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Ethics for Yoga Therapists: Legal Ethics, Roles and Boundaries (3 CE Hours)

This course is approved for 3 hours of Continuing Education for Yoga Therapists and Yoga Teachers by the Yoga Alliance.

Learning Outcome: The student will be proficient in explaining and applying the principles of legal ethics, roles and boundaries in the context of the yoga therapy practice.

Learning Objectives: After reading this course, you will...

  1. be able to explain the ethics theories and how they relate to practicing yoga therapy.
  2. be able to list and describe the virtues that define virtue ethics.
  3. be able to list and explain the 4 questions that ethical decision-making is rooted in.
  4. be able to describe legal issues related to yoga therapy and where law intersects with ethics.
  5. be able to list all the different types of legal ethics applicable to the practice of yoga therapy.
  6. be able to explain the principles of healthcare ethics applicable to practicing of yoga therapy.
  7. be able to explain appropriate professional roles and boundaries and describe how to avoid ethics violations.
  8. be able to apply the principles of heathcare ethics to presented case studies.
  9. be able to explain the importance of the articles of the code of conduct of the Yoga Alliance and IAYT code of ethics.

Introduction to Ethics for Yoga Therapists

The word "ethics" is derived from the Greek word ethos (character), and from the Latin word mores (customs). Together, they combine to define how individuals choose to interact with one another. In philosophy, ethics defines what is good for the individual and for society and establishes the nature of duties that people owe themselves and one another.  Ethics is also a field of human inquiry ("science" according to some definitions) that examines the bases of human goals and the foundations of "right" and "wrong" human actions that further or hinder these goals.  Ethics (also known as moral philosophy) is a branch of philosophy which seeks to address questions about morality.  Morality involves what is right or wrong. 

Although the terms "ethics" and "morals" are often used interchangeably, they are not identical. Morals usually refer to practices; ethics refers to the rationale that may or may not support such practices. Morals refer to actions, ethics to the reasoning behind such actions. Ethics is an examined and carefully considered structure that includes both practice and theory. Morals include ethically examined practices, but may also include practices that have not been ethically analyzed, such as social customs, emotional responses to breaches of socially accepted practices and social prejudices. Ethics is usually at a higher intellectual level, more universal, and more dispassionate than morals. Some philosophers, however, use the term "morals" to describe a publicly agreed-upon set of rules for responding to ethical problems.

Although what is right or wrong can come under debate, society agrees on the importance of basic ideals, values and rights.  Because culture and society influence our sense of what is right or wrong, norms of morality can change over time.  This can make issues regarding morality and ethics confusing. Ethics can apply to individuals, groups of individuals and professions. Personal ethics refers to our individual decisions about right and wrong.  We must accept responsibility for our actions and be accountable for them.  Professional ethics refers to agreed upon moral standards that are practiced by a profession.  When working with yoga clients, our personal and professional ethics may both be involved.  In the context of yoga therapy, proper ethics means adhering to prevailing laws, practicing within the appropriate scope of practice, following standards of conduct set forth by the profession, respecting each client and behaving in an honorable way. 

Ethical questions involve 1) responsibilities to the welfare of others or to the human community; or 2) conflicts among loyalties to different persons or groups, among responsibilities associated with one's role (e.g. as consumer or provider), or among principles. Ethical questions include (or imply) the words "ought" or "should". Ethics is important on several levels. People feel better about themselves and their profession when they work in an ethical manner. Professions recognize that their credibility rests not only on technical competence, but also on public trust. At the organizational level, ethics is good business.  Several studies have shown that over the long run ethical businesses perform better than unethical businesses.

Ethics Theories
Throughout history, mankind has attempted to determine the philosophical basis from which to define right and wrong.  Here are some of the more commonly accepted theories that have been proposed.

Utilitarianism
This philosophical theory develops from the work of Jeremy Bentham and John Stewart Mill. Simply put, utilitarianism is the theory that right and wrong is determined by the consequences. The basic tool of measurement is pleasure (Bentham) or happiness (Mill).
A morally correct rule was the one that provided the greatest good to the greatest number of people.

