ETHICS IN MASSAGE
THERAPY
GOALS AND OBJECTIVES
COURSE DESCRIPTION
“Ethics in Massage Therapy” is a home
study continuing education program for healthcare professionals. The course focuses on defining ethical
professional behavior of Massage Therapists.
Information presented includes sections on the theoretical basis for
ethical decision-making, the AMTA’s Code of Ethics and Standards of Practice,
legal standards of behavior, and hypothetical case scenarios.
COURSE RATIONALE
This course was developed to promote
and facilitate ethical behavior among therapists and other healthcare
professionals in the rehabilitation setting.
COURSE GOALS
1.
The
student will understand the theoretical basis for ethical decision-making.
2.
The
student will review and be familiar with the AMTA’s Code of Ethics and Standards
of Practice.
3.
The
student will analyze and interpret hypothetical situations to determine ethical
behavior.
4.
The
student will understand the basic rights of the patient.
5.
The
student will learn about the legal and ethical considerations of billing and
coding.
6.
The
student will understand the meaning and implications of “conflict of interest”.
7.
The
student will learn about appropriate relationships in the rehabilitation
setting.
COURSE OBJECTIVES
1.
Increase
understanding of the process required for ethical decision-making.
2.
Familiarize
therapists and assistants with their profession’s Code of Ethics.
3.
Review
and interpret the laws and rules that govern rehabilitation professionals.
4.
Develop
improved problem solving skills relating to ethical dilemmas.
5.
Review
and explain basic patient rights.
6.
Examine
the ethical considerations involved with billing for rehab services.
7.
Discuss
the meaning and implications of conflict of interest.
8.
Review
and examine appropriate relationships in rehabilitation.
COURSE EDITOR
Michael Niss PT
METHODS OF INSTRUCTION
Home study course available via
internet or written correspondence.
CRITERIA FOR ISSUANCE OF CONTINUING EDUCATION CREDITS
A documented score of 70% or greater
on the written post-test.
DETERMINATION OF CONTACT HOURS
“Ethics in Massage Therapy” will
require at least 2 hours to complete.
This estimate is based on the accepted standard for home study courses
of approximately 10-12 pages of written text (12 pt font) per hour. The complete text of this course is 21 pages
(excluding Bibliography and Post Test)
OUTLINE
page
Goals and
Objectives 1
Outline 2
Ethics 3
Why Ethics
is Important 3
Ethics vs
Morals 3
Ethical
Questions 3-4
Ethics Theories 4-5
How to Make
Right Decisions 5-7
Ethical Considerations
in Massage Therapy 7-14
Patient Rights 7-10
Confidentiality 7-8
Qualified
Care 8
Informed
Consent 8-10
Medical
Necessity 10
Billing and Coding 10-12
The
Triad 10-11
Co-payments
and Deductibles 11-12
Conflicts of Interest 12-13
Relationships 13-14
Referral
sources 13-14
Patients 14
AMTA’s
Standards of Practice 15-17
AMTA’s Code
of Ethics 18
Florida’s
Patient Bill of Rights 19-21
References 22
Post-Test 23-24
ETHICS
The word "ethics"
is derived from the Greek word ethos (character), and from the Latin
word mores (customs). Together, they combine to define how individuals
choose to interact with one another. In philosophy, ethics defines what is good
for the individual and for society and establishes the nature of duties that
people owe themselves and one another. Ethics is also a field of
human inquiry ("science" according to some definitions) that examines
the bases of human goals and the foundations of "right" and
"wrong" human actions that further or hinder these goals.
Ethics is important on several levels.
ETHICS VS. MORALS
Although the terms "ethics" and "morals" are often
used interchangeably, they are not identical. Morals usually refer to
practices; ethics refers to the rationale that may or may not support such
practices. Morals refer to actions, ethics to the reasoning behind such
actions. Ethics is an examined and carefully considered structure that includes
both practice and theory. Morals include ethically examined practices, but may
also include practices that have not been ethically analyzed, such as social
customs, emotional responses to breaches of socially accepted practices and
social prejudices. Ethics is usually at a higher intellectual level, more
universal, and more dispassionate than morals. Some philosophers, however, use
the term "morals" to describe a publicly agreed-upon set of rules for
responding to ethical problems.
