Professional Code of Ethics
Massage therapists and bodyworkers have an ethical and legal responsibility not to harm their clients.  However, humans vary greatly in their beliefs, so how are we to come together in a group and agree on priorities, values and other beliefs?  Hopefully, this can occur through a written code of ethics.  For our purposes, ethics is defined as “a set of moral principles or values; declarations of what is right or wrong and of what ought to be.” According to this definition, our ethics show themselves through our conduct and actions.  A professional Code of Ethics is a collection of rules, regulations and/or specifications for governing professional conduct. Each professional group creates its own Code of Ethics to define what actions are good and bad, and where moral duty and obligation fall. A Code of Ethics usually specifies the relationship of the practitioner to the client, to fellow practitioners and to society at large. The code may be written, unwritten, or both.  The Code of Ethics for the American Massage Therapy Association (AMTA) and for the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) are good examples. These codes also reflect beliefs and standards that are commonly held by other health professions’ organizations.

Texas Massage Therapy Licensing Program Rules
Title 25, Texas Administrative Code
Chapter 140 Health Professions Regulation
Subchapter H Massage Therapists
DIVISION 2.  CODE OF ETHICS.
§140.303. General Ethical Requirements.
(a) A licensee shall not make deceptive, untrue, or fraudulent representations in the practice of massage therapy or employ a trick or scheme in the practice of massage therapy, including, but not limited to, warranty of results of such services and false claims of proficiency in any field.

(b) A licensee shall not use a work area, equipment or clothing that is unclean or unsanitary.

(c) A licensee shall not practice massage therapy fraudulently, with gross incompetence, with gross negligence on a particular occasion, or with negligence or incompetence on more than one occasion.

(d) A licensee shall bill clients or third parties for only those services actually rendered or as agreed to by mutual understanding at the beginning of services or as later modified by mutual agreement. A licensee must either honor an unexpired gift certificate issued by that licensee or provide a full refund.

(e) For each client, a licensee shall keep accurate records of the dates of massage therapy services, types of massage therapy and billing information. Such records must be maintained for a minimum of two years.

(f) A licensee must obtain the written consent of a parent or guardian to provide massage therapy services to a person under the age of 17.

(g) On the written request of a client, a client's guardian, or a client's parent if the client is under the age of 17, a licensee shall provide a written explanation of the charges for massage therapy services previously made on a bill or statement of the client. This requirement applies even if the charges are to be paid by a third party.

(h) A licensee shall not abuse alcohol or drugs in any manner which detrimentally affects the provision of massage therapy or massage therapy instruction.

(i) A licensee may not persistently or flagrantly overcharge or over treat a client.

(j) A licensee shall not practice in an unlicensed massage establishment or massage school.

(k) A licensee shall not allow an unlicensed person to engage in activity for which licensure is required.

(l) A licensee shall not provide false information on material submitted to the department.

(m) A licensee shall not interfere with a department investigation by the willful misrepresentation of facts to the department or its authorized representative, or by the use of threats, retaliation, or harassment against any person.

(n) A licensee shall comply with any formal order issued by the department relating to the licensee.

(o) A licensee shall be subject to disciplinary action by the department if the licensee is issued a public letter of reprimand, is assessed a civil penalty by a court, or has an administrative penalty imposed by the attorney general's office under the Texas Code of Criminal Procedure, §56.31.

(p) A licensee shall notify each client of the name, mailing address, and telephone number of the department for the purpose of directing complaints to the department by providing notification:

(1) on each written contract for services of a licensee; or
(2) on a sign prominently displayed in the primary place of business of each licensee; or
(3) on a bill for service provided by a licensee to a client or third party; or
(4) by another written and documented method.

(q) A licensee shall keep his or her licensure file updated by notifying the department, in writing, of changes of names, address, telephone number and employment.

(r) A licensee shall be subject to disciplinary action for failure to truthfully respond in a manner that fully discloses all information in an honest, materially responsive, and timely manner to a complaint filed with or by the department.