Social Contract Theory
Social contract theory is attributed to Thomas Hobbes, John Locke, and from the twentieth century, John Rawls. Social contract theories believe that the moral code is created by the people who form societies. These people come together to create society for the purpose of protection and gaining other benefits of social cooperation. These persons agree to regulate and restrict their conduct to achieve this end.

Deontological or Duty Theory
Under this theory you determine if an act or rule is morally right or wrong if it meets a moral standard. The morally important thing is not consequences but the way choosers think while they make choices. One famous philosopher who developed such a theory was Immanuel Kant (1724-1804).

Ethical Intuitionism
Under this view an act or rule is determined to be right or wrong by appeal to the common intuition of a person. This intuition is sometimes referred to as your conscience. Anyone with a normal conscience will know that it is wrong to kill an innocent person.

Ethical egoism
This view is based on the theory that each person should do whatever promotes their own best interests; this becomes the basis for moral choices.

Virtue Ethics
This ethics theory proposes that ethical behavior is a result of developed or inherent character traits or virtues.  A person will do what is morally right because they are a virtuous person. Aristotle (384-322 B.C.) was a famous exponent of this view. Aristotle felt that virtue ethics was the way to attain true happiness. These are some of the commonly accepted virtues.

Autonomy: the duty to maximize the individual's right to make his or her own decisions.

Beneficence: the duty to do good.

Confidentiality: the duty to respect privacy of information.

Finality: the duty to take action that may override the demands of law, religion, and social customs.

Justice: the duty to treat all fairly, distributing the risks and benefits equally.

Nonmaleficence: the duty to cause no harm.

Understanding/Tolerance: the duty to understand and to accept other viewpoints if reason dictates.

Respect for persons: the duty to honor others, their rights, and their responsibilities.

Universality: the duty to take actions that hold for everyone, regardless of time, place, or people involved.

Veracity: the duty to tell the truth.

Making Ethical Decisions
The foundation for making proper ethical decisions is rooted in an individual’s ability to answer several fundamental questions concerning their actions.

Is it legal?
Weighing the legality of one’s actions is a prudent way to begin the decision-making process. The laws of a geographic region are a written code of that region’s accepted rules of conduct.  This code of conduct usually defines clearly which actions are considered acceptable and which actions are unacceptable.  However, a legitimate argument can be made that sometimes what is legal is not always moral, and that sometimes what is moral is not always legal.  This idea is easily demonstrated by the following situation.
It is illegal for a pedestrian to cross a busy street anywhere other than at the designated crosswalk (jaywalking).  A man is walking down a street and sees someone fall and injure themselves on the other side of the street.  He immediately crosses the street outside of the crosswalk to attend to the injured person.  Are his actions legal?  Are they moral?  What if by stepping into the street he causes a car to swerve and to strike another vehicle?
Admittedly, with the exception of policemen and attorneys, most people do not know all of the specific laws that govern their lives.  However, it is assumed that most people are familiar with the fundamental virtues from which these laws are based, and that they will live their lives in accordance with these virtues.

Is it ethical?
Professional ethical behavior as it is defined in this context relates to actions that are consistent with the normative standards established or practiced by others in the same profession.  For yoga therapists, these ethical standards are documented in the Yoga Alliance Code of Conduct and the International Association of Yoga Therapists Code of Ethics.  All yoga therapists, even those who are not members of the IAYT, are bound to these guidelines. This is because The IAYT Code of Ethics is the accepted and de facto standard of practice throughout the profession.

Is it fair?
I think most people would agree that the concept of fairness is often highly subjective. However, for these purposes, we will define fairness as meaning deserved, equitable and unbiased.  Fairness requires the decision-maker to have a complete understanding of benefits and liabilities to all parties affected by the decision.  Decisions that result in capricious harm or arbitrary benefit cannot be considered fair.  The goal of every decision should be an outcome of relative equity that reflects insightful thought and soundness of intent.

Would you want others to know of your decision?
This question presents as a true reflection of the other three.  Legal, ethical, and fair are defined quite differently by most people when judged in the comfort of anonymity versus when it is examined before the forum of public opinion.  Most often it is the incorrect assumption that “no one will ever find out about this” that leads people to commit acts of impropriety.  How would your decisions change, if prior to taking any actions, you assumed just the opposite; “other people will definitely know what I have done”.  One sure sign of a poor decision is debating the possible exposure of an action instead of examining the appropriateness of it.

