When Can You Refuse Treatment? This is a question that has been asked many times over the years. Recently CMMOTA drafted a new Anti-Discrimination Policy and updated our Standards of Practice documents for Massage Therapists. Given some recent conversations and incidents which have occurred we wanted to draw your attention to these documents and make it very clear when you can refuse to treat a client.
There are only six acceptable reasons to stop or refuse to provide treatment. They center around the safety of persons, the willingness of the client to be draped, and the ability of the client to pay.
The first acceptable reason to refuse to provide treatment or to stop treatment is if “the therapist believes that the condition of the client requires treatment that is beyond the therapist’s capable scope.” Capable scope means the sum of all of your knowledge and training up to that point in time. Many therapists have come to this conclusion at one point or another when providing treatments to a client. Whether there is simply no improvement from treatment to treatment, or if the client has a condition that you simply don’t feel you have the training to provide adequate treatment for – if you believe that you are in this situation it is your duty to stop or refuse treatment. If as a therapist you arrive at this conclusion, either before providing treatment, or having to stop mid treatment, it is important to provide a written note within the client record detailing the reason that massage or manual osteopathic treatment was not provided, or why it was stopped.
The second acceptable reason to stop treatment or to refuse to provide treatment is if “the safety of the client … is perceived to be compromised. This may mean that you as a therapist perceive that a client has a condition that would be a total contraindication (such as acute pneumonia, unstable hypertension, significant fever [38.5C, 101.5F], or any systematic, contagious, or infectious condition), is under the influence of legal drugs, illegal drugs, or alcohol which either makes their ability to provide consent in question, or where providing massage treatment or manual osteopathic treatment could put the client at some risk of harm. Bottom line – if as the therapist you perceive that the safety of the client would be compromised by providing treatment, this is an acceptable reason. If as a therapist you arrive at this conclusion, either before providing treatment, or having to stop mid treatment, it is important to provide a written note within the client record detailing the reason that massage or manual osteopathic treatment was not provided, or why it was stopped.
The third acceptable reason to stop treatment or to refuse to provide treatment is if “the safety of the therapist … is perceived to be compromised”. The ability of a person to work safely is enshrined in Canadian Labour Law and has many different recognized facets within that law. This of course extends to any situation where you perceive that your safety is compromised. Bottom line – if you feel that providing treatment to a client will put you in a situation where you perceive that your safety is compromised, you have the right to stop or refuse treatment. If as a therapist you arrive at this conclusion, either before providing treatment, or having to stop mid treatment, it is important to provide a written note within the client record detailing the reason that massage or manual osteopathic treatment was not provided, or why it was stopped.
The fourth acceptable reason to stop treatment or refuse to provide treatment is “where “sexual harassment has been perceived to occur before or during a treatment session.” 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 would be an acceptable reason to refuse treatment because it can be perceived as a threat to your safety. Sexual harassment is something to be stopped, not something to quietly endure.
The fifth acceptable reason to stop or refuse treatment is when a client refuses to follow draping procedures. A client’s refusal to be properly draped puts the therapist in a compromised position, as they would be breaking a very important standard of practice. 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.
The sixth and final acceptable reason to stop or refuse treatment is the inability for the client to pay for the treatment. This is rarely used to stop a treatment mid session, but the inability to pay is a legitimate reason for refusal of services.
These are the ONLY six acceptable reasons to stop or refuse treatment.
Over the years we have heard of therapists refusing treatment for other reasons. We want to raise a very large flag of caution here, because in some cases those “other” reasons would be considered a violation of an individual’s human rights. As a service provider, refusing to provide the service of treatment to someone on the basis of recognized human rights is considered to be discrimination and would be punishable under federal/provincial/territorial legislation across Canada. Violating those rights may also land you in civil court with a claim for damages filed against you. As massage therapists or manual osteopathic therapists you are considered to be service providers and have the Duty to Accommodate a client to the point of Undue Hardship. What this generally means is that the rights of the client supersede your right as the service provider. For more in depth understanding of what this means in your provincial or territorial jurisdiction we would encourage you to visit this link.