(s) A licensee shall not make any false, misleading, deceptive, fraudulent, or exaggerated claim or statement about the licensee's services, including, but not limited to:

(1) the effectiveness of services;
(2) the licensee's qualifications, capabilities, background, training, experience, education, certification or licensure, professional affiliations, fees, products, or publications; or
(3) the practice or field of massage therapy.

§140.304. Consultation Document.

(a) A licensee shall provide an initial consultation to each client(s) prior to the first massage therapy session and obtain the signature of the client on the consultation document. The consultation document shall include:

(1) the type of massage therapy services or techniques the licensee anticipates using during the massage therapy session;
(2) the parts of the client's body that will be massaged or the areas of the client's body that will be avoided during the session, including indications and contraindications;
(3) a statement that the licensee shall not engage in breast massage of female clients without the written consent of the client;
(4) a statement that draping will be used during the session, unless otherwise agreed to by both the client and the licensee;

(5) a statement that if uncomfortable for any reason, the client may ask the licensee to cease the massage and the licensee will end the massage session; and
(6) the signature of both the client and the licensee.

(b) If the client's reason for seeking massage therapy changes at any time and any of the information in subsection (a)(1) - (4) of this section is modified, the licensee must provide an updated consultation reflecting any changes and modifications to the techniques used or the parts of the client's body to be massaged.

§140.305. Sexual Misconduct.

(a) A licensee shall not engage in sexual contact during a session with a client. For the purposes of this section, sexual contact includes:

(1) any touching of any part of the genitalia or anus;
(2) any touching of the breasts of a female client, unless the touching is breast massage that is specifically authorized by the client through the signed consultation document referenced in §140.304(a)(3) of this title (relating to Consultation Document);
(3) any offer or agreement to engage in any activity described in paragraph (1) or (2) of this subsection;
(4) kissing;
(5) deviate sexual intercourse, sexual contact, sexual intercourse, indecent exposure, sexual assault, prostitution, and promotion of prostitution as described in the Texas Penal Code, Chapters 21, 22, and 43, or any offer or agreement to engage in any such activities; or
(6) any behavior, gestures, or expressions which may reasonably be interpreted as inappropriately seductive or sexual;
(7) inappropriate sexual comments about or to a client, including making sexual comments about a person's body.

(b) A licensee shall not allow any individual, including a client, student, licensee, employee, participant in a continuing education program, or one's self to engage in sexual contact on the premises of any massage school, massage establishment, or the licensee's own place of business.

(c) A licensee shall not allow any individual, including a student, licensee, employee, or one's self to practice massage therapy or provide other massage therapy services in the nude, while partially nude, or in clothing designed to arouse or gratify the sexual desire of any individual.

(d) A licensee shall not perform massage therapy, whether or not for compensation, at or for a sexually oriented business.

(e) A licensee shall immediately discontinue the massage therapy session, activity or the professional relationship when a client initiates any verbal or physical contact with the licensee that is intended to arouse or gratify the sexual desire of either person.

§140.306. Advertising.

(a) A person, including a massage therapy instructor, a massage school, a massage therapist, or massage establishment, who is not licensed under the Act, shall not use the word "massage" on any sign, display, or other form of advertising unless the person is expressly exempt from the license requirements of the Act. Under no circumstances may a sexually oriented business use the word "massage" or "bath" on any sign or other form of advertising.

(b) A licensee shall not use advertising that is false, misleading, or deceptive or that is not readily subject to verification. False, misleading, or deceptive advertising or advertising that is not readily subject to verification includes advertising that:

(1) makes a material misrepresentation of fact or omits a fact necessary to make the statement as a whole not materially misleading;
(2) makes a representation likely to create an unjustified expectation about the results of a health care service or procedure;
(3) compares a health care professional's services with another health care professional's services unless the comparison can be factually substantiated;
(4) contains a testimonial;
(5) causes confusion or misunderstanding as to the credentials, education, or licensure of a health care professional;
(6) advertises or represents that health care insurance deductibles or copayments may be waived or are not applicable to health care services to be provided if the deductibles or copayments are required;
(7) advertises or represents that the benefits of a health benefit plan will be accepted as full payment when deductibles or copayments are required;
(8) makes a representation that is designed to take advantage of the fears or emotions of a particularly susceptible type of client; or
(9) advertises or represents in the use of a professional name, title or professional identification that is expressly or commonly reserved to or used by another profession or professional.