ETHICAL QUESTIONS
Ethical questions involve 1) responsibilities to the welfare of others
or to the human community; or 2) conflicts among loyalties to different persons
or groups, among responsibilities associated with one's role (e.g. as consumer
or provider), or among principles. Ethical questions include (or imply) the
words "ought" or "should".
Throughout history, mankind
has attempted to determine the philosophical basis from which to define right
and wrong. Here are some of the more
commonly accepted theories that have been proposed.
UTILITARIANISM
This philosophical theory
develops from the work of Jeremy Bentham and John Stewart Mill. Simply put,
utilitarianism is the theory that right and wrong is determined by the
consequences. The basic tool of measurement is pleasure (Bentham) or happiness
(Mill).
A morally correct rule was the
one that provided the greatest good to the greatest number of people.
SOCIAL
CONTRACT THEORY
Social contract theory is
attributed to Thomas Hobbes,
John Locke, and from the twentieth century, John Rawls.
Social contract theories believe that the moral code is created by the people
who form societies. These people come together to create society for the
purpose of protection and gaining other benefits of social cooperation. These
persons agree to regulate and restrict their conduct to achieve this end.
Under this theory you
determine if an act or rule is morally right or wrong if it meets a moral
standard. The morally
important thing is not consequences but the way choosers think while they make
choices. One famous philosopher who
developed such a theory was Immanuel Kant (1724-1804).
Under this view an act or
rule is determined to be right or wrong by appeal to the common intuition of a
person. This intuition is sometimes referred to as your conscience. Anyone with
a normal conscience will know that it is wrong to kill an innocent person.
This view is based on the
theory that each person should do whatever promotes their own best interests;
this becomes the basis for moral choices.
This ethics theory proposes
that ethical behavior is a result of developed or inherent character traits or
virtues. A person will do what is
morally right because they are a virtuous person. Aristotle (384-322 B.C.) was
a famous exponent of this view. Aristotle felt that virtue ethics was the way
to attain true happiness. These are some of the commonly accepted virtues.
Autonomy: the duty to maximize the individual's right to make
his or her own decisions.
Beneficence: the duty to do good.
Confidentiality: the duty to respect privacy of information.
Finality: the duty to take action that may override the
demands of law, religion, and social customs.
Justice: the duty to treat all fairly, distributing the risks
and benefits equally.
Nonmaleficence: the duty to cause no harm.
Understanding/Tolerance: the duty to understand and to accept other
viewpoints if reason dictates.
Respect
for persons: the duty to honor
others, their rights, and their responsibilities.
Universality: the duty to take actions that hold for everyone,
regardless of time, place, or people involved.
Veracity: the duty to tell the truth.
The foundation for making proper ethical decisions is
rooted in an individual’s ability to answer several fundamental questions
concerning their actions.
Weighing the legality of
one’s actions is a prudent way to begin the decision-making process. The laws
of a geographic region are a written code of that region’s accepted rules of
conduct. This code of conduct usually
defines clearly which actions are considered acceptable and which actions are
unacceptable. However, a legitimate
argument can be made that sometimes what is legal is not always moral, and that
sometimes what is moral is not always legal.
This idea is easily demonstrated by the following situation.
It is illegal for a pedestrian
to cross a busy street anywhere other than at the designated crosswalk
(jaywalking). A man is walking down a
street and sees someone fall and injure themselves on the other side of the
street. He immediately crosses the
street outside of the crosswalk to attend to the injured person. Are his actions legal? Are they moral? What if by stepping into the street he causes a car to swerve and
to strike another vehicle?
Admittedly, with the
exception of policemen and attorneys, most people do not know all of the
specific laws that govern their lives.
However, it is assumed that most people are familiar with the
fundamental virtues from which these laws are based, and that they will live
their lives in accordance with these virtues.