Legal Issues
Although law and ethics are separate areas, laws may intersect ethics.  Laws are formal rules of conduct set up at the federal, state or local levels to govern activities of members of society.  Citizens should know and follow the laws that affect them personally and professionally. 
Due to the nature of health and illness, healthcare professionals sometimes apply procedures that have the potential liability of risk of harm to the client.  These liabilities are called torts.  A tort is a civil wrong or a harm against a person.  There are four types of torts:

  • Negligence is based on neglect or carelessness.
  • Intentional torts are actions that intentionally inflict harm or that do not involve consent.
  • Quasi‐intentional torts are the use of words to inflict harm.
  • Strict liability is a legal doctrine that creates liability regardless of intention.

Negligence
Negligence is defined as conduct that is culpable because it falls short of what a reasonable person would do to protect another individual from foreseeable risks of harm.  It is the failure to use such due diligence of care as a reasonably prudent person would use under similar circumstances.  It occurs when a person is careless, inattentive, neglectful, or reckless and harm comes to someone due to that negligence.  Professional negligenceis the commission by a healthcare provider in the rendering of professional services that becomes the proximate cause of a personal injury or wrongful death.  Negligence can also be the omission of something that causes harm.  An example of professional negligence for a yoga therapist is applying a yoga technique to a condition for which it is contraindicated.

Intentional tort
Intentional tort describes a civil wrong resulting from an intentional act on the part of the person causing harm.  It usually involves assault, battery, defamation, false imprisonment or intentional infliction of emotional distress.  The degree of intent needed to commit an intentional tort means more than just having a desire to harm someone, it means having the knowledge and desire that a particular action will harm someone.

Assault is defined as causing someone to experience immediate fear or apprehension of unwanted harmful or distasteful touch.  Sexual assault or misconduct, a violation of the patient-therapist relationship, is an intentional tort.  All of the yoga professional organization’s codes of ethics (e.g., yoga alliance, IAYT) do not allow sexual activity between the therapist and the client.

Batteryis the physical, harmful or offensive touching of another or another’s property without consent of the other or without a legally justifiable reason.  Any touching of a patient can be battery, if the patient doesn’t consent or if it’s not an emergency.  The action does not have to be based on ill intent and the action doesn’t even have to touch the patient.  For example, if a patient wants to leave treatment early and you grab the patient’s keys, you have committed battery even though your intent may have been concern for the patient’s health.  The main issue is the client’s consent. 

False imprisonment involves the unlawful detention of a person against his/her will. This person is confined within a given area either by physical barriers and/or physical force or threat of force, and this person must be aware that s/he is confined.  In many hospitals and nursing homes, patients are restricted in order to prevent injury to themselves and/or others.  When using a restraint, the professional must document the reasons for the restraint in the patient’s record and obtain written consent from the family, if possible, for the use of any type of restraint.  Restraint such as sheets to hold a patient in a wheelchair, belts or any other form of physical restraint should be used only after all other possible legal applications have been tried and only at the approval by facility policy and the physician.  False imprisonment is sometimes used as a complaint in hospital settings.  When a patient wishes to leave the hospital against medical advice, you may talk to this patient about the consequences and possible complications of such a decision, but a competent person can’t be forced to remain in treatment or in a hospital against his/her will.  If a patient is not competent, a hospital may be justified in restraining him/her against their will.  When it comes to minors, the hospital may attempt to restrain them only with a court order.  Otherwise, all they can do is talk to the minors and their parents or guardians.  Patients have the right to refuse treatment and to leave the hospital when they choose (unless their stay is through legal procedures).  Also, it’s illegal for hospitals to hold patients for reasons of the bill.  Patients may leave even before settling the bill or indicating how it will be paid.

Intentional Infliction of Emotional Distress consists of behavior that is outrageous, obviously flagrant and beyond the bounds of common decency.
Trespass to land is a tort that occurs when someone enters onto another’s land or causes something or someone else to enter such land without the owner’s consent. This happens most often in the home healthcare area.  When you are in someone else’s home as a healthcare provider, you are still a guest and as such, must leave when the patient instructs you to do so. Even if you are concerned for the health of the patient, you must leave at the patient’s request or you are committing the tort of trespass.