(c) When an assumed name is used in a person's practice as a massage therapist, the full legal name of the massage therapist or license number of the massage therapist must be listed in each advertisement and each time the business name or assumed name appears in writing. The license number of a massage establishment must be listed in conjunction with the assumed or legal name of the massage establishment. An assumed name used by a massage therapist must not be false, misleading, or deceptive.

(d) A massage school shall not make false, misleading, or deceptive statements concerning the activities or programs of another massage school.

(e) A massage school shall not maintain, advertise, solicit for or conduct any course of instruction intended to qualify a person for licensure as a massage therapist without first obtaining licensure from the department.

(f) Advertisements by a massage therapy educational program seeking prospective students must clearly indicate that training is being offered, and shall not, either by actual statement, omission, or intimation, imply that prospective employees are being sought.

(g) Advertisements seeking prospective students must include the full and correct name and license number of the massage therapy educational program and massage school.

(h) No statement or representation shall be made to prospective or enrolled students that employment will be guaranteed upon completion of any program or that falsely represents opportunities for employment.

(i) No statement shall be made by a massage therapy educational program or a massage school that it has been accredited unless the accreditation is granted from a nationally recognized accrediting agency or organization. The name of the accrediting agency or organization must be used in any accreditation statement.

(j) No massage therapy educational program shall advertise as an employment agency under the same name or a confusingly similar name or at the same location as the educational program. No representative shall solicit students for a program through an employment agency.

(k) A massage therapy school shall not use endorsements, commendations, or recommendations by students in favor of a massage therapy educational program except with the consent of the student and without any offer of financial or other material compensation. Endorsements shall bear the legal or professional name of the student. An endorsement of a school by a student in compliance with this subsection is not a testimonial as referenced in subsection (b)(4) of this section.

§140.307.  Massage Therapy Licenses.

(a) The department will send each applicant whose application for licensure has been approved a license containing a license number. Individual licensees will also be sent an identification card. Licenses and identification cards remain the property of the department and must be surrendered to the department on demand.

(b) A license must be displayed in an appropriate and public manner at the business location of the licensed business, or in the primary office or place of employment of the licensed individual. In the absence of a primary office or place of employment, the licensed individual shall carry a current identification card.

(c) Business licenses may not be sold or transferred to another address. If a licensed business is sold, or is closed at a particular address, the license certificate shall be returned to the department.

(d) Neither the licensee nor anyone else shall display a photocopy of a license or carry a photocopy of an identification card in lieu of the original document.
(e) Neither the licensee nor anyone else shall make any alteration on a license or identification card issued by the department.

(f) The department will replace a lost, damaged, or destroyed license or identification card upon written request from a licensee and payment of the appropriate replacement fee. The request shall include a statement detailing the loss or destruction of the original license or identification card, or be accompanied by the damaged license or card.

(g) Licenses and cards that were issued but may have not been received by a licensee may be replaced at no charge if the licensee notifies the department in writing and within 30 days of the date the license or card was issued.

ABMP Code of Ethics

As a member of Associated Bodywork & Massage Professionals (ABMP), I pledge my commitment to the highest principles of the massage and bodywork profession as outlined here:

