In the autumn of 2021, we witnessed a sudden and widespread assault on individual Canadians’ medical privacy, informed consent, and bodily autonomy. Prior to this these were bedrocks of Canada’s healthcare ethics, as they should be in any enlightened healthcare practice. They are values that I, as a Registered Massage Therapist, uphold every day. I was shocked as I watched medical ethics erode before my eyes, first with vaccine passports and then with mandated vaccines for publicly employed healthcare workers. And perhaps most disappointingly of all was the complete lack of reaction from many of my colleagues. Even many educators who had taught me the tenets of medical ethics were mute when these very same ethics were violated.
Not only did our government’s actions violate the ethics we were plainly taught during our training, but that very same government had announced only months before that never would inequity be increased via vaccine passports or mandates. As was repeated by our prime minister and public health officials alike, inequity in society had already been exacerbated “due to COVID”.
Each and every practitioner who works in a regulated field in healthcare will have gone through similar, clear training regarding professionalism and ethical practice. When I reflect upon the education that I received in my journey to become an RMT, the clarity with which the information was presented stands in stark contrast to our government’s actions.
Medical Privacy
“She’s 55 and was diagnosed with IT band friction syndrome two months ago. The pain is way worse when she walks for 20 minutes or more, and sitting to standing is super painful”, said one classmate. Another responded, “Oh, did you try Noble’s test on her?” This was around October of 2018 while I was in massage therapy college, and I was witnessing two of my classmates, currently in the classroom during a break, audibly discussing a patient that they both were actively treating in the student clinic. A teacher also overheard and quickly jumped in to put a prompt end to the discussion. Despite the name of the patient not being mentioned, we were told that we MUST err on the side of caution. Perhaps some identifying characteristics would be disclosed and an unintended third party would become privy to information that a patient disclosed to practitioners in confidence.
In our Professional Development classes, which spanned through all five terms of our education, we were explained the importance of medical ethics including patient privacy. We were told that we must keep each of our patient’s personal and health data confidential. Confidentiality, it was explained, is a commitment to keep private patient information from being shared with unauthorized individuals. Authorized individuals are ONLY those people that the patient has given express permission to receive the information. In massage therapy, we were taught, maintaining client confidentiality is a foundation of professional practice.
In the Autumn of 2021 our government enabled the widespread disclosure of citizens’ private medical information via mandated injections for healthcare workers in public settings and via vaccine passports. Any healthcare worker actively working in a hospital setting was clearly vaccinated. Any Canadian in a restaurant or cinema was vaccinated. And those left over clearly weren’t. This was not only a violation of medical privacy, but also promoted division and discord among segregated groups in the Canadian population.
Informed Consent
Not only must consent for treatment be obtained, we were taught, but we must always fully explain the treatment, including the techniques that we will use, areas of the body that will be addressed and draped, as well as the likely benefits and possible adverse reactions to the treatment. Once the client fully understands how we are going to proceed, and the likely benefits and possible risks are fully disclosed, then our patient has given informed consent.
There was good reason for our instructors making such a painstaking effort to convey the importance of informed consent. In Canada, obtaining informed consent is enshrined into law. In the 1980 Supreme Court decision of Hopp & Lepp, it is made clear that despite “prior consent by a patient to a proposed surgery or therapy, this does not immunize a surgeon or physician from liability for battery or for negligence if he has failed in a duty to disclose risks of the surgery or treatment, known or which should be known to him, and which are unknown to the patient. The underlying principle is the right of the patient to decide what, if anything, should be done with his body” (1).
The concept of consent is defined further in the 1999 Supreme Court decision of R. v. Ewanchuk. “To be legally effective consent must be freely given… no consent is obtained where the complainant submits or does not resist by reason of: a) The application of force to the complainant; b) Threats or fear of the application of force to the complainant or to a person other than the complainant; c) Fraud; d) The exercise of authority” (2).
Yet despite my instructors’ painstaking efforts and the very law of the land we call home, in the Autumn of 2021, this pillar of ethical healthcare practice was discarded. Not only did many Canadians acquiesce instead of consent under the force of coercion, but most Canadians who acquiesced had no knowledge of potential adverse outcomes.
Bodily Autonomy
Every person’s physical body, we were taught, is inviolate. Human beings must be permitted self-ownership and self-determination over their own bodies. Violation of the integrity of another person’s body is unethical, intrusive, and possibly criminal. Each patient must be given the space to make informed, uncoerced decisions.
I hold this principle in utmost regard in my practice. Every treatment I give starts with me reminding patients that, “If anything I’m doing feels uncomfortable or painful, if you want me to change or stop what I am doing, please let me know. You are the ultimate boss when it comes to your body!” I encourage a collaborative approach; one that empowers patients to appreciate the wisdom of their own bodies. Indeed, they have been in possession of their bodies their whole lives, whereas I’ve only known them for a brief time.
Despite the phenomenal education healthcare workers receive regarding this pillar of ethical healthcare and despite my faithful implementation of it in my practice, Canadians’ bodily autonomy was ripped from them in the Autumn of 2021 when under duress many Canadians submitted to a medical procedure that they did not need or want.
Looking back at my education and my practice, the importance of medical privacy, informed consent, and bodily autonomy (the three pillars of ethical healthcare practice) stand out as of great importance and the zealous widespread violation of them by our government remains as indefensible as ever. Over a year has passed since the vaccine passport and mandates for public healthcare workers were implemented; however, my disbelief at them has not waned. While the vaccine passports have now been dropped, here in British Columbia, our public health officials still refuse to hire back our unvaccinated healthcare workers, despite a crumbling healthcare system in desperate need of every last trained professional.
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A Concerned Registered Massage Therapist
- https://scc-csc.lexum.com/scc-csc/scc-csc/en/item/2553/index.do
- https://scc-csc.lexum.com/scc-csc/scc-csc/en/item/1684/index.do
