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This came out of another topic and Susan Salvo rightly pointed out that right of refusal is an excellent topic all on it's own.  So, do you have the right to refuse doing a massage when you work for someone else?  If so, under what conditions can you refuse?  This discussion came up because a therapist wasn't comfortable with their knowledge level when a client undergoing chemo arrived for an appointment.  Her employer did not agree with the decision not to do the massage because of the therapist's comfort level. 
My feeling is that you can only refuse if there is a medical or ethical reason for doing so. 

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However, Emmanuel, when you say a therapist's right of refusal is based on "the ability to do good for the client without doing harm (emotional, physical, psychological) to the client......while the physical harm we could do is usually evident (most of the time), how do we know if and when emotional/psychological harm is EVER done? That is beyond our scope of practice and I, for one, would not want to make that call. We don't know the emotional/psychological harm a simple Swedish massage could do to a client with baggage, much less to a client being refused a massage after having chemo and having a doc's release.

Rick, good point. The whole scenario with Vanessa and her employer was flawed from the beginning and I hope everyone, therapists and employers alike, learn from this and establish better lines of communication all the way around.
Choice, I agree that we can’t easily tell if and when psychological/emotional harm is ever done as a result of a Swedish massage to a client; even physical harm to the client can be hard to define. In the case of a Swedish massage it may easier to define harm that is done to the therapist or to the profession, and that is why I included "therapist" and "profession" in “doing no harm”.

In general, I would think that a therapist can do a treatment if they can be fairly certain that the treatment can help the client and that the treatment will not hurt the client, the therapist, or the profession... Am I right?

I totally agree about the communication part, and about how everything should be spelled out ahead of time. At our school clinic, the policy states “We reserve the right to refuse appointments or terminate treatment sessions for the following reasons: conditions or pathology are present for which massage is contraindicated, poor hygiene, improper or lewd conduct, sexualizing the session, or for any other reasons that compromise the integrity and safety of the school, the clinic, our clients, and our students.” Do any of you have similar written policies where you work, and how do you communicate that to your clients?


Choice Kinchen said:
However, Emmanuel, when you say a therapist's right of refusal is based on "the ability to do good for the client without doing harm (emotional, physical, psychological) to the client......while the physical harm we could do is usually evident (most of the time), how do we know if and when emotional/psychological harm is EVER done? That is beyond our scope of practice and I, for one, would not want to make that call. We don't know the emotional/psychological harm a simple Swedish massage could do to a client with baggage, much less to a client being refused a massage after having chemo and having a doc's release.

Rick, good point. The whole scenario with Vanessa and her employer was flawed from the beginning and I hope everyone, therapists and employers alike, learn from this and establish better lines of communication all the way around.

Interestingly I also work for ME and it is increasingly alarming concerns over right of refusal that has led me to this discussion. 

At our location (this is not true of all ME clinics, as I have worked at other locations), we are consistently being overriden when even up to 6 available LMT's expressed concern over the safety of performing a massage.  We have felt pressured (due to the battle-axe personality of our manager) to perform things such as hot stone massage on people with neuropathy, massage to a man who broke his spine 2 weeks prior in a motorcycle accident and refused to wear his prescribed back brace--we wanted a Dr's note-- and prenatal massage on a woman with pitting edema.  This list is by no means comprehensive, but to illustrate the kinds of things our business-minded manager tells us we must do because "we don't turn anyone away". 

In Ohio, we have what is called a limited medical license--so we consider ourselves (to some degree) medical professionals who should "do no harm". I'm sure this is true of many therapists, regardless of the semantics. Naturally, we are not of the doctor caliber, but there are some things that even a layperson should be able to understand are dangerous.  But, our clinic is all about the dollar bill. The only way to get out of a massage that we feel is risky is to come up with 3 online sources on the spot that support our decision.  Otherwise, too bad. 

So, on the issue of "working for someone else" being raised--particularly when the owner or manager has no medical or massage experience whatsoever--I don't think there should be ANY question as to who has the right to determine safety/health concerns other that us--particulary when it is MY medical license and MY liability insurance that is at risk.  Who are they to determine what I should risk those for? Why is who owns the business of any relevance when it comes to potentially harming someone? Do we care who owns a medical clinic? Who gets sued when a doctor MALPRACTICES and does something he knows he shouldn't have done?

I just don't know what to do with this place.  I wish I were in the position to quit.  I'm looking for legal/professional sources to back us up, but I honestly don't know how this is going to end and its sad that I have to feel threatened into going against my education to keep a job vs being crushed by a big corporation.  Sure wish sometimes that we had a union.  I know that's not everyone's cup of tea, but some of us struggling little people would definitely like to feel strong against the giants.