  1. Commitment to High-Quality Care
    I will serve the best interests of my clients at all times and provide the highest quality of bodywork and service possible. I recognize that the obligation for building and maintaining an effective, healthy, and safe therapeutic relationship with my clients is my responsibility.
  2. Commitment to Do No Harm
    I will conduct a thorough health history intake process for each client and evaluate the health history to rule out contraindications or determine appropriate session adaptations. If I see signs of, or suspect, an undiagnosed condition that massage may be inappropriate for, I will refer that client to a physician or other qualified health-care professional and delay the massage session until approval from the physician has been granted. I understand the importance of ethical touch and therapeutic intent and will conduct sessions with the sole objective of benefitting the client.
  3. Commitment to Honest Representation of Qualifications
    I will not work outside the commonly accepted scope of practice for massage therapists and bodywork professionals. I will adhere to my state's scope of practice guidelines (when applicable). I will only provide treatments and techniques for which I am fully trained and hold credible credentials. I will carefully evaluate the needs of each client and refer the client to another provider if the client requires work beyond my capabilities, or beyond the capacity of massage and bodywork. I will not use the trademarks and symbols associated with a particular system or group without authentic affiliation. I will acknowledge the limitations of massage and bodywork by refraining from exaggerating the benefits of massage therapy and related services throughout my marketing.
  4. Commitment to Uphold the Inherent Worth of All Individuals
    I will demonstrate compassion, respect, and tolerance for others. I will seek to decrease discrimination, misunderstandings, and prejudice. I understand there are situations when it is appropriate to decline service to a client because it is in the best interests of a client's health, or for my personal safety, but I will not refuse service to any client based on disability, ethnicity, gender, marital status, physical build, or sexual orientation; religious, national, or political affiliation; social or economic status.
  5. Commitment to Respect Client Dignity and Basic Rights
    I will demonstrate my respect for the dignity and rights of all individuals by providing a clean, comfortable, and safe environment for sessions, using appropriate and skilled draping procedures, giving clients recourse in the event of dissatisfaction with treatment, and upholding the integrity of the therapeutic relationship.
  6. Commitment to Informed Consent
    I will recognize a client's right to determine what happens to his or her body. I understand that a client may suffer emotional and physical harm if a therapist fails to listen to the client and imposes his or her own beliefs on a situation. I will fully inform my clients of choices relating to their care, and disclose policies and limitations that may affect their care. I will not provide massage without obtaining a client's informed consent (or that of the guardian or advocate for the client) to the session plan.
  7. Commitment to Confidentiality
    I will keep client communication and information confidential and will not share client information without the client's written consent, within the limits of the law. I will ensure every effort is made to respect a client's right to privacy and provide an environment where personal health-related details cannot be overheard or seen by others.
  8. Commitment to Personal and Professional Boundaries
    I will refrain from and prevent behaviors that may be considered sexual in my massage practice and uphold the highest professional standards in order to desexualize massage. I will not date a client, engage in sexual intercourse with a client, or allow any level of sexual impropriety (behavior or language) from clients or myself. I understand that sexual impropriety may lead to sexual harassment charges, the loss of my massage credentials, lawsuits for personal damages, criminal charges, fines, attorney's fees, court costs, and jail time.
  9. Commitment to Honesty in Business
    I will know and follow good business practices with regard to record keeping, regulation compliance, and tax law. I will set fair fees and practice honesty throughout my marketing materials. I will not accept gifts, compensation, or other benefits intended to influence a decision related to a client. If I use the Associated Bodywork & Massage Professionals logo, I promise to do so appropriately to establish my credibility and market my practice.
  10. Commitment to Professionalism
    I will maintain clear and honest communication with clients and colleagues. I will not use recreational drugs or alcohol before or during massage sessions. I will project a professional image with respect to my behavior and personal appearance in keeping with the highest standards of the massage profession. I will not actively seek to take someone else's clients, disrespect a client or colleague, or willingly malign another therapist or other allied professional. I will actively strive to positively promote the massage and bodywork profession by committing to self-development and continually building my professional skills.

