Professional standards, training and membership.
Professional standards, training and membership.
Ethics in IEMT Practice: Lesson 2.6
Equality, Inclusion and Reasonable Adjustments
Welcome
Everyone who comes to you deserves the same care, courtesy and professional standard. This lesson looks at what the Equality Act 2010 requires of you, what inclusive practice looks like day to day, how to make reasonable adjustments, and how to decline or refer a client without discriminating.
All human beings are born free and equal in dignity and rights.
United Nations, Universal Declaration of Human Rights (1948), Article 1
Learning Objectives
By the end of this lesson, you will be able to:
- Name the nine protected characteristics and the main kinds of discrimination.
- Explain what a reasonable adjustment is, and how to decide what is reasonable.
- Apply the Association’s Standards of Competence on communication, inclusion and accessibility.
- Work respectfully with language, culture, belief, gender identity and neurodivergence, without stereotyping.
- Explain why conversion practices are prohibited, and how to respond if a client asks for one.
Why inclusion is an ethical duty
In Lesson 1.2 you met the principle of justice: fairness in how people are treated and in who is able to benefit from care. Equality law turns part of that principle into a legal duty. Professional ethics goes further than the law. It asks you to notice who may be shut out of your practice without anyone meaning to shut them out, and to do something about it.
I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient.
World Medical Association, Declaration of Geneva (2017 version)
The law in plain English
The Equality Act 2010 applies to anyone who provides a service to the public or to a section of the public, whether they charge for it or not (section 29). A self-employed IEMT practitioner is covered. In short, you must not treat a client worse because of a protected characteristic, and you must make reasonable adjustments for disabled clients.
| Protected characteristic | What it covers | What it can mean in practice |
|---|---|---|
| Age | Being of a particular age or age group. In services, the protection applies to people aged 18 or over; the rules on children and consent are in Module 3. | Do not assume an older client cannot follow the process, or that a younger adult cannot make a considered decision. |
| Disability | A physical or mental impairment with a substantial and long-term effect on normal day-to-day activities. Cancer, HIV and multiple sclerosis are covered from diagnosis. | Step-free access, longer appointments, written instructions, breaks, assistance dogs welcomed. |
| Gender reassignment | Anyone proposing to undergo, undergoing or having undergone a personal process of changing their gender. No medical treatment is needed. | Use the name and pronouns the client gives you, and keep what you record accurate, relevant and confidential. |
| Marriage and civil partnership | Being married or in a civil partnership. This is protected in employment but not in the provision of services. | Treat all clients fairly whatever their relationship status. |
| Pregnancy and maternity | Pregnancy, and the period after birth, including breastfeeding. | Consider comfort and breaks. Do not refuse a pregnant client without a clinical reason you can explain and record (see the Pre-Session Assessment Guidelines and your insurer’s conditions). |
| Race | Colour, nationality, and ethnic or national origins. | Do not make assumptions. Language is not itself a protected characteristic, but a rule that disadvantages people who speak little English may be indirect race discrimination. |
| Religion or belief | Any religion or belief, including a lack of one, and philosophical beliefs. | Respect prayer times, dress, fasting and preferences about who treats them, as far as is reasonable. |
| Sex | Being a woman or a man. | The same standard of care and the same safe boundaries for everyone. |
| Sexual orientation | Being heterosexual, gay, lesbian or bisexual. | Never try to change or suppress a client’s orientation (see conversion practices below). |
The main kinds of discrimination
- Direct discrimination: treating someone less favourably because of a protected characteristic.
- Indirect discrimination: a rule or practice that applies to everyone but puts people who share a characteristic at a disadvantage, unless you can justify it. A policy of taking bookings only by telephone is an example.
- Discrimination arising from disability: unfavourable treatment because of something connected to a person’s disability, such as ending a session because of involuntary movements, unless you can justify it.
- Failure to make reasonable adjustments: a duty owed to disabled people (explained below).
- Harassment: unwanted conduct related to a protected characteristic that violates someone’s dignity or creates an intimidating, hostile, degrading, humiliating or offensive environment.
- Victimisation: treating someone badly because they have complained about discrimination or supported someone who has.
Standards of Competence, section 6 (Communication, inclusion and accessibility), asks members to consider disability, neurodivergence, culture, religion, language, literacy, age, gender, sexuality and social context without stereotyping. It also asks you to use a competent interpreter where needed and to address confidentiality and consent before the session.
