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  • When Healthcare Isn’t Healthy

    *Warning: You may find this post a bit political and wonder how on earth it pertains to massage. Bear with me and you’ll understand.

    No Healthcare discriminationThe future of healthcare is in jeopardy and I don’t say that lightly.

    As I write this (in mid-January) the Affordable Care Act is supposed to prohibit healthcare providers from discriminating based on sex, gender, or previous termination of pregnancy. But… On December 31st, a federal judge ruled that doctors and other healthcare providers could refuse to treat patients who were transgender or who’d had an abortion, based on their own religious beliefs.

    This sets a dangerous and unethical precedent for all healthcare providers. Let me explain.

    “In any moment of decision, the best thing you can do is the right thing. The worst thing you can do is nothing.”

    ~ Theodore Roosevelt

    Do No Harm

    Many people think that the Hippocratic Oath states, “Do no harm.” Sadly, it doesn’t. Neither the original translation nor the modern version uses that term. It’s also untrue that all doctors swear the Hippocratic Oath. They all swear an oath, but it might be the Hippocratic oath, the Osteopathic Oath, the Oath of Maimonides, or the Declaration of Geneva, or one they wrote themselves. In addition, if they’re a member of the American Medical Association, they agree to abide by the Association’s code of ethics (which is available in book form, it’s that long), regardless of which oath they swore.

    Here’s, in part, what those oaths and codes say:

    Hippocratic Oath – I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick

    Hippocratic Oath – I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm

    Osteopathic Oath – I will be mindful always of my great responsibility to preserve the health and the life of my patients

    The Oath of MaimonidesMay I never see in the patient anything but a fellow creature in pain

    The Declaration of Geneva I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient

    The Declaration of GenevaI will not use my medical knowledge to violate human rights and civil liberties, even under threat

    American Medical AssociationSection 1.1.2 Prospective Patients
    As professionals dedicated to protecting the well-being of patients, physicians have an ethical obligation to provide care in cases of medical emergency. Physicians must also uphold ethical responsibilities not to discriminate against a prospective patient on the basis of race, gender, sexual orientation or gender identity, or other personal or social characteristics that are not clinically relevant to the individual’s care. Nor may physicians decline a patient based solely on the individual’s infectious disease status. Physicians should not decline patients for whom they have accepted a contractual obligation to provide care.

    It seems clear to me, from these oaths and the code of ethics, that doctors are ethically bound to not discriminate against sick people, regardless of whatever other deeply held beliefs they may have; in addition to the deeply held belief that they want to prevent disease and restore health in their fellow human beings, that is.

    “Whatever is my right as a man is also the right of another; and it becomes my duty to guarantee as well as to possess.”

    ~ Thomas Paine, Rights of Man

    The Dangerous Precedent

    If the courts now rule that doctors, who are held to the highest standards of all healthcare professionals, can discriminate based on their religious beliefs, that means that so can the rest of us. This includes massage therapists, because in many states, including Michigan where I live and work, we are licensed as healthcare providers.

    It also means that, with the new precedent set by this federal judge, it might not be long before any healthcare provider will be able to discriminate based on ANY religious belief, not just those pertaining to abortion and gender identity. Pharmacists already have the right to not fill your birth control prescription if it violates there religious beliefs, and employers can deny you access to certain forms of birth control if it goes against the corporation’s religious beliefs.

    So, if a provider’s religion prohibits blood transfusions, they could soon be able to refuse to treat anyone who’s had a transfusion. If a healthcare provider’s religion prohibits the ingestion of pork, they could soon be able to refuse to treat anyone who eats pork. Who else might be turned away on religious grounds? What about someone who cheats on their spouse, beats their spouse, or is a convicted rapist or murderer? What about someone who’s just thought about doing one of those things? After all, some religions teach that it’s just as bad to think of committing a sin as it is to actually commit it; I know my church taught me that when I was growing up. Where do we draw the line?

    Most healthcare providers go into their professions to help people. But how can you help someone if you refuse to treat them? How is it ethical to turn someone away from the ER who’s at risk of bleeding to death because their gender identity isn’t what you think it should be? How is it ethical to leave someone in pain because they chose a treatment that their religion doesn’t prohibit but yours does?

