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An Issue of Ethics: Winter 2006

Many professional codes of ethics documents contain a clause or at least a statement encouraging health professionals to respect and support each other.
Collegiality is highly valued in the health care professions and, in fact, quite often a norm of professional practice. Banding together to protect common interests is considered highly desirable. In fact, some healthcare professions and in turn their codes of ethics even contend that health professionals have a duty of loyalty or fidelity to their fellow professionals to try and ensure that no harm is done to them. In addition, health professionals have personal relationships and emotional ties with colleagues as associates, employers or employees.

We want and desire to practice massage therapy in an environment in which legal and ethical behaviour is respected and observed.  We intend to act ethically and to behave responsibly towards our clients and all those affected and influenced by the delivery of our services. However, sometimes this will not be the case; sometimes some massage therapists will participate in behaviours and activities that are unethical or illegal.

When this occurs we may be faced with the difficult and sometimes heart wrenching question of whether or not to blow the whistle on a colleague.

Health professionals who find themselves seriously contemplating whistle blowing may encounter significant challenges, the least of which being a health care culture that socially frowns upon disloyalty and betrayal. However, when a massage therapist discovers behaviour or activities that are unethical, immoral or
illegal, professional ethics, law and of course personal conscience compel him or her to at least think about blowing the whistle because it may be the right thing to do.

Let’s illustrate with the example below:
Peter Blair, RMT is informed that one of the clients in the spa (of which he is co-owner) is unable to pay full price for his spa massage but has extended health care coverage and that the spa could recover the full fee for the service rendered if the spa billed for that service under Peter’s billing number.
Peter has been a co-owner of Blue Sky spa for a little over a year and enjoys a positive working relationship with Tim, his associate and spa co-owner. Peter also enjoys a good working relationship with the two spa practitioners working at the spa, one of whom is also a personal friend whom he hired to work at the spa.

Peter also knows the spa is struggling financially and as Tim reminds him “really doesn’t need another hit”. Peter is not comfortable with the idea and only reluctantly agrees to allow this to happen “this one and only time” as he states.

Soon thereafter, however, Peter learns that Tim, also an RMT, has been billing spa practitioner’s clients under his own billing number for the past six months. Peter confronts Tim about this. Tim appears frustrated and annoyed with what he describes as Peter’s “anal obsession with rules.” He tells Peter to “let it go.” After all, he rationalizes with Peter, “These practitioners will only be doing relaxation massage anyway, nobody’s going to get hurt and everybody’s going to get what they need. Don’t ruin a good thing, take a load off and relax.”

What should Peter do? The consequence of blowing the whistle on Tim could be quite extreme and could have a significant impact on all their lives. How, in fact, should Peter work through this dilemma? That is, what factor or factors should Peter, or any massage therapist, consider when contemplating blowing the whistle on a colleague?

Is there a requirement to blow the whistle in a situation like this?
One of the first places to start in reflecting on this or any dilemma of this kind is to ask the question, “Is there a requirement to blow the whistle in a situation like this?”  For example, does the Professions Code of Ethics prohibit this behaviour and therefore require us to blow the whistle? Clearly, most Massage Therapy Code of Ethics prohibit this behaviour and so to participate in this behaviour, even as a silent accomplice (doesn’t do it himself but allows Tim to keep doing it) would be to breach the Professions Code of Ethics, including the duty to report unethical behaviour.

Get the facts, all the facts and get them straight.
In any situation where we have an important ethical decision to make we must first, and foremost, check the facts. If the unethical or illegal behaviour we are considering blowing the whistle on is not something we have first-hand experience of (ie: we are responding to a rumour or information that comes to our attention through a third party) we need to be careful not to jump to the conclusion that this third party or hearsay information is accurate and true.
Since we do have a duty of loyalty to our colleague to protect their best interests, we need to proceed with caution. This means that we must gather all the relevant facts and ascertain the details. In Peter’s case he knows first-hand that Tim is billing spa practitioner massages under his billing number. Tim has admitted to Peter that this is the case and has clearly communicated to Peter that he intends to continue to do so.

Is this a unique one-time incident or is this a recurrent incident?
We all make mistakes and sometimes unethical or even illegal behaviour can be the result of a mistake or error in judgement which occurs in a single solitary instance; typically, in a stressful situation where the practitioner may react without thinking or at the very least not thinking clearly.

If Tim had only utilized Peter’s billing number in one instance; recognized that this was wrong and agreed to cease doing so the need to blow the whistle might somewhat be mitigated, especially if Peter believed that Tim was sincere and Peter was clear with Tim that if this ever occurred again he would have to blow the whistle on him.

What is the potential for harm in this instance?
One of the most important questions that needs to be asked in a situation like this is what is the potential harm or harms that may result from this unethical behaviour?

In this instance, he will have to look at harm(s) to all concerned but first and foremost harm(s) to the client. Is there a risk of harm to the client in this scenario? There is not perhaps a risk of physical harm to the client, given that the spa practitioners will only be providing a relaxation massage, but what about other harm(s)? What about the less obvious but certainly problematic potential harm to the client’s belief in the credibility of massage therapy and his or her perception of massage therapists as ethical and competent health professionals? If the practices of Blue Sky spa are discovered, this discovery could create an irreparable breach of trust between the client(s) and the spa and all practitioners employed by the spa.

Secondarily, Peter will need to consider the potential harm to himself personally. The fact that if the insurance company finds out they may take legal action against him or at the very least refuse to accept his billing number and potentially report him to the regulatory authorities. This, in turn, could result in a loss of Peter’s licence, receiving a fine – or both.

Peter will also have to consider the harm to the business and to the profession of massage therapy. If the business is discovered to be participating in this unethical and even illegal (fraud) activity the business could be shut down or simply cease to generate clients when the public learns that they are dishonest practitioners who cannot be trusted to conduct their business ethically and legally. The slippery slope of mistrust will typically slide down to the profession and the public may come to perceive massage therapists (as a whole) as dishonest and unethical.

Finally, notwithstanding the above very obvious tangible harms there is also the often forgotten but significant issue of harm to self. That is, harm to the self-esteem and self-respect of the practitioner. In our deepest selves we know when we have compromised our values and broken our professional commitment to serve our client’s best interests. When we violate our own values and fail to keep our commitments, we lose respect for ourselves.

What should Peter do?
Think carefully, consider and weigh all the relevant factors we have discussed and make an informed and considered decision. Remember at all times his or her professional promise to protect the client’s best interests and act diligently when he or she knows that blowing the whistle is the right thing to do.

What would you do?
Send your comments/solutions regarding this ethical dilemma to info@massagetherapycanada.com