Make reasonable adjustments within competence and explain when an adjustment would materially change or prevent the proposed procedure.
The Association for IEMT Practitioners, Standards of Competence, section 6
Challenge discrimination and avoid conversion, coercive or humiliating practices.
The Association for IEMT Practitioners, Standards of Competence, section 6
Reasonable adjustments
If a client is disabled within the meaning of the Act, you have a duty to make reasonable adjustments so that they can use your service as far as possible as a non-disabled person would. The duty is anticipatory. You are expected to think ahead about the barriers that disabled people could meet, not wait until someone is turned away. It covers three things:
- Provision, criterion or practice: changing the way you do things, for example allowing a longer appointment, taking bookings by email as well as by phone, or allowing breaks.
- Physical features: changing or working around the place where you practise, for example offering a ground-floor room or a step-free venue.
- Auxiliary aids and services: providing extra help, for example information in large print or plain English, or an interpreter or note-taker.
What is reasonable depends on the circumstances. Relevant points include how effective the change would be, how practicable it is, what it would cost, the size and resources of your practice, and health and safety. You cannot charge a disabled client extra to cover the cost of an adjustment (section 20(7)). Neurodivergent clients may or may not meet the legal definition of disability, but you should treat reasonable adaptations as good practice either way.
IEMT involves guided eye movements. Some clients will have a visual impairment, an eye condition, limited eye movement or a neurological condition. Do not assume. Ask the person what they can and cannot do, and apply the Association’s screening guidance (Scope of Practice Policy sections 4 and 5, and the Pre-Session Assessment Guidelines) to the individual in front of you, not to a label. If an adjustment would materially change or prevent the procedure, or if medical advice is needed first, say so honestly, give the reason, and help the person find suitable alternatives. Record the reason in terms of safety and suitability, never in terms of the characteristic itself.
Communicating inclusively
- Plain language. Avoid jargon and unnecessary certainty. Offer forms, consent information and your privacy notice in plain English and, where you can, other formats such as large print or easy read.
- The client’s own words. Listen for how the person describes themselves and their experience, rather than imposing your own model or labels.
- Neurodivergence. Ask what helps: a written outline of the session, a quiet room, predictable timings, more breaks, or the option to look away. Do not assume that what helps one autistic or ADHD client will help another.
- Language and interpreters. Use a competent interpreter where needed. Explain confidentiality and obtain consent to the interpreter before the session. Do not rely on family members or children to interpret, except in an emergency. Agree in advance how interpretation will be arranged and paid for.
- Culture, faith and belief. Ask about preferences, such as who is present, who treats them, timing around prayer or fasting, or dress. Respect them as far as you reasonably can, and if you cannot, say so politely and help the person find someone who can.
- Gender identity and sexuality. Use the name and pronouns the person gives you. Ask only what you need to ask, and treat anything you are told as confidential special-category information (see Lesson 2.5).
- Age, literacy and digital access. Do not assume that someone cannot manage an online form or a written summary, or that they can. Ask.
Conversion practices
The Association is clear that IEMT must never be used to try to change or suppress a person’s sexual orientation or gender identity. Its policy applies to every member, in every country.
This policy applies to all members practicing globally, ensuring that everyone is treated with respect, dignity, and care, regardless of their sexual orientation or gender identity.
The Association for IEMT Practitioners, Policy on Prohibition of Conversion Therapy
If a client asks whether IEMT can change who they are attracted to, or change their gender identity, do not agree to work towards that aim. Explain kindly that IEMT will not be used for that purpose, listen without judgement, and ask whether they are distressed or at risk. Consider whether they would be better supported by an appropriately qualified, affirming professional, and use the risk and crisis guidance in Module 4 where there is any sign of danger. Being gay, lesbian, bisexual or trans is not an illness, and a client’s distress about it is not a reason to try to remove it.
Declining, referring and ending work fairly
You may decline a client, or refer on, for genuine clinical reasons: the work is outside your competence or scope, the person is unsuitable at this time, or you cannot make it safe. You may not do so because of a protected characteristic. A good test is to ask whether you would make the same decision for another client with the same clinical picture who did not share the characteristic. When you do decline or refer:
- Give a clear and respectful reason, in plain language, and do it promptly.
- Offer alternatives or signposting where you can.
- Record the reason in clinical terms in the client’s file.
- Never let your own beliefs, discomfort or assumptions stand in for a clinical reason.
