Across the same city, the owner of a rival successful studio instructed his teachers as follows: “Adjustments should be correct, precise, standard. Teach every student the correct pose.” He demonstrated. “Tailbone tucked in, shoulders back, like so.” He added, “Now you do exactly like me.”
In a third studio somewhere between the two, a student began crying during shivasana.
“Process emotions through the breath,” the teacher responded, and the student immediately stifled her tears. In a fourth studio nearby, the teacher encouraged another student’s crying. “These are all of our griefs,” he said. In response, many pent-up voices wailed at once.
Which of these practices are ethically and legally risky? And which could be justified as essential components of yoga teaching? Would it make a difference if, in any of these studios, one of the students claimed an injury (physical or emotional) from the recommended advice?
If your answer to each of these questions is “it depends,” you are well into the gray zone of ethics. Like questions of liability, most ethical issues require analysis, call for a delicate balancing of values, and cannot easily be answered with certainty. While at times academic, ethics discussions are meant to be applied in practical situations, and the values that guide the discussion are quite established, at least in the care-giving professions.
For example, clinical providers in health care are guided typically by two primary ethical duties. The first is nonmaleficence, the classic obligation to “do no harm.” The second is known as beneficence, the obligation to act in a way that is beneficial to the patient or client.
Ethically speaking, in applying these values to the first and second anecdotal examples above, the key question is whether teachers who give a standard adjustment will fail to provide any benefit and even, possibly, injure students. In general, touch in yoga teaching is completely necessary yet also fraught with risk; depending on the context, motivation, and extent of permission or implied consent, touch can wound or heal (see The Ethics and Liabilities of Touch). Despite the desire for a “standardized” correction, respecting students’ limitations while giving adjustments can be seen as one form of nonmaleficence.
Similarly, in the third and fourth anecdotal examples above, the answer to the ethical question depends on whether encouraging cathartic release will do no harm and provide the student benefit. Again, this can vary according to the situation; intuiting the right response may depend a lot on experience, sensitivity, and rapid assessment of the needs of both the individual and the group.
Sometimes it is better to err on the side of restraintfor example, when the student’s expression of emotions becomes so overwhelming that it may threaten other students or make them feel unsafe. Respecting emotional boundaries can be seen as a form of nonmaleficence (see Legal Implications of Health Advice for Yoga Teachers, Parts 1 and 2)
On other occasions, it may be appropriate to encourage a limited cathartic release while providing an intimate space of emotional and physical safety. A student may unlock the body and mind by allowing currents of emotional energy, which the yoga pose has now released, to stir emotions that had previously been suppressed. The teacher must decide how to respond by using a combination of rational understanding, intuitive discernment, and spot-decision making that is sensitive to the student’s needs and perceptions, the environment, and the whole situation.
The key ethical principles include not only the yoga instructor’s duties of nonmaleficence and beneficence, but also the obligation to respect the yoga student’s autonomy. In clinical care, this can translate into the right to make autonomous choices regarding one’s own body and health. Informed consent, the obligation to disclose viable treatment options, is meant to help safeguard this right. In yoga teaching, this could translate into the obligation to give students the option to decline a standardized adjustment. A studio owner may consider a standardized adjustment to be nonmaleficent and beneficent, but such a process may violate the student’s right (and ability) to feel centered in his or her own body.
Placing yoga teaching within the broader context of health care generally, the clash of these three ethical values of nonmaleficence, beneficence, and autonomy occurs frequently. In medicine, the physician may recommend a certain course of treatment as the most beneficent and nonmaleficent (e.g., surgery), while the patient may want to make an autonomous choice to try a complementary therapy (e.g., yoga, meditation, visualization, or nutrition).
A recent Institute of Medicine (IOM) report, Complementary and Alternative Medicine in the United States (see How Integrative Medicine May Affect Yoga Teaching and Business) addressed this ethical complexity in care giving. To complicate matters, the report considered two additional ethical values: pluralism, the value of honoring different healing traditions beyond the biomedical; and accountability, the value of making care sensitive to the needs of the public and all its constituent groups. In yoga teaching, these twin values can translate into: (1) recognition of the role of conventional medical care where it is needed; and (2) maintenance of high professional standards with sensitivity to the many facets of the yoga student’s quest for wholeness and healing.
Complementary care modalities, including chiropractic and acupuncture, share these values. For example, if a patient’s condition exceeds the chiropractor’s skill and training, then the chiropractor has an ethical (and legal) duty to refer the patient to a medical provider for appropriate medical diagnosis and treatment. Sometimes patients and providers committed to holistic care dismiss conventional carejust as their medical counterparts may dismiss therapies such as acupuncture, chiropractic, massage therapy, and yoga as “all placebo.” But the values of pluralism and accountability demand respect across disciplines and methods.
The IOM report offers a starting point for applying ethical standards across the board, whether the modality is deemed conventional or complementary; whether the intervention focuses on the body, the mind, or the spirit; whether the diagnosis and treatment are within the medical domain or outside and possibly beyond it; and whether one is offering physical therapy, acupuncture, or yoga instruction and therapy. Respect for healing and acknowledgement of the client’s decision-making capacity are at the core of the IOM principles.
In this sense, the IOM report embodies traditional yogic ethical principles such as ahimsa, typically translated as “nonharming,” but also reflective legally of nonmaleficence. Although the IOM report is relatively new and the values it articulates have yet to filter more fully through the professional health-care provider communities, an early grasp of the report’s central description of ethical issues can help yoga studios and teachers in the ongoing translation of yoga and the other therapeutic disciplines into the broader health care world. Ethics remains a puzzle, yet one that is shared across clinical care disciplines and increasingly applicable to yoga teaching and the business of yoga.
Michael H. Cohen, J.D., M.B.A., is a principal in the Law Offices of Michael H. Cohen and publishes the Complementary and Alternative Medicine Law Blog (www.camlawblog.com).
The materials in this website/e-newsletter have been prepared by Michael H. Cohen, J.D., M.B.A., and Yoga Journal for informational purposes only and are not legal (or ethical) opinion or advice. Online readers should not act upon this information without seeking professional legal counsel.