Professional ethical behavior
as it is defined in this context relates to actions that are consistent with
the normative standards established or practiced by others in the same
profession. For Massage Therapists,
these ethical standards are documented in the American Massage Therapy
Association’s Code of Ethics. All Massage
Therapists, even those who are not members of the AMTA, are bound to these guidelines.
This is because The AMTA Code of Ethics is the accepted and de facto standard
of practice throughout the profession.
I think most people would
agree that the concept of fairness is often highly subjective. However, for
these purposes, we will define fairness as meaning deserved, equitable and
unbiased. Fairness requires the decision-maker
to have a complete understanding of benefits and liabilities to all parties
affected by the decision. Decisions
that result in capricious harm or arbitrary benefit cannot be considered fair. The goal of every decision should be an
outcome of relative equity that reflects insightful thought and soundness of
intent.
This question presents as a
true reflection of the other three.
Legal, ethical, and fair are defined quite differently by most people
when judged in the comfort of anonymity versus when it is examined before the
forum of public opinion. Most often it
is the incorrect assumption that “no one will ever find out about this” that
leads people to commit acts of impropriety.
How would your decisions change, if prior to taking any actions, you
assumed just the opposite; “other people will definitely know what I have
done”. One sure sign of a poor decision
is debating the possible exposure of an action instead of examining the
appropriateness of it.
1. Confidentiality
The information
contained in each patient’s medical record must be safeguarded against
disclosure or exposure to nonproprietary individuals. The right to know any medical information about another is always
predicated on a sound demonstration of need.
Frequently, many individuals require access to information contained in
a patient’s medical record. Their right to access this information is limited
to only that information which is deemed necessary for them perform their job
in a safe, effective, and responsible manner.
Case Study
John Jones LMT, Sue Brown (receptionist), and Mary
Smith (accounts payable), are in a private office discussing the fact that they
are treating Biff Simpson, a star NFL quarterback. John says, “I can’t believe that I’m actually treating Biff
Simpson.” Mary asks, “How bad do you
think his injury is?” John replies, “I
saw his MRI report, it looks like he is going to need surgery.”
Is this a breach in confidentiality?
The
first questions we must ask are “What information is being disclosed and do the
three individuals engaged in the conversation have a need to know this
information?”
John’s
first statement discloses the name of person receiving care, and his second
statement reveals private patient medical information. Certainly, as the client’s massage therapist,
John would need to know the client’s name and therapy related diagnosis in
order to provide care. Sue, the
receptionist, may also need this information to schedule appointments and
perform other essential clerical tasks. Mary, whose job it is to manage
accounts payable, most likely has no compelling reason to know either the
patient’s identity or any of his medical information. Therefore, the disclosure
to Mary of the client’s identity and medical information is a breach of patient
confidentiality.
2. Care Provided By Qualified Individuals
The practice of massage
therapy is regulated throughout the United States. Most states, through legislation, establish minimal licensure and
practice standards. This is done to
protect the general public against fraud and substandard care by
under-qualified practitioners. It is
each massage therapist’s responsibility to adhere to the standards of care and
licensure requirements specific to the state in which they practice. The
therapist must also ensure that all care provided not directly by them, but
under their supervision, also meets these standards.
Case Study
You work in very busy outpatient rehab clinic. One of your coworkers is an aide who has
worked in rehabilitation for more than 20 years. Frequently, she is called upon to perform treatments that should
be done by a licensed massage therapist.
The patients always give her compliments, and frequently request her to
treat them. She demonstrates
exceptional skills and achieves outstanding outcomes.
Is the clinic providing ethical care to its
patients?
The answer is
no. In this situation, the aide’s
abilities and outcomes are considered irrelevant. The key sentence in the paragraph is: “perform treatments that
should be done by a licensed massage therapist.”. The “should” in this case must not be interpreted as merely a
casual suggestion but rather a legal definition regulated by the state’s Massage
Therapy Practice Act. Any treatment or
procedure that should be performed by a licensed professional, must
be performed by a licensed professional.
