Conflict of Interest

cidalia paiva, PHD
August 31, 2007
By cidalia paiva, PHD
A massage therapist promotes his business by pressuring his clients into participating in print testimonials, even though some of them feel uncomfortable doing this.

A massage therapist, working in a spa, is required as part of his job description to sell spa products as well as services. However, he and a colleague have developed their own bath additive products and he is secretly selling his products to the spa customers at a discount.

A massage therapist, currently working in a clinic, is planning to start his own business and is secretly recruiting the clinics’ clients for his own new clinic.
A massage therapist, who is the head of the Education Department at a Massage Therapy College, hires a friend as one of the instructors.

A Massage Therapy Association accepts corporate sponsorship for a Massage Therapy Workshop it is hosting knowing that the sponsor will expect the Association to exclusively endorse and promote its’ products and services at their upcoming Annual General Meeting. What do all these behaviours have in
common? They are all examples of situations that pose a conflict of interest.

A conflict of interest is a situation in which someone, in a position of trust, has a competing professional or personal interest. These competing interests make it difficult for him or her to objectively execute their primary duty or responsibility, which is to first and foremost serve the best interests of their clients. If we go back to our examples, in the first case, the massage therapist who is pressuring his clients to promote his clinic through print testimonials, despite their discomfort in doing so, has introduced a competing interest – namely his desire to promote his clinic as a business to the detriment of some of his client’s well-being or at least comfort.

In our second example the massage therapist, as an employee of the spa, has a primary duty and loyalty to the spa business, which in this case at least quite clearly includes promoting and selling the spa’s product line. By offering spa clients his own products, he is in effect competing with the spa and promoting his own personal interests to the detriment of the spa’s interests.

Example number three is similar to example number two in that the massage therapist has a professional duty and obligation to be honest, ethical and loyal to the clinic he is currently employed by. By actively recruiting clients away from this clinic to his own he is clearly serving his own interests first.

In example number four, the massage therapist who is the Education Department Head at a Massage Therapy School and hires a personal friend to be an instructor there, is clearly in conflict as he has a responsibility to support an objective and equitable hiring process. By offering his friend the position he is placing his personal interests, in this case his desire to help his friend, above his primary duty which is to ensure that the College’s hiring process is fair and
based on objective criteria.

In our last example, the massage therapy Association has a professional ethical duty to be objective and impartial in all its dealings with all persons and organizations. By accepting this specific corporate sponsorship opportunity they are in effect committing themselves to preferential treatment to this particular corporate sponsor at the detriment of other massage therapy suppliers.

Now, some might argue that a conflict of interest only exists if an unethical or improper act results. The reality is that a conflict of interest exists even if there are no improper actions as a result of it.

Think of it this way, in a conflict of interest scenario a massage therapist is placed in a situation in which he or she has to play two roles with two separate job descriptions; one of these is to protect their client’s best interest and the other to promote their own. Many times these two interests will not coincide and often they will conflict. However, whether they do or do not conflict does not change the fact that there are two roles with two potentially competing agendas and therefore a conflict of interest does exist.

Moreover, even if no unethical or inappropriate act results from a conflict of interest scenario, conflict of interest scenarios can create an appearance of impropriety that can undermine confidence in the practitioner and in the profession.

Returning to our massage therapy department head example, even if the department head chose to endorse his friend for the position because he truly and sincerely believed that he was the best qualified for the job, others, based on the inherent competing interests in a situation such as this, might not believe this and feel that he is simply trying to support his friend.

Why do we underplay the danger and potential for harm created by conflict of interest scenarios?

Sometimes we are genuinely unaware we are engaged in a conflict of interest scenario. Like our massage therapy department head, we may believe that we are simply promoting the best person for the job, who just happens to be a close friend. It may be difficult for us to understand and appreciate that even if we are ‘right’ our position will appear prejudiced and biased. And, in a case such as this one, ‘appearing to be unbiased’ is almost as important as ‘actually being unbiased’ given the importance of maintaining fairness and equality in the college’s hiring process.

At other times we naively believe that even though we are in a conflict of interest scenario we are nevertheless above being influenced inappropriately. We believe we are far too ethical to be influenced or to promote our best interests above those of our clients or our profession. However, as human beings, our own personal self-interest is always going to be paramount. Very few of us will ever sacrifice our own self-interest for that of another, especially when we have a competing interest that threatens our livelihood.

Finally, we rationalize our participation in conflict of interest scenarios by telling ourselves that we can excuse ourselves from conflict of interest
scenarios simply by bowing out of any of the decision-making.

Sometimes this may be possible and there may be specific scenarios where a person can actually abstain from making a decision. As an example,
the department head could remove himself from the hiring committee.

However, he will still have the opportunity to influence his colleagues through ongoing dialogues. In fact, there are so many different ways we can promote our personal interests and no fail proof way to ensure that our personal agenda is not preempting our professional commitment even in some small or minor way.

What can we do about conflict of interest? The best way to handle conflict of interest scenarios is to avoid them altogether. Don’t place yourself in a position where you will be dealing with conflicting interests. Play one role at one time with each and every person you provide massage therapy services to.
If despite your best efforts you simply can’t avoid being involved in a conflict of interest scenario, make sure that you disclose the actual or potential conflict of interest situation to the relevant person(s) or bodies involved.

Thirdly once you have disclosed that you are in a conflict of interest scenario make sure that you abstain yourself from decision-making where a conflict of interest exists or could be perceived to exist.

If at all possible, seek professional guidance and support from an ethics committee that can act as an independent third-party and provide an impartial evaluation of the situation. Remember, for this evaluation to be valid the committee must be made up of independent individuals who are indeed arms lengths from the situation and who as a result can provide an impartial and fair perspective.

As health care professionals, we have an ethical duty to avoid wherever possible conflict of interest scenarios which undermine our clients’ trust in us personally and professionally.

The best practice is always to act professionally, keep boundaries intact and work within our primary role and obligations to the best of our abilities.
We need to be conscientious and wise and ensure that our behaviour personally and collectively serves to promote public trust and confidence in massage therapy.

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