If you are implying that I am somehow trying to get out of performing a massage or that I am undereducated, you are wrong.  I work 40+ hours a week on all kinds of people with all kinds of conditions. We have been taught to avoid certain conditions for a reason and it is your choice if you think you are educated enough about everything that comes your way that you can supercede conventional practice.  Obviously accepted practice for every profession changes over time and that is in part because people challenge the norms.  I'm not going to potentially burn someone to challenge the norms. But you feel free.

Just like a doctor with a medical license, my medical license is given to me with the understanding that I will follow standards and not harm anyone. I did not say that any of us were uneducated about disorders and THAT is why we didn't want to do them.  What would be the point of taking a CEU anyway if you're going to do what you want with your education and overrule what you are taught?

The POINT is that a non-massage/non-medical trained person is making the decision for us.  The POINT is that we should have the right in the first place to say that we think its risky.  The POINT is that we should not be in a position to put our licenses at risk via the greed of someone else. This is NOT about OUR knowledge. That statement makes no sense...that I have to help people even if I don't feel comfortable or recognize the condition?  How dumb would it be of me to WORK on someone's condition that I've never heard of? If I had time to research it, great.  But we do not.  We have about 3 minutes between every client if we're lucky. We also have a duty to refer to other people that can help if we can't, not experiment on them. 

What I do know is that neuropathy is a bad idea in a hot stone massage.  I do know that recently broken bones should not have direct pressure but on them--and frankly when its someone spine with possible nerve damage, I'm not going to deep tissue the guy's spine because that's what HE wants.  Are you serious? Frankly, if half a dozen LMT's agree with me, then I'd say that's a pretty good indicator that everyone agrees is shouldn't be done. But, next time we have someone with pus and inflammation all over their back from not cleaning out their skin folds, we'll send them to you so you can cure them like the God that you are.

This is a good discussion. After reading Susan's article I have changed my policy to include a right of refusal for illness, contraindications, inability to pay, and inappropriate behavior.  I think that having good boundaries allows us to not be a doormat but an informed professional.

Cheers,

Jody H.

Hi Jennifer,  

An aspect of your post that isn't being mentioned is that in the situation you describe the liability you're talking about  is tied up in the business you are working for.  If something were to go wrong and you as an employee were following company policy or orders from your supervisor then it's very possible that the business itself and not you would be held liable.   Businesses don't usually think about liability in terms of the harm they might do to someone, they think about it in terms of $ and risk. And since any business has liability insurance there's a good chance that even if something does go wrong, their insurance carrier will cover it.  If your state licensing requires you to maintain liability insurance then you yourself are also protected to a large degree from a suit. 

As health-oriented or health-care providers MT's are usually thinking about the horror of actually hurting someone in a significant way. But that's not the business point of view.

As a professional therapist Ive always had the right to refuse whoever I want.  That being said...I dont think I ever have? If they can lay on the table I massage them...I've worked on several kimo people(breast cancer) clients on a regular basis.. Uhm,  I have stopped a few massages early on once I discovered that they are in so much pain they cant lay comfortably on the table, and sent them to a medical doctor.. We can work on people that Chiropractors cant. Sometimes the lightest of touch can be soothing and healing..A few months ago I worked on a couple of people like that..We can adjust the pressure to feather weight if we want...touch is healing.  Deep tissue for me means working specifically as opposed to in general.  But as a professional, we should be able to refuse a client if we feel its important for whatever the reason.  Being forced to massage someone that you think you might hurt or cause harm to is ridicules.

Frankly, I am highly uncomfortable taking the thinking that it's okay for me to do what an untrained person tells me to or that I am uncomfortable doing becase insurance companies will pick up the bill.  You should never assume that you're covered no matter what happens just because you paid the premium.  To me that's like saying you don't have to take responsibilty for crashing your car into someone and killing them because you felt protected by your car insurance. You still have a duty to DO NO HARM and if they find you operated under what you said you wouldn't, can you guarantee that they will have your back?  If someone sues me and can prove that I operated under what is generally accepted as a contraindication, not only can I lose my malpractice insurance, but my medical license.  The question here is NOT the business view, which I think is quite obvious to everyone, but that I have any right to refuse to do something I don't think I should.  As Gordon says, being forced. 

