Ethics in Oncology Massage and Hospice Care

My client complained about her doctor, the nurses, and the general care she was receiving during cancer treatment. She went on for some time.

Now and then, she took a breath, then looked at me as though to ask “Do you agree?”

I held her gaze.

It seemed like a challenge to choose sides.

Agree, that she was getting poor care? Disagree? Question her account of her treatment?

I breathed. I wavered. I considered the options.

In the end, I chose reflective listening: “It sounds really hard, what you’re going through.” And a few more questions: “What happened next? Who have you talked to about this? What kind of support are you getting, or do you need?”

I drew her out a bit, and eased the conversation over to the plan for her massage session. Next session I did the same, while encouraging her to vocalize her concerns to her care team.

What would you have said?

This exchange could happen anywhere, with any client, but it is somewhat unique to a massage practice focused on cancer care, hospice care, or people with medically complex conditions.

Why?

In massage therapy, the relationship dynamics are delicate. Clients are typically unclothed and hurting in some way, and are hoping for some sort of help.

Our clients are uniquely vulnerable.

A health crisis compounds that vulnerability. The uncertainty of diagnosis, the transition at end of life, the challenges of treatment–these heighten a client’s needs and sensitivities. Massage therapists navigate trickier waters.

In such situations, my words have as much weight as my touch.

There are countless examples specific to this kind of work: How to manage family dynamics and funerals. How to turn down requests for more pressure when the tissues are frail. How to answer hard questions when the stakes are high.

How to manage professional relationships with physicians, nurses, and PTs I might never meet, but who are lifelines for my client.

In the example above, I knew my client needed moral support, but that I needed to not undermine her care team. Whether or not I agreed with her, I knew the most professional response was to stay supportive, encouraging, and neutral. To let her vent a bit, without joining her on the bandwagon. To support her finding her own, best solution.

These circumstances call on our ethics.

Then I thought of Dianne Polseno

A dear colleague of mine, the late Dianne Polseno, wrote a regular column, “Ethically Speaking” for the Massage Therapy Journal. It was one of a great body of work and service that she left behind.

Over our long, collegial history, I found myself agreeing with Dianne about 50% to 75% of the time. The disagreements did nothing to diminish my admiration for her. Instead, they spawned a rich dialogue.

Recently I dug up an old column of hers and found a great statement.

“Ethics is a verb.”

She explained that it makes itself known through behavior more than belief or commitment.

I loved that, of course. Her writing was always clean and to the point.

Yet reading this, five years after Dianne’s death, I found myself once again agreeing with some parts, but not with everything.

For me, ethics is also profoundly inner process

Yes, it’s a measure of behavior, but the struggles are set in my internal landscape. Reflection and searching are in order. Ethics comes from my relationship with me.

Why? Because tricky situations make me uncomfortable. Uncertainty makes me rush to solutions. Strong feeling gives me…strong feelings.

It’s super easy, when I’m uncomfortable,  to act on impulse.

My impulse was to join in my client’s righteous anger.

This needs to stop, to change! She needs to tell them X or Y! Someone should write a letter! Maybe I should write a letter!

Yet I knew that in that particular relationship, my outrage would not serve my client. I needed to control that particular impulse.

Instead, I sensed that the best stance was supportive, but neutral. I knew that doctor-bashing, an all-too-popular sport in my field, would serve no one.

In the pause between stimulus and response, ethics entered in.

Ethics needs a clear invitation, and a little time.

In the moment, I needed to breathe. I needed to notice my body. To acknowledge my strong feelings, and let them know I would get back to them later, but I hit the pause on my righteousness.

Instead, in breathing, I found my compassion for my struggling client, for all of us who struggle to be heard, seen, and understood.

When I finally spoke, I spoke from that compassion.

Charged circumstances, high-stakes conversations, pain and suffering. All can give rise to tender ethical dilemmas for massage therapists.

For decades, I’ve heard and tended these dilemmas in my oncology massage classrooms.

So I made a new course.

Two courses, actually.

A new one, “Ethics in Oncology Massage and Hospice Care.” Launching in September in Boston, it’s 4 CE hours.

Paired with a 3 CE hour course, “Cancer and Massage Therapy: What Does the Research Say?”

I want to address the ongoing needs of massage therapists in cancer care and hospice. I want to support them in the challenges that come up.

Aside from the spectacular convenience of knocking out two common CE requirements in one day, why these two in tandem?

Because of overlap.

The common theme is truth.

Ethical dilemmas present competing truths, and call us to deal with the hard truths. Some truths are liberating, such as the one, “I don’t have to solve this client’s problem, I only have to give them the best massage I can” dangling at the end of the process.

Research is about the search for truth.

There are competing truths about the effects of massage, and competing research results. Some of the massage truths we’ve relied on (Endorphin bursts! Toxin releases!), aren’t really true when lifted up to scrutiny. Yet there are others, underappreciated, that have been waiting in the wings: The potential for massage to help with the worst of anxiety and depression, or ease a distressing symptom or side effect.

In our search for truth, we raise more questions.

What do I do? How do I respond? How does massage help my client with cancer? How do we know? How do I market the effects of massage when we’re not quite sure?

What do I say to my client who complains?

And feelings.

What happens when I feel helpless?

How do I manage my own strong feelings? What if I listen to my pain and it actually speaks? What if it drags me down?

How do I cope, seeing and touching the hardest of human experience, day in and day out?

Do I have a right to complain? Compared to my clients’ struggles, mine are trivial.

And so on, yada.

What about you?

I’m curious about the kinds of challenges MTs face on the front lines of illness. I’m curious how you are handling yours.

I can’t respond to comments here for a couple of weeks, it being August and heading off the grid and all, but I’m grateful for anything you contribute, and I look forward to reading it when I return.

Free resources

Check out the Massage Therapy Foundation for my free eBook, “5 Myths and Truths about Massage Therapy.”

Read everything on massage and ethics in our highly acclaimed texts.

Check out archives of Dianne Polseno’s column in Massage Therapy Journal. Classic, conversational, and on point.

Or come talk to us.

Right? We never talk anymore.

Check out our two new live, face-to-face courses on research and ethics.