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. College documents such as the Standards of Practice and the Professional Misconduct Regulation set out explicit expectations with respect to ethical behaviour and attitudes. In addition, the College’s Code of Ethics supports Massage Therapists in understanding and applying the ethical principles and values which are foundational to the practice of the profession.

As regulated health professionals, Massage Therapists 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 Clients and Serve Their Best Interests

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

Treat all Clients with Respect and Dignity

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

Not Harm Clients

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

Be Responsible and Accountable

To fulfill the goal of being responsible and accountable, Massage Therapists act in the best interest of the client and not in the interest of the Massage Therapist. Massage Therapists are accountable, not just for their own actions and behaviors, 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 Clients and Serve Their Best Interests

To fulfil the goal of benefiting clients and serving their best interests, Massage Therapists:

1. commit to benefiting clients and serving clients’ 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, client perspective and practitioner experience;
3. clearly provide clients with the information they need to make informed decisions about their healthcare;
4. encourage client engagement and focus on client goals and preferences;
5. use oral and written communication to facilitate client understanding and conflict resolution;
6. are aware of and attentive to transference and counter-transference in the client-Massage Therapist relationship; and
7. are knowledgeable about other regulated health professions and work collaboratively with other professionals to improve client care, reduce risks, increase client safety and optimize health outcomes.

Principle 2: Treat all Clients with Respect and Dignity

To fulfill the goal of treating all clients with respect and dignity, Massage Therapists:

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

Principle 3: Not Harm Clients

To fulfill the goal of not harming clients, Massage Therapists:

1. refrain from participating in behaviours that could potentially harm clients, and make every reasonable effort to prevent harm to clients;
2. do not, under any circumstance, participate in any form of sexual behaviour with clients, including “consensual” behaviours”^[2];
3. do not, under any circumstance, participate in any form of harassment of clients, colleagues, other health professionals or employees;
4. ensure they are not impaired in their professional ability by any physical or mental condition or disorder 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 client needs;
6. act with honesty and transparency if harm does occur, take responsibility for disclosing this harm to the client and initiate steps to minimize the harm and prevent future occurrences;
7. ensure they provide clients with the information they need to make informed decisions regarding treatment, and obtain clients’ informed consent prior to treatment;
8. avoid dual relationships^[3];
9. ensure that the client-Massage Therapist relationship is not exploited by the Massage Therapist 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; and
12. ensure that client and business records are securely retained.

Principle 4: Be Responsible and Accountable

To fulfill the goal of being responsible and accountable, Massage Therapists:

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 clear, legible and comprehensive client 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. recognize their right to refuse care to clients who:
   1. sexualize or attempt to sexualize the therapeutic relationship;
   2. physically abuse or threaten to abuse the Massage Therapist; or
   3. are unable or unwilling to provide payment for care requested;
10. responsibly use private and public healthcare resources to care for clients;
11. responsibly use electronic communication, social media and other forms of digital technology;
12. do not participate in any kind of fraud, including but not limited to fraudulent billing practices;
13. do not participate in any form of conduct, advertising or promotion that discredits or reflects poorly on the profession or breaches 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 behavior is not explicitly articulated 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 client is defined as sexual abuse in the RHPA. It is not a defence if the client “consents” to the sexual touch. Please see the Standard of Practice: Prevention of Sexual Abuse for additional information.

^[3] Please see the Standard of Practice: Professional Boundaries 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 to the profession is called “conduct unbecoming” in the College’s Professional Misconduct Regulation.