{"id":1034,"date":"2018-08-29T09:00:52","date_gmt":"2018-08-28T23:00:52","guid":{"rendered":"http:\/\/blog.amt.org.au\/?p=1034"},"modified":"2018-08-29T10:54:40","modified_gmt":"2018-08-29T00:54:40","slug":"the-challenge-of-ethics","status":"publish","type":"post","link":"https:\/\/blog.amt.org.au\/index.php\/2018\/08\/29\/the-challenge-of-ethics\/","title":{"rendered":"The Challenge of Ethics"},"content":{"rendered":"

By Tim Clark<\/h4>\n

If you\u2019ve studied entry-level ethics, or even if you haven\u2019t, you might have heard Lawrence Kohlberg\u2019s (1981)1<\/sup> story about Heinz and his wife. Heinz had done all he could lawfully to acquire a prohibitively expensive new cancer drug for his dying wife and ultimately decided to steal it from his chemist\u2019s laboratory. Kohlberg asked students to determine if it was right for Heinz to do this.<\/p>\n

As with any moral dilemma, there is no \u2018correct\u2019 answer, but whatever answer you do reach may reveal something about your ethical maturity (more on this later). Whether you have an answer or not, take a moment to think about how you make ethical decisions.<\/p>\n

What processes, if any, do you follow?<\/p>\n

Is reason your first port-of-call? Or intuition, emotions, or the advice of others?<\/p>\n

What are the unshakeable values that underpin your decisions?<\/p>\n

And how do you handle the uncertainty that accompanies moral dilemmas?<\/p>\n

\"\"Or perhaps you\u2019ve reached a point where you feel you\u2019ve got it all covered, and decision-making is easy and automatic. If that sounds like you, I would argue that the challenge of ethics is not simply to reach a magical endpoint of being an ethical practitioner, but to remain ever-vigilant to how our changing circumstances and unconscious material may influence our behaviour.<\/p>\n

Massage training, in colleges and as part of professional development, needs to prepare us to meet this challenge. My experience of ethics training for massage consisted largely of reviewing the codes of the professional bodies and learning what I was and wasn\u2019t supposed to do. I was introduced to notions of boundaries and scope of practice, the imperative of client confidentiality, and the curiously abstract terms \u2018transference\u2019 and \u2018countertransference\u2019.<\/p>\n

For the record, AMT\u2019s Code of Practice<\/a> is an invaluable resource and should be a cornerstone of massage therapy practice.<\/p><\/blockquote>\n

Coincidentally, I was completing a degree in counselling and psychotherapy at the same time as my massage diploma. In counselling, ethics is an entire subject in itself, and students must complete it successfully before they can move on to their industry placement. Ethics does not run parallel to the work of the counsellor. In many ways it is<\/em> the work of the counsellor. Studying the ethics of counselling did not just teach me how to be a good counsellor: it fundamentally affected my character, and now informs decision-making in every sphere of my life.<\/p>\n

Why then, I was left to wonder, was the ethics training in my massage course so much less life-changing than in my counselling course? Admittedly, the two qualifications are at different levels of the Australian Qualifications Framework, so expectations are different, but that doesn\u2019t take away from the fact that massage practitioners require a high degree of ethical maturity to cope with the demands of the work.<\/p>\n

The ethical decisions we face in clinical practice range from small-but-important to potentially very significant, and sometimes a seemingly innocuous decision can have big consequences:<\/p>\n

\"\"Have I had enough sleep to be able to treat at full capacity?<\/p>\n

Have I given my client enough information to make an informed choice?<\/p>\n

Is my need to maintain a business leading me to over-service?<\/p>\n

But dilemmas arise where a \u2018right\u2019 answer is even less clear. This was evident in a recent discussion in the AMT private Facebook group when AMT member, Clyde Andrews raised a question about a 17-year-old male client, who asked Clyde if it would be okay to be treated without his mother in the room. This is fairly cut-and-dry according to the AMT Code of Practice<\/a>, which states:<\/p>\n

\u201cAMT requires therapists to have a parent, legal guardian or caregiver present at all times during treatment of persons under 18.\u201d<\/em><\/p><\/blockquote>\n

However, the therapist needs to tackle questions like:<\/p>\n

What is truly best for this<\/em> client in these<\/em> circumstances?<\/p>\n

What is likely to cause the least harm, including to the therapeutic relationship?<\/p>\n

How can I best support my client\u2019s autonomy?<\/p>\n

Which decision am I<\/em> most comfortable with?<\/p>\n

Being ethically mature means we have a clear approach to decision-making in situations like this and can live with the decisions we make, even when doubt lingers.<\/p>\n

In Clyde\u2019s case, he discussed with his client and the client\u2019s parents, and ultimately they agreed that the client\u2019s adult brother would sit in on future treatments.<\/p>\n

With due credit to the massage educators already teaching these concepts, there are at least three areas in which massage training could use the lessons of counsellor training to help practitioners move toward ethical maturity.<\/p>\n

\"\"<\/p>\n

Ethical Decision-making Models<\/strong><\/h6>\n

Massage therapists need to be able to justify their decisions on a regular basis, and models of decision-making can be very useful to give structure and clarity to the process. Most ethical decision-making models contain the following steps (Cottone & Claus, 2000):2<\/sup><\/p>\n

    \n
  1. Clearly and precisely identify the problem.<\/li>\n
  2. Consult guidelines and colleagues.<\/li>\n
  3. Identify all possible decisions.<\/li>\n
  4. Enumerate the possible consequences of each decision.<\/li>\n
  5. Evaluate each course of action against existing values.<\/li>\n
  6. Implement a course of action.<\/li>\n
  7. Reflect on the experience.<\/li>\n<\/ol>\n

    Realistically, no practitioner is going to follow such a formula for every decision they have to make, but processes like this, even when used informally, can help us to see that there may be options we hadn\u2019t considered and outcomes we hadn\u2019t anticipated. Reflection on the experience is key to our continued growth as ethical therapists and can help us to recognise gaps between our intentions and our actions. An ethically mature therapist will recognise that good intentions are not enough. We need to be able to implement our decisions.<\/p>\n

    Stages of Moral Development<\/strong><\/h6>\n

    The Heinz dilemma was Kohlberg\u2019s tool for figuring out what stage children were up to in their moral development, but it\u2019s useful for us all to consider where we sit on the scale. Kohlberg and Hersh (1977)3<\/sup> hypothesised three overall stages of moral development:<\/p>\n