3. Informed Consent
Informed
consent is the process by which a fully informed patient can participate in choices
about their health care. It originates from the legal and ethical right the
patient has to direct what happens to their body and from the ethical duty of
the therapist to involve the patient in her health care.
The
most important goal of informed consent is that the patient has an opportunity
to be an informed participant in their health care decisions. It is generally
accepted that complete informed consent includes a discussion of the following
elements:
·
the nature of the
decision/procedure
·
reasonable alternatives
to the proposed intervention
·
the relevant risks,
benefits, and uncertainties related to each alternative
·
the consequences on
non-treatment
·
the goals of treatment
·
the prognosis for
achieving the goals
·
assessment of patient
understanding
·
the acceptance of the
intervention by the patient
In order for the
patient's consent to be valid, they must be considered competent to make the
decision at hand and their consent must be voluntary. It is easy for coercive
situations to arise in medicine. Patients often feel powerless and vulnerable.
The therapist should make clear to the patient that they are participating in a
decision, not merely signing a form. With this understanding, the informed
consent process should be seen as an invitation for them to participate in
their health care decisions. The therapist is also generally obligated to
provide a recommendation and share their reasoning process with the patient.
Comprehension on the part of the patient is equally as important as the
information provided. Consequently, the discussion should be carried on in
layperson's terms and the patient's understanding should be assessed along the
way.
Case Study
Sam is a LMT who has just received orders from a
physician to begin massage to the legs of a 75-year-old woman who has recently
become bed ridden and is developing edema in her lower extremities. He goes to her hospital room to provide the
massage. She refuses the treatment and
asks Sam to leave. Sam explains to her
that her doctor has left orders for her to receive the treatment. The patient again refuses. Sam leaves and returns the next day to try
again. Again, she declines treatment
and he leaves.
Under the guidelines of informed consent, were the
therapist’s actions adequate?
The therapist’s
actions were not sufficient. None of
the required information was offered to the patient. The most important thing
the therapist failed to explain to the patient was the consequences of
non-treatment. The patient cannot make
an informed decision regarding therapy without this information. It could be argued that her decision to
refuse therapy may have changed had she known that one of the consequences of
this decision could be the development of secondary complications. (i.e.
increased risk of morbidity or mortality)
4. Care Based on Medical Necessity
Therapists are
obligated to propose and provide care that is based on sound medical rationale,
patient medical necessity, and treatment efficacy and efficiency. It is unethical to either alter or withhold care
based on other extraneous factors without the patient’s knowledge and consent.
Case Study
Steve is a massage therapist who owns his own
therapy clinic. He recently signed a
contract with an HMO to provide massage therapy services. The contract stipulates that Steve will be
compensated on a case rate basis. (A
fixed amount of money per patient, based on diagnosis) Steve has performed a thorough cost analysis
on this contract and has determined that the financial “breakeven” point
(revenue equals expenses) on each of these patients is 5 visits. He informs his staff that all patients
covered by this insurance must be discharged by their fourth visit.
Is limiting care in this manner ethical?
No, it is not
ethical. In this instance, the quantity
of care is not being determined by the medical necessity of the patient. A therapist must be able to justify all of
their professional decisions (such as the discharging of a patient from
clinical care) based on sound clinical rationale and practices.
BILLING AND CODING
The Triad
Ethical conduct as it relates to billing and coding for rehab services,
revolves around one ideological triad.
The triad being: What was
performed = What was documented = What was billed. All three components of the triad must always be identical. A clinician must be sure never to perform
one service, and then document it or bill it as something different. To do so, represents a fraud, and it
subjects the therapist to possible prosecution.
Co-payments and Deductibles
All co-payments and deductibles must be collected. In most instances, the decision on whether
or not to collect this money cannot be made by the provider. The reason for this is quite simple. When a patient purchases a health insurance
policy, (either as an individual or through a group plan), they are signing a
legal contract that contains specific terms and stipulations. Typically, the cost of the policyholder’s
monthly premiums is based on the amount of coverage they have purchased and
also the amount of co-payment and deductible.
