Imagine this scenario: before beginning a class, you ask whether any of your students are pregnant or injured so that you can design the class appropriately for their needs. But instead of giving you a simple description of their concerns, several students ask complicated health-related questions.
Three students have questions: the first is healing from whiplash and wonders whether Shoulderstand or Headstand could possibly compromise her chiropractic sessions; the second has asthma and asks about the potential benefits of these postures for his condition; the third has a heart condition and heard from his energy healer that "turning upside down could reverse the energy flow and spin the heart chakra backwards." You deflect these questions by muttering, "well, then, maybe skip the pose." Then, after class, a fourth student asks whether certain Chinese herbs are helpful for menopause and another wonders whether acupuncture can help augment flexibility.
How can you appropriately respond to all of these students, especially given the wide range of questions that they have? How can you maintain a boundary between your area of expertise—yoga teaching—and the health professions?
The boundaries are blurred, and for a reason. First of all, yoga has always been a healing discipline. In fact, historically, yoga was transmitted one-on-one, because this form of teaching allowed the teacher to be attentive to the student's individual needs regarding both spiritual and physical health. In fact, yoga masters prescribed specific yoga poses to treat various ailments. Of course, today yoga teachers are rarely trained in that level of expertise.
And even if they were, U.S. licensing laws restrict who can give certain kinds of health advice. In the late nineteenth century, organized medicine in the U.S. increased standards for medical education and practice, enhancing the profession's quality and stature, but also marginalizing many forms of holistic health care. States passed medical licensing laws, conceptualizing all healing as "medicine" and making the unauthorized practice of medicine a crime. Chiropractors, naturopaths, massage therapists, and other healers were jailed.
Decades later, these professions achieved licensure for their own members. Even so, while physicians have "unlimited" legal authority to diagnose and treat disease, non-medical professionals must operate within a more limited scope of practice that is delineated by statutes and regulations. For example, in the allied health professions, licensure to practice psychology or physical therapy only authorizes diagnostic and therapeutic work related to mental health and physical rehabilitation respectively; similarly, other healers are limited to modalities specific to their professional training. For example, licensing law definitions in many states allow chiropractors only to use spinal manipulation to readjust the flow of "nerve energy" in their patients; acupuncturists to use traditional oriental medicine to adjust the "flow and balance of energy in the body;" and massage therapists to engage in "rubbing, stroking, kneading, or tapping" the muscles to promote relaxation and create well-being.
Yoga teachers can receive professional credentialing, but no state grants yoga teachers licensure based on specified educational and clinical training requirements. Therefore, even well intended health advice could cross the line into the unlicensed practice of medicine, psychology, or even other disciplines.
Of course, some yoga teachers have licenses in other health care professions, which may give them greater latitude, but there are still complexities when one carries dual licensure and is operating in one sphere (e.g., the yoga studio instead of the acupuncture clinic). Given this environment, the following suggestions may help limit legal trouble and also maintain healthy boundaries around one's current, professional role:
1.Acknowledge the limitations of yoga teaching. It's ok—and often advisable—to tell your students that you simply aren't qualified to give advice about their conditions. When asked for advice, remind them that although in the holistic model of health, the body, mind, and spirit may constitute a seamless whole, our licensing laws do assign different tasks to different providers. Being modest about your knowledge and authority is a great way to smooth over any tension this acknowledgement might create. Less is more; it's better to be humble than to "punt." It would be perfectly acceptable, for example, to admit to students that you do not know whether and how inversions could affect their ongoing chiropractic care for whiplash, medical care for asthma, or heart condition.
2.Emphasize the role of licensed health professionals in dispensing health advice. The 200 or 500-hour yoga teacher training required for certification should and typically does include information about potential contraindications, and it is important to review these with students. At the same time, you can remind your students to consult an appropriate health professional. Saying "I am not a medical doctor, so you should consult your physician regarding your heart condition" would be an appropriate response to the third student. Thus, the corollary to suggestion 1 is to refer students to their licensed chiropractor, medical doctor, acupuncturist, or appropriate health care professional for information and advice regarding their specific condition.
3.Beware of nutritional recommendations, especially involving dietary supplements. It may be tempting to recommend dietary supplements, especially when asked. But scientific evidence for many supplements and their ingredients has been mixed at best and many adverse effects have been reported. In many cases, licensing boards have disciplined health care providers who have offered patients nutritional advice, finding this to exceed their legally authorized scope of practice. Caution pays.
4.Appropriately acknowledge students' health concerns. As a yoga teacher, one of your challenges is making judgment calls when it comes to encouraging students to move past their fears. There is a line between facing one's "edge" and acknowledging potential health concerns and limitations (see "Should Yoga Studios Ask Students to Sign a Liability Waiver?"). "If you feel uncomfortable for any reason, don't do the pose" is a safe suggestion. If, after appropriate medical or other professional health advice, it turns out the student can attempt the pose without any health risk, then it is fine to encourage the student to do so.
Yoga Journal's medical editor, Timothy McCall, MD, gives very cogent advice on this matter in "Can You Prove That Yoga Works?": "When we don't know precisely why something works, it's best to admit it, rather than dress it up in the language of science to make it sound more impressive….The irony is that when we try to explain yoga in scientific terms when the science just isn't there, we risk undermining our attempts to persuade others of yoga's benefits."
The legal corollary would be that when, based on our own professional education, training, and licensure, we don't know precisely how to answer someone's request for health advice, it's best to admit it and refer our students to an appropriate health care provider. When we exceed our professional authority, we risk crossing professional boundaries, obfuscating instead of clarifying and jeopardizing our authority and legitimacy in the process. Legal boundaries represent limits, but attending to them can help prevent injury and enhance professionalism, and, in this way, deepen what is sacred between teacher and student.
Michael H. Cohen, JD publishes the Complementary and Alternative Medicine Law Blog (www.camlawblog.com), an informational resource for health care professionals and the health care industry.
The materials in this website/e-newsletter have been prepared by Michael H. Cohen, JD and Yoga Journal for informational purposes only and are not legal opinion or advice. Online readers should not act upon this information without seeking professional legal counsel.