    Every religion has its own version of the golden rule of “Do unto others as you would have them do unto you.” Christianity in particular mandates that whatever we do to the least of our brothers, we do to God. It also commands us not to judge, lest we be judged in a similar way. So how is it ethical to refuse to treat someone? How do providers not violate their own religion when they refuse to treat others as they would want to be treated?

    “Ethics is knowing the difference between what you have a right to do and what is right to do.”

    ~ Potter Stewart

    The Massage Profession

    That brings me to massage.

    There are two main professional associations for massage therapists, Associated Bodywork and Massage Professionals (ABMP) and the American Massage Therapy Association (AMTA). There’s also the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) which is responsible for Board Certification of those massage therapists who have the required education, experience, and desire to attain this advanced certification. Each of these entities has a code of ethics that each member must pledge to adhere to.

    Here’s what they say about discrimination:

    ABMP  – Section 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.

    AMTA – Section 2 

    Acknowledge the inherent worth and individuality of each person by not discriminating or behaving in any prejudicial manner with clients and/or colleagues.

    NCBTMB – Section VII and VIII

    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.

    None of this means that no one can ever turn a client or patient away.

    It is unethical to treat someone using a method or treatment you are not fully trained in or that could possibly harm the client. This is one of the reasons we ask for health information. The deep work you want on your legs may help your tight quads, but if you have varicose veins, are on blood thinners, have a bleeding disorder, or have a condition that predisposes you to lymphedema, it will harm you. Ethical therapists will refuse to treat you in a way that will harm you. They will give you alternatives and let you choose the alternate treatment that you prefer. If they are not adequately trained in the the alternative you choose, they will refer you to someone who is.

    But that begs the question: Is it unethical to refuse to treat someone that you have the training, means, and ability to help? Answer: Yes. Usually. Clients may ethically be refused service for their own unethical behavior such as requesting sexual services, making sexual references, engaging in stalkerish behavior (yes, it does happen), or the constant pushing of boundaries. They may also be refused service for disrespectful behavior that affects the business’ bottom line, like repeated no-shows or late cancellations.

    “Ethics are more important than laws.”

    ~ Wynton Marsalis

    My Promise to You

    I will never turn you away because of:

    • Your sexual orientation
    • Your gender identity
    • Your current or past medical treatments (but I may need to modify treatment)
    • Your current or past medication use (but I may need to modify treatment)
    • Your HIV status (but I may need to modify treatment)
    • Your religious beliefs (or lack thereof)
    • Your political beliefs/affiliations (or lack thereof)
    • Your socioeconomic status
    • Your ethnic background
    • Your country of origin
    • Your marital status
    • Your level of physical ability
    • Your level of developmental or cognitive ability (but I may require special consent or accompaniment)
    • The color of your skin
    • The size of your body
    • The clothes you choose to wear
    • The color or colors of your hair
    • The length of your hair (or lack there of)
    • The style of your hair (or lack thereof)
    • The amount of body hair you have (or don’t have)
    • Your treatment for a mental health issue (unless you endanger my well-being)
    • Your hobbies
    • The amount of alcohol you consume or don’t consume (but it would be unsafe for me to work on you if you’re currently inebriated)
    • Any headcovering you wear
    • The jewelry you wear
    • Your body art, tattoos, or piercings

    I’m sure I’ve left some things off this list. If so, don’t worry. I won’t turn you away just because I forgot to put it on the list.

    Now it’s your turn:

    If you’re a healthcare provider of any kind, I urge you to either share this post or create your own public notice of your intent to not discriminate against patients or clients.

    If you’ve been discriminated against in a healthcare setting and you’re willing to share your story please do so in the comments below. If you’d like to tell me how I/we can do better and go beyond the obvious steps, I’d love to hear that too.

     “A person may cause evil to others not only by his actions but by his inaction, and in either case he is justly accountable to them for the injury.”

    ~ John Stuart Mill, On Liberty