A high co-payment/deductible results in a lower monthly premium. Conversely, a low co-payment/deductible will
result in a higher monthly premium. By
not collecting the co-payment/deductible, the therapist is effectively
conspiring with the patient to defraud their insurance company. (After all, doesn’t the insurance company
have a legitimate argument that the patient should be paying a higher monthly
premium if they don’t have to pay a co-payment or deductible?) The common response given by providers is
“Why should the insurance company care, I’m the one who is not getting
paid?” That is true, however,
ultimately, the insurance company ends up paying out more because the patient,
without any financial responsibility, will usually attend more therapy
sessions.
Case Study (true)
A chiropractic office
located in Sunrise, Florida began offering free massages to all city employees.
Everyday the facility was overflowing with policemen, maintenance workers,
clerical staff, and even council members. Everyone enjoyed the free service and
visited frequently.
The chiropractors were able
to provide this service “free” to the city employees because they billed the
massage recipient’s insurance and then waived their mandatory co-pay.
Soon after, the insurer
began receiving the bills. The insurer
in this case was the City of Sunrise itself. (The city was self-insured.)
The city then contacted the
FBI to have the doctor’s office investigated for insurance fraud. Numerous
employees were demoted or fired for their role in the scheme. One of the doctors has been convicted on several
counts of insurance fraud and the other three doctors are currently being
prosecuted.
What effect do you think
writing off the co-payments has on the total visits per patient and the
associated charges billed to the insurer?
The answer is quite clear.
Managed care companies are modeled on the fact that patients who must
pay for a portion of their healthcare upon delivery, request fewer services and
subsequently have lower total bills than those who pay nothing.
CONFLICTS OF INTEREST
A conflict of interest is a situation in which a person has a private or
personal interest that influences the objective exercise of his or her
professional duties. As a professional you take on certain responsibilities and
obligations to patients, employers, and others. These obligations must take
precedence over a therapist’s private or personal interests.
In addition to avoiding all real instances of conflict of interest,
therapists must also avoid any apparent or potential conflicts as well.
An apparent conflict of interest is one in which a reasonable person
would think that the professional's judgment is likely to be compromised, and a
potential conflict of interest involves a situation that may develop into an
actual conflict of interest.
How do you determine if you are in a conflict of interest, whether
actual, apparent, or potential? The key is to determine whether the situation
you are in interferes or is likely to interfere with your independent judgment.
A good test is the 'trust test': Would relevant others [my employer, my
patients, professional colleagues, or the general public] trust my judgment if
they knew I was in this situation. Trust is at the ethical heart or core of
this issue. Conflicts of interest involve the abuse, actual or potential, of
the trust people have placed in professionals. This is why conflicts of
interest not only injure particular patients and employers, but they also
damage the whole profession by reducing the trust people generally have in
therapists.
Case Study
Debi Jones LMT is employed in
a private massage practice. She is
meeting with a vendor whose company is introducing a new over-the-counter
dietary supplement. He offers her 10
bottles of the supplement to “try out” on patients. The vendor states that if Debi continues to order and dispense a
certain amount of supplement each month, she will qualify to receive
compensation from his company by automatically becoming a member of its
National Clinical Assessment Panel.
Does this represent a
conflict of interest?
Yes, there exists a conflict of interest in this situation. Debi’s primary obligation is to her patient.
It is her professional duty to only provide and recommend care that is
appropriate and beneficial to the patient.
Conflict of interest occurs when she begins to accept compensation from
the vendor in direct or indirect response for her dietary supplement
orders. Even if she truly believes it
is the best supplement for her patient, by accepting the money she has
established at least an apparent conflict of interest. Under this situation she is obligated to
disclose to all parties her financial interest in recommending the product.
This disclosure is necessitated because the potential for personal gain would
make others rightfully question whether her objectivity was being influenced.
RELATIONSHIPS
Referral Sources
It is unethical for a massage therapist to offer anything of value to
physicians or any other referral source in direct or indirect response for
the referral of patients or services. This includes cash, rebates, gifts, discounts, reduced rent,
services, equipment, employees, or marketing.
