Code of Ethics

Introduction

Massage Therapy is a regulated health profession in Ontario. It is governed by the Regulated Health Professions Act, 1991 (the RHPA) and the Massage Therapy Act, 1991. The RHPA requires that regulatory Colleges such as the College of Massage Therapists of Ontario (the College) develop, establish and maintain standards of professional ethics for Massage Therapists. The College’s Code of Ethics supports Registered Massage Therapists/Massage Therapists (RMTs/MTs) in understanding and applying the ethical principles and values which are foundational to the practice of the profession.

As regulated health professionals, RMTs/MTs must ensure they maintain the public’s confidence in the profession and provide the highest level of safe, ethical and quality Massage Therapy care. This is accomplished by exercising professional judgement and integrity.

The College’s Code of Ethics is grounded in four ethical principles.

Benefit Patients and Serve Their Best Interests

To fulfill the goal of benefiting patients and serving their best interests, Massage Therapists endeavour to positively contribute to their patients’ health and well-being.

Treat all Patients with Respect and Dignity

To fulfill the goal of treating patients with respect and dignity, Massage Therapists treat all patients with compassion and consideration of the patient’s right to be the decision maker in their healthcare.

Not Harm Patients

To fulfill the goal of not harming patients, Massage Therapists take every precaution to prevent harm to patients.

Be Responsible and Accountable

To fulfill the goal of being responsible and accountable, Massage Therapists act in the best interest of the patient and not in the interest of the Massage Therapist. Massage Therapists are accountable, not just for their own actions and behaviours, but for those of the broader profession as well.

This document explains the behaviours, actions and attitudes that support the four ethical principles listed above.

Who does the College’s Code of Ethics apply to?

The College’s Code of Ethics provides guidance to all Massage Therapists in Ontario, regardless of practice context. It can also be used by Massage Therapy students, educators, researchers and others associated or working with Massage Therapists in Ontario.

Using Professional Judgement

As the Code of Ethics provides Massage Therapists with ethical guidance, Massage Therapists may encounter situations in which they will need to apply their professional judgement in interpreting and applying relevant principles and guidelines.

Accompanying Documents

In interpreting the Code of Ethics, Massage Therapists may refer to the accompanying Glossary of Terms.

Principle 1: Benefit Patients and Serve Their Best Interests

To fulfil the goal of benefiting patients and serving their best interests, RMTs/MTs:

1. commit to benefiting patients and serving patients’ best interests by using their knowledge, skill and professional judgement;
2. ensure that their professional knowledge and skill are current and evidence-informed, based on clinical research, practice context, patient perspective and practitioner experience;
3. clearly provide patients with the information they need to make informed decisions about their healthcare;
4. encourage patient engagement and focus on patient goals and preferences;
5. use oral and written communication to facilitate patient understanding and conflict resolution;
6. are aware of and attentive to transference and counter-transference in the patient-Massage Therapist relationship; and
7. are knowledgeable about other regulated health professions and work collaboratively with other professionals to improve patient care, reduce risks, increase patient safety and optimize health outcomes.

Principle 2: Treat all Patients with Respect and Dignity

To fulfill the goal of treating all patients with respect and dignity, RMTs/MTs:

1. recognize patients’ ethical and legal rights to be the decision makers in their healthcare;
2. obtain patient’s informed consent to treatment prior to providing care and respect the patient’s right to accept or refuse treatment without prejudice;
3. recognize the power imbalance inherent in the patient-Massage Therapist relationship and maintain professional boundaries;
4. keep patient health and personal information confidential, except with the consent of the patient or as required by law;
5. provide patients with advance notice and a referral before discharging them from care except in the case of an abusive patient
6. provide fair and equitable access and consistent quality care to all patients, free of discrimination based on the protected grounds and social areas outlined in the Ontario Human Rights Code^[1].

Principle 3: Not Harm Patients

To fulfill the goal of not harming patients, RMTs/MTs:

1. refrain from participating in behaviours that could potentially harm patients, and make every reasonable effort to prevent harm to patients;
2. do not, under any circumstance, engage in any form of sexual behaviour with patients, including “consensual” behaviours”^[2];
3. do not, under any circumstance, participate in any form of harassment of patients, colleagues, other health professionals or employees;
4. ensure they are not impaired in their professional ability by any physical or mental condition or disorder, or substance and have the knowledge, skill and judgement to practise Massage Therapy safely;
5. practise only within their Scope of Practice, recognize their limitations and refer, when appropriate, to a colleague or other health professional whose expertise can best address patient needs;
6. act with honesty and transparency if harm does occur; take responsibility for disclosing this harm to the patient and initiate steps to minimize the harm and prevent future occurrences;
7. provide patients with the information they need to make informed decisions regarding treatment, and obtain patients’ informed consent prior to treatment;
8. avoid dual relationships^[3];
9. do not exploit the patient-Massage Therapist relationship for any real, perceived or potential personal, social, emotional and/or financial reason(s) or conflict of interest;
10. provide therapeutic touch thoughtfully and tactfully in a sensitive and professional manner;
11. maintain a clean, hygienic and safe working environment

Principle 4: Be Responsible and Accountable

To fulfill the goal of being responsible and accountable, RMTs/MTs:

1. individually and collectively have a professional responsibility to maintain public trust and confidence;
2. conduct themselves with personal and professional integrity at all times;
3. assume responsibility for their actions and decisions as healthcare professionals;
4. assume responsibility for upholding their ethical and professional obligations and for advising employers when these conflict with employer expectations;
5. maintain and securely retain clear, legible and comprehensive patient and business records;
6. meet all mandatory reporting obligations^[4], and consider reporting any other unethical behaviour;
7. meaningfully participate in advancing Career Span Competencies and continuing professional development through self-evaluation of practice and appropriately respond to the outcomes of evaluations and assessments;
8. commit to self-care and personal health and wellness;
9. must only discontinue providing care that is needed to a patient if the discharge process has been documented in the patient’s file and:
   1. the patient requests discontinuation; or
   2. alternative services are arranged, or the patient is given reasonable opportunity to arrange alternative services; or
   3. the patient is unable or unwilling to provide payment; or
   4. the patient is abusive toward the RMT/MT or poses a real or perceived threat, and the RMT/MT has referred the patient to CMTO’s Public Register.
10. responsibly use private and public healthcare resources while caring for patients;
11. responsibly use electronic communication, social media and other forms of digital technology;
12. do not participate in any kind of fraud, including fraudulent billing practices;
13. do not participate in any form of conduct, advertising or promotion that discredits or reflects poorly on the profession or could reasonably be seen to breach public trust and confidence;
14. demonstrate the integrity and professionalism expected of a Massage Therapist as a regulated health professional^[5]; and
15. do not justify unethical behaviour by rationalizing that such behaviour is not explicitly prohibited in this document or other legislation or regulation.

^[1] The Ontario Human Rights Code, 1962, prohibits actions that discriminate based on a protected ground, including: age, ancestry, colour, race, citizenship, ethnic origin, place of origin, creed/religion, disability, family status, marital status, gender identity, gender expression, sex and sexual orientation.

^[2] Sexual contact with a patient is defined as sexual abuse in the RHPA. It is not a defence if the patient “consents” to the sexual touch. See also the Standard of Practice: Prevention of and Zero Tolerance for Sexual Abuse for additional information.

^[3] See also the Standard of Practice: Professional Boundaries, Draping, and Physical Privacy for additional information.

^[4] An overview of mandatory reporting obligations can be found on College’s website.

^[5] Participating in conduct which could bring disrepute to discredit the profession is called “conduct unbecoming” in the College’s Professional Misconduct Regulation.