This is a question that comes up frequently. CMMOTA has an Anti-Discrimination Policy and has recently updated its Standards of Practice for Massage Therapists and Spa Therapists. In light of recent conversations and incidents, we want to bring these documents to your attention and clearly outline when it is acceptable to refuse or stop treatment.
There are only eight valid reasons for refusing or discontinuing treatment. These reasons primarily focus on ensuring the safety of both the therapist and the client, as well as respecting the client’s willingness to follow proper treatment protocols and the ability to pay.
1. When the Condition is Outside the Therapist’s Scope of Practice
If a therapist believes that a client’s condition requires treatment beyond their knowledge or training, they should refuse or stop treatment. “Capable scope” refers to the sum of your current knowledge and expertise. If you encounter a client whose condition you feel unqualified to treat—whether due to a lack of progress or because you lack the specialized skills required for effective treatment—it’s your responsibility to stop the treatment. In such cases, document the reason for discontinuing or refusing treatment in the client’s record.
2. When the Client’s Safety is at Risk
If the therapist perceives that the client’s safety may be compromised, treatment should be stopped. This can include situations where the client has a condition that is a total contraindication (e.g., acute pneumonia, unstable hypertension, significant fever, or any contagious/infectious condition). If the client is under the influence of drugs or alcohol, their ability to provide consent may also be in question, which could pose a risk. The safety of the client always takes precedence—if this is the case, document the reason for stopping or refusing treatment.
3. When the Therapist’s Safety is at Risk
The safety of the therapist is also paramount. If a therapist feels that providing treatment could put their personal safety in jeopardy, they have the right to stop or refuse service. Canadian labor laws ensure that workers, including massage therapists, are not required to work in unsafe conditions. If you believe your safety is compromised, it’s crucial to document this in the client’s record.
4. When Sexual Harassment is Perceived
If a therapist perceives or experiences sexual harassment before or during a treatment session, this is a valid reason to refuse treatment. As mentioned in the CMMOTA article entitled What NOT to do When You Have Been Sexually Harassed, past sexual harassment, or sexual harassment which occurs during a treatment is an acceptable reason to refuse treatment because it can be perceived as a threat to your safety. Sexual harassment is a serious issue, and as a therapist, you are entitled to refuse treatment if you feel unsafe. It is important to address harassment immediately and to not silently endure it.
5. When the Client Refuses Draping
Draping is a non-negotiable requirement for providing safe and professional massage treatments. Draping is not optional – it is a must when providing treatments to clients who are not fully clothed. Where clients are clothed, then draping can be modified, however the principles of draping still apply – that only the area of the body being worked on should be undraped or uncovered. If a client refuses to follow draping procedures, it compromises the therapist’s ability to perform the treatment according to professional standards. If a client is unwilling to comply with draping guidelines, treatment should be refused.
6. When the Client Cannot Pay for the Treatment
While it is rare, if a client cannot pay for the treatment, the therapist has the right to refuse services. This could apply before or after treatment has begun. If payment is an issue, it should be clearly communicated and documented.
7. When the Client’s Ability to Provide Informed Consent is Compromised
No circumstance exists where treatment should ever move forward where a client or their substitutionary decision maker are not able to provide consent. In every such instance, refusal or postponement of treatment must take place. Where informed consent is compromised, this must be clearly communicated to the client, and should be documented within the treatment record.
8. When the Client’s is Under the Influence of Alcohol or Drugs
This can be both a safety issue as well as an issue surrounding consent. Where it is suspected that a client is under the influence of alcohol or drugs, the refusal or postponement of treatment is acceptable. Should such an instance occur, it should be clearly communicated and documented within the treatment record.
Important Note: Human Rights and Discrimination
The eight reasons listed above are the only acceptable grounds for refusing treatment. Over the years, there have been instances where therapists have refused treatment for other reasons, some of which could be considered discriminatory. Refusing treatment based on factors such as race, gender, disability, sexual orientation, or other protected characteristics can be a violation of human rights laws. Such actions may result in legal consequences, including civil lawsuits.
As service providers, massage therapists and manual osteopathic therapists have a Duty to Accommodate clients, within reasonable limits. This means you must make reasonable efforts to provide treatment, even in cases of disability or other protected characteristics, unless doing so would cause “undue hardship” for you as the service provider. To learn more about the Duty to Accommodate and Undue Hardship, visit this link.
It’s critical to avoid any form of discrimination in your practice, as doing so could expose you to legal repercussions. If you’re unsure about the application of human rights in your province or territory, we encourage you to review the resources available at CMMOTA Human Rights Resources.