Many mistakenly believe that it is a normal acceptable business practice
to offer these things to referral sources.
It is not. In most states, the
practice is not only unethical, but it is also illegal. Exchanges of valued items or services
between therapists and referral sources must never have any relationship to the
referral of patients. Goodwill
gifts of nominal value are acceptable provided that no correlation can be made
between the magnitude or frequency of the gift giving and referral
patterns. All business agreements and
transactions should always be well documented and most importantly, reflect
fair market value.
Case Study
Larry Jones LMT owns a
private practice. Business has been
poor. He decides to sublease half of his space to a Chiropractic Physician. Larry’s current lease is at $20/sq ft. The
doctor wants to pay $15/sq ft. They come to a compromise of $17/sq ft. Larry
also agrees that if the doctor refers him 10 patients per month, he’ll make him
the Medical Director of the facility and pay him a salary of $500/month.
Is this
an ethical arrangement?
No, this agreement is not ethical.
The most notable infraction involves offering to designate the physician
as Medical Director contingent upon the number of referrals he sends. This is undeniably a direct offer of cash
for patients. Another area of concern
is the rent. At first glance, the rent
amount of $17/sq ft seems fair because it was a compromise between the two
parties. However, closer scrutiny
reveals this to be unethical. The fair
market value for rent has been established as $20/ft. (Larry’s current rental agreement with his landlord) By discounting the doctor $3/sq ft on his
rent, Larry is giving a referral source something of value.
Patients
A high potential for conflict of interest and loss of
professional objectivity exists whenever a therapist participates in a romantic
relationship with an active patient.
Therefore, it is considered highly unethical for a
therapist to become romantically involved with a patient currently under their
care. (refer to the AMTA’s Code of Ethics)
AMTA’s Standards of
Practice
Purpose Statement: These American Massage
Therapy Association (AMTA) Standards of Practice were developed to assist the
professional massage therapist to:
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 of AMTA, 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.
AMTA Code of Ethics for
Massage Therapists
This Code of Ethics is a summary statement of the standards by which massage therapists agree to conduct their practices and is a declaration of the general principles of acceptable, ethical, professional behavior.
Massage therapists shall:
• Have a sincere commitment to provide the highest quality care to those who seek their professional service.
• Perform only those services for which they are qualified and represent their education, certifications, professional affiliations, and other qualifications honestly.
• Acknowledge the inherent worth and individuality of each person and, therefore, do not unjustly discriminate against clients or colleagues and work to eliminate prejudices in the profession.
• Strive for professional excellence through regular assessment of personal strengths, limitations and effectiveness and by continued education and training.
• Actively support the profession through participation in local, state, and national organizations which promote high standards of practice of massage therapy.
• Work in their communities toward the understanding and acceptance of massage therapy as a valuable health service, abide by all laws governing massage practice and work for the repeal or revision of laws detrimental to the legitimate practice of massage therapy.
• Acknowledge the confidential nature of the professional relationship with a client and respect each client’s right to privacy.
• Respect all ethical heath care practitioners and work together amicably to promote health and natural healing.
• Conduct their business and professional activities with honesty and integrity and project a professional image in all aspects of their practices.
• Accept the responsibility to self, clients and associates to maintain physical, mental and emotional well-being.
• Respect the integrity of each person and, therefore, do not engage in any sexual conduct or sexual activities involving their clients.
Florida Patient's Bill of Rights and
Responsibilities. (abridged)
(4) RIGHTS OF PATIENTS.--Each health
care facility or provider shall observe the following standards:
(a) Individual dignity.--
1. The individual dignity of a patient
must be respected at all times and upon all occasions.
2. Every patient who is provided
health care services retains certain rights to privacy, which must be respected
without regard to the patient's economic status or source of payment for his or
her care. The patient's rights to privacy must be respected to the extent
consistent with providing adequate medical care to the patient and with the
efficient administration of the health care facility or provider's office.
However, this subparagraph does not preclude necessary and discreet discussion
of a patient's case or examination by appropriate medical personnel.