NCBTMB Code of Ethics

NCBTMB certificants and applicants for certification shall act in a manner that justifies public trust and confidence, enhances the reputation of the profession, and safeguards the interest of individual clients. Certificants and applicants for certification will:
I. Have a sincere commitment to provide the highest quality of care to those who seek their professional services.
II. Represent their qualifications honestly, including education and professional affiliations, and provide only those services that they are qualified to perform.
III. Accurately inform clients, other health care practitioners, and the public of the scope and limitations of their discipline.
IV. Acknowledge the limitations of and contraindications for massage and bodywork and refer clients to appropriate health professionals.
V. Provide treatment only where there is reasonable expectation that it will be advantageous to the client.
VI. Consistently maintain and improve professional knowledge and competence, striving for professional excellence through regular assessment of personal and professional strengths and weaknesses and through continued education training.
VII. Conduct their business and professional activities with honesty and integrity, and respect the inherent worth of all persons.
VIII. Refuse to unjustly discriminate against clients and/or health professionals.
IX. Safeguard the confidentiality of all client information, unless disclosure is requested by the client in writing, is medically necessary, is required by law, or necessary for the protection of the public.
X. Respect the client's right to treatment with informed and voluntary consent. The certified practitioner will obtain and record the informed consent of the client, or client's advocate, before providing treatment. This consent may be written or verbal.
XI. Respect the client's right to refuse, modify or terminate treatment regardless of prior consent given.
XII. Provide draping and treatment in a way that ensures the safety, comfort and privacy of the client.
XIII. Exercise the right to refuse to treat any person or part of the body for just and reasonable cause.
XIV. Refrain, under all circumstances, from initiating or engaging in any sexual conduct, sexual activities, or sexualizing behavior involving a client, even if the client attempts to sexualize the relationship unless a pre‐existing relationship exists between an applicant or a practitioner and the client prior to the applicant or practitioner applying to be certified by NCBTMB.
XV. Avoid any interest, activity or influence which might be in conflict with the practitioner's obligation to act in the best interests of the client or the profession.
XVI. Respect the client's boundaries with regard to privacy, disclosure, exposure, emotional expression, beliefs and the client's reasonable expectations of professional behavior.  Practitioners will respect the client's autonomy.
XVII. Refuse any gifts or benefits that are intended to influence a referral, decision or treatment, or that are purely for personal gain and not for the good of the client.
XVIII. Follow the NCBTMB Standards of Practice, this Code of Ethics, and all policies, procedures, guidelines, regulations, codes, and requirements promulgated by the National Certification Board for Therapeutic Massage & Bodywork.
©2008 by the National Certification Board for Therapeutic Massage and Bodywork.

AMTA Code of Ethics

This code of ethics is a summary statement of the standards by which massage therapists agree to conduct their practices and is a declaration of the general principles of acceptable, ethical and professional behavior.
Massage therapists shall:
• Demonstrate commitment to provide the highest quality massage therapy/bodywork to those who seek their professional service.
• Acknowledge the inherent worth and individuality of each person by not discriminating or behaving in any prejudicial manner with clients and/or colleagues.
• Demonstrate professional excellence through regular self‐assessment of strengths, limitations and effectiveness by continued education and training.
• Acknowledge the confidential nature of the professional relationship with clients and respect each client’s right to privacy.
• Conduct all business and professional activities within their scope of practice, the law of the land and project a professional image.
• Refrain from engaging in any sexual conduct or sexual activities involving their clients
• Accept responsibility to do no harm to the physical, mental and emotional wellbeing of self, clients and associates.
© Copyright American Massage Therapy Association.

Case Study #1 - Confidentiality

John Doe, LMT and Jane Jones (therapy receptionist) are in a private Massage Therapy office discussing the fact that they are treating Joe Superstar, an NFL quarterback.  John says, “I can’t believe that I’m actually treating Joe Superstar.”  Jane asks, “How bad do you think his injury is?”  John replies, “I saw his MRI report, I think he is going to need surgery.”

Is this a breach in confidentiality?

The information contained in each patient’s medical record must be safeguarded against disclosure or exposure to nonproprietary individuals.  The right to know any medical information about another is always predicated on a sound demonstration of need.  Frequently, many individuals require access to information contained in a patient’s medical record. Their right to access this information is limited to only that information which is deemed necessary for them perform their job in a safe, effective, and responsible manner.

The first questions we must ask are “What information is being disclosed and does the individual engaged in the conversation have a need to know this information?”
John’s first statement discloses the name of person receiving care, and his second statement reveals private patient medical information.  Certainly, as the therapist, John would need to know the patient’s name and therapy related diagnostic imaging in order to provide proper care.  Therefore, the disclosure to Jane of the patient’s private medical information is a breach of patient confidentiality.  NCBTMB Code of Ethics Article IX

Case Study #2 – Qualifications of Practice

You work in very busy massage therapy practice in a state that requires licensure to practice massage.  The receptionist is a massage student who is almost completed with her training. A potential massage client comes in and you are booked with a massage. The receptionist decides that she will perform the massage since she knows she can give the client a professional massage.