Asking for a doctor's note is not turning someone away. It is saying I WILL work on you as long as we're sure it won't hurt you.  For the record I have only done this once (and was denied by the manager) because the guy had a stroke and a heart attack and a veritable grab bag history of several other neurological problems and surgeries.  He had just, in fact, had a quadruple bypass only a few weeks prior wherein he died on the table twice and had both lungs collapse.  In the case of the woman with neuropathy--I wasn't refusing to work on her but trying to steer her in the direction of regular massage versus hot stone. But the hot stone made more money, so I was strong-armed into providing it--and the woman felt like crap afterward and I felt horrible for doing something I thought was wrong and not guiding her in the direction I felt she should go with her treatment.  No one else should tell me how to provide treatment who doesn't know what they're talking about.  I could care less about the business point of view when it comes to robbing me of my livelihood--or robbing someone else.  Even if the robbery is only petty theft.

I think some of you are mistaking the fact that I want to preserve my RIGHT to say no with the idea that I don't know how to alter my approaches or that I'm being too timid to work on anyone.Just as we make the choice TO work on someone, we should be allowed NOT TO. ME requires me to carry my own insurance and the way this clinic is run, I would not for an instant put it past her to turn her back on me and throw me to the wolves. Because I should know better. And then what stops the owners from turning around and suing me?

 

Jennifer,

There's risk in whatever we do or whoever we work on. If someone came in with a contraindication but didn't bother to mention it, then came back and sued because of possible adverse reaction, you'd be facing a similiar problem. They could make the claim that you or the employer should have sussed it out somehow.  Or if later after a massage someone with no apparent condition develops an acute problem of some sort, you could be sued because they think it's related to the session, even if it has nothing to do with your treatment.  Insurance isn't there so we can blithely ignore all common sense. It's there to protect against the vagaries and randomness of our work. If you follow standard protocols and act with integrity, you might still be sued,but it's very unlikely that you'd ever end up in a courtroom or lose your license.

If you are afraid to say "no" because you'll lose your job, then you only have one other option, which is to quit, right?

Best....Lee

That is true.  But yet again the question remains what my rights are legally and professionally, which keeps getting danced around. It's one of those sticky wickets and the fact that I seem to have no rights is the problem, not whose insurance is going to cover what.

If only it were so easy to just quit.  Like many areas these days, this county has been hit hard by financial problems. Every day driving down the road in the last 5 years I have watched businesses close in waves like they caught infectious diseases. We are one of those places that was once thriving due to big manufacturing companies and such and then in droves, people lost their jobs. Over 700 people applied for one janitor job here at a local school. The fact that I still have anywhere to go is a double-edged blessing.  I am a single mom and I don't have the funds to start my own business--or the space, or the set up my city would require.  I'm not complaining but those are the facts. 

My only option upon quitting is to take a minimum wage job and fight with many thousands of people over it, at which I will probably be told I'm "over-qualified" because I have 3 college degrees, not to mention not be able to make ends meet and end up on welfare.  There are 3 massage schools in the immediate area and no shortage of massage therapists who can't make ends meet. The other option is to retrain and get out of the business, which is actually what I am doing at present but will take a couple of years since I have to work, too.  Regardless, that doesn't release me from treating my occupation as a going-concern.  And it doesn't make what corporations do any less wrong just because people walk away or ignore it. If there is something I can do, I want to do it. 

Those of you who work for yourselves or whose education is respected where you work, you don't really know what you have. But you never do realize what your rights are until you need them, do you? You're not upset about other people's lack of rights until it affects YOU. I'm guilty, too.  I didn't know. I find it kind of appalling how many people can dismiss it because they're doing fine.  But now that I do know, it would be even more appalling in my opinion to walk away and leave the next generations of slave labor to deal with it if I can make any change at all.  There is no way I could ever enter a place like that in the years to come, knowing what I know (and believe me, this isn't the only problem), and feel right about making people work under those conditions.  I don't know how people do it--ignore things they know are wrong and go about their merry way. I'm not trying to take on the world.  I just don't want to lose what I have worked hard for.  And even moreso, I want to be able to live with the quality of care people have trusted me to give them.

hi Jennifer,

It sounds tough where you live.  Sorry to hear that!  It would be great if you could change things. 

The reason I keep talking about insurance is because several times you mentioned possibly getting sued and losing your license.  My only point is, lawsuits are what liability insurance is for, and it's unlikely you'll lose your license if behave yourself :-)

That said, I'm not aware of MT's having any special professional rights, whatever that even means. Legal rights: a local lawyer is probably the only person who can answer that. Or maybe a state MT organization.

good luck.......Lee

as employee,  i refused a client that reeked of pot (maybe it was smoke or something legal) b/c i was pregnent.  so lucky to have an excuse.  I actually had to fake getting sick to get out of it.   I worked really hard to be healthy and wasn't risking it.

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