Professional Practice and Ethics in Massage

A profession is a contract

A profession is a contract between its practitioners and the public:

the public get a reliable, trusted service,

and the professionals get in return a monopoly in the exercise of their skills.

Therefore there are three relationships involving the professional:

between the professional and the profession as a whole;

between the professional and the client;

and between the professional and the public as a whole.

Codes of ethics will be analyzed below in terms of these three relationships.

How is being a professional masseur different from being a grocer?

A profession is distinguished by a specialized body of knowledge. In the case of massage, this relates to the physical practice of massage and to anatomy and physiology.

This leads to two possible relationships between the professional and the client:

Agency-where the professional simply carries out the client's wishes, with no significant decisions

Paternalistic-where the client transfers all decisions to the professional

Massage ranges in between the two extremes, depending on the wishes of the client.

Massage is different from grocery, then, in two respects.

The masseur must be able to make decisions on behalf of the client

The masseur must also consider his responsibility to the public good and to the profession.

A professional body

A profession has a specialized body of knowledge. This implies that it must be self-governing. A professional body is needed to self-govern systematically.

One job of the professional body is to certify the competence of its members.

The intent is that the public as a whole is protected.

(This sets massage apart from, say, philosophy which requires no certification of competence, or child-minding in which anyone can certify competence).

Also because of the specialized body of knowledge, it is up to the profession to define the common good in relation to itself and to work to advance the common good in this field.

The professional provides a trusted, useful service to the public

The profession has a special responsibility of care to the public. The professional must be willing to meet emergencies. (This issue is more relevant to medicine than massage.)

In order to meet the trust placed in it by the public as a whole, the professional must have care for the setting in which the profession is practised: the human setting of massage, the ethical setting, and the overall political setting.

This involves the professional voluntarily accepting an ethic code that goes beyond that required of ordinary citizens by law.

History of ethical codes

The first ethical code was the Hippocratic Oath, formulated in the 5th century BC and still taken by medical practitioners today.

The first UK code was one of medical ethics. It was created by Tomas Percival in 1803.

Between 1870 and 1910, many professional institutes of engineering and applied science incorporated codes of ethics into their professional statutes.

After 1910 there was less interest.

But in the past twenty years or so, many more professions have included ethical codes.

Ethical codes were originally very general-for example, "A doctor must always bear in mind the obligation of preserving human life" in the International Code of Medical Ethics, developed by the World Medical Association shortly after the second world war.

They have recently become more precise in an attempt to ward off malpractice law-suites.

Massage ethics relating to public interest

The practitioner must practice health and safety to protect the public health.

Must ensure he has knowledge and understanding of relevant legislation, regulations and standards. In massage this relates primarily to the Health and Safety Act.

Must not work against the public interest. This code is less relevant to massage than it is to scientific research.

Must keep up to date with current developments in the field. Practically, this involves subscription to the appropriate trade journal and an awareness of relevant scientific research.

Massage ethics relating to clients

The primary responsibility is for the health and safety of the client. Work must be carried out with due care and diligence. In practical terms, the professional must be familiar with the necessary parts of first aid, must cover cuts or sores with appropriate covering (e.g. Micropore), must use disinfectant hand wipes between appropriate parts of massage, and must ensure that no contraindications are exhibited. The table must be made safe and the sheets and towels hygienic.

The masseur must act in accordance with the requirements of the client. If his professional judgement is overruled, he must indicate the likely consequences. Practically, this involves having the client acknowledge in writing that he is aware of the contraindications and does not exhibit any of them.

The work must be completed on time and be of an acceptable standard. The masseur should not attempt to work beyond his competence. In practice, the masseur must decline requests for work in which he has not been trained: medical physiotherapy, psychological counseling and so on.

The masseur must not take advantage of the ignorance or inexperience of others. False claims must not be made as to the effects of massage.

The dignity of the client must be preserved. The client should not be intimidated or scared. Practically in massage this means covering with a towel those parts of the client that are not being massaged, not pursuing with any massage or removal of clothes that the client finds uncomfortable, and maintaining the client's personal privacy at all times. It also means not leaving the client unattended, since lying alone without clothes on a massage table is a position of insecurity and vulnerability.

There is a duty of confidentiality. The masseur must preserve the absolute secrecy of all he knows about his client because of the confidence entrusted in him.

Massage ethics relating to the profession

The reputation of the profession should be upheld, and standards improved.

The public knowledge and understanding of the profession should be advanced.

A professional masseur should act with integrity towards his fellow members. he should encourage and support them in their professional development, including new entrants, up to the limit of his competence.

The term 'act like a professional' is typically used in relation to the first point mentioned in this section:

When engaged as a professional, dress smartly, in uniform. (Probably all whites).

Ensure that the surroundings are clean, respectable. Clothes folded neatly on a chair. Equipment close to hand and neatly laid out. Clean, hygienic sheets and towels.

Ensure that the surroundings are appropriate. No interruptions. Privacy.

The masseur should move about directly and with confidence.

Q1. Possible sickness

If the masseur finds sign during massage of a serious medical condition-such as a tumour or a slipped disc-what should he do? Tell the client? Inform the client's doctor?

The answer is to tell the client. It would be a breach of confidentiality to pass on any information gained as a consequence of the massage.

The client should be informed in an appropriate manner. If the condition is sufficiently minor, the masseur might continue the massage and simply avoid the particular part without interrupting the massage; the client can recommended at the end to see a doctor. If the condition is major then the massage obviously must stop immediately.

Q2. Good comes from counseling

Suppose there is a client who has been massaged by a friend, and the client would talk to this friend about the client's personal problems, and the client derived much benefit from this counseling aspect of massage. The client now comes to a professional masseur expecting a higher quality of the same. Should the masseur listen and advise?

No, the masseur should not act as counselor. (Unless, that is, the masseur is also a professional counselor who has set up a practice that combines massage with counseling). Counseling is probably beyond the masseur's competence.

Q3. Good comes from prolonged course

A lot of the good of massage comes from regular massage over a sustained period. But the professional also has a financial interest in attracting regular custom. Should he recommend to the client that he make repeated visits?

The masseur must at all times be honest. The positive benefits of regular massage should be pointed out, since this is part of enhancing the public understanding of the field. The masseur must also not pressure the client, since to do so would be to take advantage of the client's ignorance and inexperience. The client could be made aware of other massage institutions to avoid the charge of vested interests.

Q4. Patient insists on something that is bad

Suppose there is a patient who insists that the masseur perform something that might be harmful: massaging with nut-oil a client who has a nut-allergy, or massaging without medical authorization a body part that has suffered injury. Should the masseur comply with the request?

The masseur must make plain to the client his professional misgivings, and must do his best to persuade the client of their validity. If the client still insists, the masseur will have to refuse. This constitutes a failure in his duty of service to the client, but is unavoidable.

A masseur may turn away undesirables. But it is important not to turn away potential clients without good reasons: to do so would bring the profession into disrepute, and would constitute a failure in the duty of service to the general public.

Q5. Possible employment as a sports masseur.

Suppose a masseur is offered a job as a sports masseur for a cycling team, and is suitably qualified. Should he accept?

Medical research to date indicates that massage (petrissage, effleurage and kneading in particular) does not increase blood flow to the limbs. There is no noticeable benefit in shortening recovery time or in lessening post-exercise soreness. The primary benefits of massage are psychological. The professional masseur should be aware of this because it is his responsibility to keep abreast of developments in his field. These facts should be made aware to the person who offered him the job, since not to do so would implicitly make false claims about massage. If the person persists with their offer, though, there is no reason not to take it up.