Is the practice providing ethical care to this client?

The practice of massage therapy is closely regulated throughout the United States.  Each state, through legislation, establishes minimal licensure and practice standards.  This is done to protect the general public against fraud and substandard care by under-qualified practitioners.  It is each massage therapist’s responsibility to adhere to the standards of care and licensure requirements specific to the state in which they practice. The therapist must also ensure that all care provided not directly by them, but under their supervision, also meets these standards.

In this situation, the receptionist’s abilities are considered irrelevant.  The key issue here is that the receptionist is a massage student and is not yet licensed to practice massage and is not yet qualified to perform massage. NCBTMB Code of Ethics Article II

Case Study #3 – Privacy

John Doe is a massage therapist working in private practice and is at the end of a long day. His massage client Jane Smith requests a full body massage and John realizes that there are no clean flat sheets to cover her, so he uses a towel instead. The towel barely covers Jane and during the massage, John has to constantly maneuver the towel to keep Jane covered.  Jane is aware of this and holds on to the towel with her hands during the massage.

Is this a breach of client privacy?

Yes. The massage therapist must provide adequate draping so that the client feels safe and comfortable at all times. NCBTMB Code of Ethics Article XII

Case Study #4 – Acknowledge Limitation and Contraindications
Jane Doe is a massage therapist at a spa in a country club. A member of the country club comes into the spa for a massage. He has just played golf and is feeling pain in his shoulder, which he wants Jane to massage. As Jane begins to massage his shoulder, the member is wincing in pain, but insists that she continue.  His shoulder is swollen, warm and red.  Contrary to her better judgment, Jane continues to massage his shoulder.

Is Jane honoring her ethical commitment?

No. Jane should realize that acute inflammation is a contraindication to massage and either work around the acutely injured area or refer the client for medical assessment. NCBTMB Code of Ethics Article IV

Case Study #5 – Conflicts of Interest
John Smith, LMT, works in a chiropractic clinic.  He is meeting with a vendor whose company is introducing a new line of massage lotion onto the market.  The vendor offers him a free case of lotion  to “try out” on patients. The vendor states that if John continues to order more lotion, he will qualify to receive compensation from his company by automatically becoming a member of its National Massage Therapy Panel.

Does this represent a conflict of interest?

Yes, there exists a conflict of interest in this situation.  John has two primary obligations to fulfill.  The first is to his client. It is his professional duty to use the best lotion for his clients. The second obligation is to his employer, the chiropractic clinic.  As an employee, it is his responsibility to manage expenses by thoroughly and objectively seeking effective products that also demonstrate economic efficiency.  The conflict of interest occurs when he begins to accept compensation from the vendor in direct or indirect response for his orders.  Even if he truly believes it is the best lotion for her clients, and it is the most cost effective lotion that the clinic could purchase, by accepting the money he has established at least an apparent conflict of interest.  Under this situation he is obligated to disclose to all parties his financial interest in ordering the lotion. This disclosure is necessitated because the potential for personal gain would make others rightfully question whether his objectivity was being influenced.
A conflict of interest is a situation in which a person has a private or personal interest that influences the objective exercise of his or her professional duties. As a professional you take on certain responsibilities and obligations to clients, employers, and others. These obligations must take precedence over a therapist’s private or personal interests.
In addition to avoiding all real instances of conflict of interest, therapists must also avoid any apparent or potential conflicts as well.
An apparent conflict of interest is one in which a reasonable person would think that the professional’s judgment is likely to be compromised, and a potential conflict of interest involves a situation that may develop into an actual conflict of interest.
How do you determine if you are in a conflict of interest, whether actual, apparent, or potential? The key is to determine whether the situation you are in interferes or is likely to interfere with your independent judgment. A good test is the ‘trust test’: Would relevant others (my employer, my clients, professional colleagues, or the general public) trust my judgment if they knew I was in this situation. Trust is at the ethical heart or core of this issue. Conflicts of interest involve the abuse, actual or potential, of the trust people have placed in professionals. This is why conflicts of interest can not only injure particular clients and employers, but they also damage the whole profession by reducing the trust people generally have in therapists. NCBTMB Code of Ethics Article XVII

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