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Features Education Regulations
An Issue of Ethics: Fall 2004

The evolution of ethics as a distinct discipline of study within the field of registered massage therapy in Canada has certainly involved a unique and distinctive developmental process. Perhaps its earliest origins can be traced back to the desire by our predecessors to retain and nurture what they felt was key in the delivery of massage therapy services, i.e., the affectivity and caring that has been and is a crucial part of the identity of massage therapy in Canada.


September 25, 2009
By Cidalia Paiva

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The evolution of ethics as a distinct discipline of study within the field of registered massage therapy in Canada has certainly involved a unique and distinctive developmental process. Perhaps its earliest origins can be traced back to the desire by our predecessors to retain and nurture what they felt was key in the delivery of massage therapy services, i.e., the affectivity and caring that has been and is a crucial part of the identity of massage therapy in Canada.

As a direct result of the affective nature of massage therapy, early educators in this area essentially taught ethics as personal process and specifically chose to focus on the personal and psycho-emotive experience of becoming a massage therapist. Course work revolved largely around facilitated discussion that probed the students’ feelings and concerns as they found themselves contemplating the therapeutic role.

ethics.jpgThe focus of ethics education, in at least this period, was the student and his or her feelings and the patient or client was a secondary consideration even though the latter served as a rationale for the former.

Ethics education as personal and group process work gradually transitioned into a much more sophisticated form which ultimately culminated in the development and adaptation of curriculum content as distinct from process in communication and interpersonal relationship skills.

This curriculum largely borrowed from nursing provided us with substantive curriculum content that allowed us to include curriculum and concepts similar to our counterparts in other allied health professions.

A second, and no less important, developmental period for ethics education in Canada came into being when industry leaders and regulators began strategically aspiring to achieve the credibility and professional status that was much desired by our infant profession. They recognized the need to prescribe certain behaviours as appropriate and desirable and others correlatively as inappropriate and undesirable. This, in turn, resulted in the creation of ethics curriculum which in effect consisted of long lists of “dos” and “do nots”prohibited by legal and regulatory authority.

This new curriculum offering reflected current legislation at the time and often treated law and ethics as synonymous terms. Moreover, early attempts to articulate a code of ethics or values for the profession were essentially written in “legalese” and only included ethics content as an appendage and addendum to these.

The inclusion of massage therapy in the Regulated Health Professions Act heralded a new time and further evolution for ethics education.

In the mid-’90s, gross boundary violations but also to a lesser extent other forms of dual relationships “came out of the closet,” so to speak, and the momentum began to emerge for the development of course curriculum that focused on professional boundaries in ethics education. The advent of the zero tolerance philosophy with regards to sexual relationships with patients/clients brought with it a sustained and recurrent focus on the professional role and the importance of professional boundaries. At that time, the therapeutic relationship was meaningfully coined in massage therapy and boundaries curriculum began to predominate ethics education, though again intimately and intricately merged with the legalistic approach which was its distant forerunner.

In the 21st century, ethics education in massage therapy came of age and similarly to our colleagues in other allied health professions we have come to recognize and appreciate that law and ethics are not synonymous, that personal reflection and process, though valuable and important parts of owning the therapeutic experience, are not exhaustive and that boundaries, while certainly necessary, are not sufficient.

Ethics education today finds us discovering and learning about the discipline of health care ethics, its history, theoretical framework, language and terminology, and developing applied decision making skills. We have come to understand that doing ethics requires examining our arguments and assessing these on the basis of a thoughtful deliberative process.

Does this mean that there is no place today for feeling or personal process in studying ethics? We often suffer from the tendency to separate feeling and thought as though the two were mutually exclusive. This point of view, however, is mistaken. Feeling and thought are complementary and there is room for both in studying ethics.

What we need to remember is that feelings are spontaneous and impulsive and therefore perhaps offer us a springboard for thought and the pursuit of a more rational approach to solving our ethical problems. 

This will assist us in ensuring that we have the impetus and skills necessary to scrutinize our own moral beliefs and conduct and will support the efforts of our profession to live up to standards of ethical behaviour that are reasonable and solidly based.

As we prepare for our next step and in unison with the imminent development of the first Bachelor of Science in Massage Therapy degree we must continue to strive to develop ethics curriculum that reflects the state of the discipline today. For articulation purposes it will become essential for massage therapy ethics curriculum to become compatible and consistent with ethics education course work in public post secondary institutions which are degree granting.

Learning and teaching health care ethics as a discipline of study will enable us to finally join our colleagues in the other regulated health professions. By embracing this opportunity and this challenge, we will once again take a giant step forward in the very young life of massage ethics as a vibrant and informed branch of health care ethics.


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