Quasi-Intentional tort
Quasi-intentional torts are based on speech and they include: defamation, invasion of privacy and breach of confidentiality.

Defamation involves wrongful damage to someone else’s reputation. Written defamatory statements are called libel.  Spoken defamatory statements are called slander.  To be liable for defamation, it’s not enough to just tell him/her.  Your statements must be published to third parties and you must have known or, in some way, should have known the statements were false.  There also must be proof that actual harm did occur to the reputation of the other, such as public hatred, contempt, ridicule or degradation.  However, some defamatory statements do not need to be shown to have harmed the reputation of the other or plaintiff.  These statements are called defamatory per se and include: serious allegations of sexual misconduct, serious criminal behavior or that the plaintiff has HIV/AIDS or some other loathsome disease.  The best defense to defamation is the truth, even if it damages the other person’s reputation. Truth is truth and it cannot be shown to be defamation.  When bringing a suit, public officials and certain others must prove that the defendant intended malice.  However, qualified privileges protect people from defamation suits.  For example, if a healthcare professional sees evidence of child or elder abuse and reports it, the healthcare professional is protected from liability, according to the standards set by all states concerning such reports.  Qualified privileges are also given to peer review members as long as certain requirements are met.  The individuals must belong to a properly convened peer review committee and the committee must be approved by the facility to conduct peer review.  The comments and all reports developed during the meeting must be kept confidential.  Qualified privileges are intended for the members of the committee only during the meeting.  They are not extended to the individuals when they are outside of the meeting. If they speak freely to the public about committee findings or proceedings, they will be liable for defamation.  A challenging lesson to learn regarding defamation is to never talk about coworkers.  Supervisors of healthcare professionals need to keep all comments about the quality of care given by the individual professionals confidential.  In addition, all inquiries from potential new employers regarding any current professional or former professional should be handled by one designated department set up for such services so that standardization is maintained.

Invasion of Privacy usually involves information that is true but it’s also information that a person wants to keep private. It’s the tort of wrongly intruding upon another’s privacy by:

  • Taking his/her name or likeness
  • Unreasonably interfering with his/her seclusion
  • Publicizing private facts
  • Placing a person in a false light

Taking a likeness may include the use of photographs of the person without that person’s consent, or going beyond the scope of the consent. For example, sometimes a client will allow his/her image to be used only for teaching or treatment purposes.  However, if the image is used for another purpose, or if consent is not given at all, then no image of this person can be used for any reason.

Breach of Confidentiality is a tort related to inappropriate release of confidential information. 
People expect healthcare professionals to keep their information confidential.  In fact, every state mandates patient/client confidentiality, except in very limited situations.  If you publicize private facts or disclose confidential client information, you may be liable for breach of contract, breach of confidence, negligence, intentional infliction of emotional distress and/or defamation.  As a healthcare professional, you are allowed to see information only for the patient you are treating, and you should speak about the patient’s care only with others who are actively involved in that care.  If you give information to anyone, including another healthcare professional who is not actively involved, you open yourself up to a lawsuit.  Today, computers are making it easier to gain access to people’s medical records.  Concern for this was a reason for the enactment by Congress of the Health Insurance Portability and Accountability Act of 1996 (also called HIPAA).  This act called for a federal standard in authorizing the release of medical information and the rules for the establishment of this federal standard were published by the U.S. Department of Health and Human Services in 2000.  Now, by whatever method healthcare professionals receive patient information, it’s their responsibility to keep it confidential, including assessments, conversations, treatments and any information about the client/patient. 

Strict Liability
Strict liabilityis a legal doctrine in tort law that makes a person responsible for the damages caused by their actions regardless of culpability (fault).  Strict liability often applies to those engaged in hazardous or inherently dangerous ventures.  A classic example of strict liability is the owner of a tiger rehabilitation center; no matter how strong the tiger cages are, if an animal escapes and causes damage and injury, the owner is held liable.  The law imputes strict liability to situations that it considers to be inherently dangerous.  It discourages reckless behavior and needless loss, by forcing potential defendants to take every possible precaution. It also has the effect of simplifying litigation and allowing the victim to become whole more quickly.

 

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