3. A patient has the right to a prompt
and reasonable response to a question or request. A health care facility shall
respond in a reasonable manner to the request of a patient's health care
provider for medical services to the patient. The health care facility shall
also respond in a reasonable manner to the patient's request for other services
customarily rendered by the health care facility to the extent such services do
not require the approval of the patient's health care provider or are not
inconsistent with the patient's treatment.
4. A patient in a health care facility
has the right to retain and use personal clothing or possessions as space permits,
unless for him or her to do so would infringe upon the right of another patient
or is medically or programmatically contraindicated for documented medical,
safety, or programmatic reasons.
(b) Information.--
1. A patient has the right to know the
name, function, and qualifications of each health care provider who is
providing medical services to the patient. A patient may request such
information from his or her responsible provider or the health care facility in
which he or she is receiving medical services.
2. A patient in a health care facility
has the right to know what patient support services are available in the
facility.
3. A patient has the right to be given
by his or her health care provider information concerning diagnosis, planned
course of treatment, alternatives, risks, and prognosis, unless it is medically
inadvisable or impossible to give this information to the patient, in which
case the information must be given to the patient's guardian or a person
designated as the patient's representative. A patient has the right to refuse
this information.
4. A patient has the right to refuse
any treatment based on information required by this paragraph, except as
otherwise provided by law. The responsible provider shall document any such
refusal.
5. A patient in a health care facility
has the right to know what facility rules and regulations apply to patient
conduct.
6. A patient has the right to express
grievances to a health care provider, a health care facility, or the appropriate
state licensing agency regarding alleged violations of patients' rights. A
patient has the right to know the health care provider's or health care
facility's procedures for expressing a grievance.
7. A patient in a health care facility
who does not speak English has the right to be provided an interpreter when
receiving medical services if the facility has a person readily available who
can interpret on behalf of the patient.
(c) Financial information and
disclosure.--
1. A patient has the right to be
given, upon request, by the responsible provider, his or her designee, or a
representative of the health care facility full information and necessary
counseling on the availability of known financial resources for the patient's
health care.
2. A health care provider or a health
care facility shall, upon request, disclose to each patient who is eligible for
Medicare, in advance of treatment, whether the health care provider or the
health care facility in which the patient is receiving medical services accepts
assignment under Medicare reimbursement as payment in full for medical services
and treatment rendered in the health care provider's office or health care
facility.
3. A health care provider or a health
care facility shall, upon request, furnish a patient, prior to provision of
medical services, a reasonable estimate of charges for such services. Such
reasonable estimate shall not preclude the health care provider or health care
facility from exceeding the estimate or making additional charges based on
changes in the patient's condition or treatment needs.
4. A patient has the right to receive
a copy of an itemized bill upon request. A patient has a right to be given an
explanation of charges upon request.
(d) Access to health care.--
1. A patient has the right to
impartial access to medical treatment or accommodations, regardless of race,
national origin, religion, handicap, or source of payment.
2. A patient has the right to
treatment for any emergency medical condition that will deteriorate from
failure to provide such treatment.
3. A patient has the right to access
any mode of treatment that is, in his or her own judgment and the judgment of
his or her health care practitioner, in the best interests of the patient,
including complementary or alternative health care treatments, in accordance
with the provisions of s. 456.41.
(e) Experimental research.--In
addition to the provisions of s. 766.103,
a patient has the right to know if medical treatment is for purposes of
experimental research and to consent prior to participation in such
experimental research. For any patient, regardless of ability to pay or source
of payment for his or her care, participation must be a voluntary matter; and a
patient has the right to refuse to participate. The patient's consent or
refusal must be documented in the patient's care record.
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www.ethics.ubc.ca/mcdonald/conflict.html
Michael McDonald
www.philosophyclass.com
Thomas
E. Wallenmaier, Dec. 11, 2001
http://www.amtamassage.org/about/codeofethics.htm
http://www.amtamassage.org/about/standards.htm
http://www.doh.state.fl.us/mqa/Profiling/billofrights.htm
ETHICS IN
MASSAGE THERAPY
POST-TEST