Worked examples
These are illustrations to help you think, not instructions for every case.
| Situation | What to think about | A sensible approach |
|---|---|---|
| A Deaf client emails to book a session. | Communication needs, valid consent, confidentiality with an interpreter. | Ask how they prefer to communicate. Arrange a sign language interpreter or typed or written support, agree who pays, brief the interpreter on confidentiality, allow extra time, and record the adjustments agreed. |
| A wheelchair user wants to book, and your room is upstairs. | The anticipatory duty, and reasonable alternatives. | Offer a ground-floor room or a different venue. Do not ask the client to sort out access. If you cannot provide access, say so early and help them find someone who can. |
| A client with little English says “okay” to every question. | Whether consent is real, and the risk of misunderstanding. | Use an interpreter and plain language. Ask the client to say back in their own words what will happen. Do not go ahead until you are satisfied they understand. |
| A client asks if IEMT can “fix” their attraction to people of the same sex. | Conversion practices, welfare and possible risk. | Decline that aim clearly and kindly, explain the Association’s policy, listen, check how they are, and signpost to affirming support. Use Module 4 if there is any risk. |
| For religious reasons, a client asks for a practitioner of the same gender as them. | Respect for belief, and your own position as a sole practitioner. | Treat it respectfully. If you cannot meet the request, say so politely and help them find someone who can. Do not argue about the belief. |
| You catch yourself thinking an older client “won’t be able to follow this”. | Bias, and the assumption of capacity. | Capacity is assumed unless shown otherwise (Lesson 2.1). Adapt how you explain things, check understanding, and do not reduce the client’s choices on a hunch. |
An inclusive practice checklist
- I ask every client how they prefer to communicate and whether they need any adjustments, before the first session.
- My booking process, forms and privacy notice are in plain language and can be provided in other formats.
- I know how I would arrange an interpreter, and who would pay.
- I have thought about physical access to my venue, and what I would offer if it is not suitable.
- I use the name and pronouns each client gives me.
- I apply screening and safety rules to the person in front of me, not to a label.
- I will never offer or agree to work that aims to change or suppress a person’s sexual orientation or gender identity.
- I record adjustments and reasons in a factual and respectful way, and keep those records secure.
- I challenge discriminatory language or behaviour, including in my own marketing and social media.
The Equality Act 2010 applies in England, Scotland and Wales. Northern Ireland has its own equality legislation, including the Disability Discrimination Act 1995 and separate regulations on race, sex and sexual orientation, and the Equality Commission for Northern Ireland publishes guidance. Outside the UK, equality and disability law varies widely, so check the law where you practise. The Association’s Standards and its conversion practices policy apply to all members wherever they work.
Where to find more
- GOV.UK: Discrimination, your rights (plain-English summary of the protected characteristics and types of discrimination)
- GOV.UK: Equality Act 2010 guidance
- Equality and Human Rights Commission (guidance and codes of practice for England, Scotland and Wales)
The Armed Forces Covenant Policy says that military experience does not by itself show trauma, illness or a need for treatment. Work within your lawful scope, avoid stereotyping, obtain informed consent, respect confidentiality, and recognise when occupational health, NHS, Defence Medical Services, safeguarding, crisis or specialist trauma support is needed. IEMT must not be presented as a substitute for emergency, psychiatric, medical or evidence-based trauma care, and you must not imply endorsement by the Ministry of Defence, the NHS or the Covenant just because the Association has signed it.
Self-Reflection Exercise
Take a few minutes to reflect on your own practice:
- When did I last make an assumption about a client from how they looked, sounded, or the label they carried?
- If a Deaf client, a wheelchair user, or someone who speaks very little English booked tomorrow, what exactly would I do?
- Are my website, forms and venue accessible? What one change could I make this month?
- Are there beliefs or values of my own that could get in the way of treating a client fairly? How would I notice, and what would I do?
Key Takeaways
- The Equality Act 2010 covers you as a service provider. Do not treat clients worse because of a protected characteristic.
- You must think ahead and make reasonable adjustments for disabled clients, and you cannot charge extra for them.
- Apply screening and safety rules to the person, not to a label, and record reasons in clinical terms.
- Use plain language and competent interpreters, and respect culture, faith, gender identity and sexuality.
- IEMT must never be used to try to change or suppress someone’s sexual orientation or gender identity.
- Challenge discrimination, including your own assumptions.
Next Steps
Module 3 turns to safeguarding: how to protect children and adults at risk, how to understand children’s rights and Gillick competence, and what to do if you are worried about someone’s safety.