guidance/belmont.htm#xbasic 14. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Making Health Care Decisions. Washington, DC: U.S. Government Printing Office, 1983. 15. http://www.nida.nih.gov/Infofacts/understand.html 16. About Massage, Bodywork, and Somatic Therapies, Associated Bodywork and Massage Professionals (ABMP) Professional code of Ethics, 2003. 17. Alternative Therapies: Journal of Alternative Therapies in Health and Medicine 18. American Massage Therapy Association; AMTA Massage: Definition of Massage, Code of Ethics, 2003 19. Ashton, Joseph, and Cassel, Duke, Review for Therapeutic Massage and Bodywork Certification, Lippincott, Williams &Wilkins, Baltimore, Maryland, 2002. 20. Beck, Mark F., Miladys Theory and Practice of Therapeutic Massage, 3rd edition, Milady Publishing Company, Albany, NY, 1999. 21. Benjamin, Ben E., and Sohnen-Moe, Cheree, The Ethics of Touch, SMA Inc, 2003. 22. Burnum JF. Preventability of adverse drug reactions. Ann Intern Med 1976;85(1):80-1. 23. Calvert, Robert Noah, The History of Massage, Healing Arts Press: Rochester, Vermont, 2002. 24. Cohen-Horwitz, B. (1991). The nurse as defendant. Trial Lawyer 14(8):39-47. Page 8 Massage.EliteCME.com