COURSE PRICE: $20.00
CONTACT HOURS: 2
This course has been approved by the Texas Board of Physical Therapy Examiners, course approval #44751A. This course meets the two-hour ethics and professional responsibility continuing education requirement for license renewal purposes for Texas PT's and PTA's.
The planners and authors of this CE activity have disclosed no relevant financial relationships with any commercial companies pertaining to this activity.
Persis Mary Hamilton has a rich background in nursing, nursing education, and writing. She has written fourteen nursing textbooks for two major publishers. Her doctoral dissertation investigated the relationship of learning to behavioral objectives and visual design in a textbook. Persis Hamilton works with Wild Iris Medical Education to ensure compliance with American Nurses Credentialing Center accreditation guidelines. She is involved with assessing needs, planning, implementing, and evaluating all nursing continuing education activities offered by the company. Over the years Hamilton has worked in most areas of nursing. She taught for more than 40 years in vocational, associate degree, baccalaureate degree, and graduate nursing programs, served as item writer for the League for Nursing, and was the principle speaker at numerous continuing education workshops. In addition, she has conducted research in Micronesia as well as Guam. Currently, Persis maintains a private practice in psychotherapy. Recently she completed a historical novel about the care of psychiatric patients in the 1930's, entitled Deportation Train.
Upon completion of this course, you will be able to:
Many folks roll their eyes and change the subject when they hear the word ethics, viewing it as too controversial or too complex for discussion. Nonetheless, ethics is a significant concern of thinking, caring persons, especially healthcare providers such as physical therapists, physical therapy assistants, nurses, and physicians.
Ethics is a branch of philosophy concerned with the rightness or wrongness of human behavior and the goodness or badness of its effects. Because ethics assumes that people have the ability to make choices about their behavior, it has been the subject of philosophical discussion for centuries, generating an enormous body of literature. Those who study ethics divide these writings into three general categories: descriptive (characteristics), analytical (meta-ethics), and prescriptive (normative).
A teleological (consequential, utilitarian, situational) perspective affirms that the rightness or wrongness of an act is determined by the end results of an action. The term comes from the Greek teleos, meaning "end." If the end result harms others, the act is considered wrong or bad. If the end result benefits others, the act is considered good or right. The central issue of this perspective is the principle of the "greatest good." The utilitarian teachings of John Stuart Mill and the situation ethics of Joseph Fletcher maintain that end results and circumstances are essential factors in considering the rightness or wrongness of human behavior (Hamilton, 1996).
Teleological theories foster morality by developing the capacity of humans to make choices. These theories reject fixed moral codes of conduct such as the biblical command "Thou shalt not kill" (Exodus 20:13). For example, a man is suffering with intractable pain caused by an incurable disorder. He begs his physician to give him enough pain medication to lessen his suffering, even though the drug dose may hasten his death. According to teleological perspective, the physician should provide the medication because the end result (relieving pain) is a greater good than keeping the man alive but suffering intractable pain.
The deontological (nonconsequentialist) perspective fosters morality by teaching humans to accept and obey fixed laws. The term comes from the Greek deontos, meaning "duty to obey." Immanuel Kant is the theorist most often identified with deontological ethics. He maintained that certain acts are inherently right or wrong, regardless of the situation or the end results. In deontological ethics, there are no exceptions or mitigating circumstances. According to this perspective, preserving the life of the man with intractable pain is a greater good than relieving his pain and hastening his death. The physician's duty is to obey the commandment "Thou shalt not kill," regardless of the situation or end result. Thus, the deontological perspective simplifies ethical decision making by removing the issue of mitigating circumstances.
Bioethics is the application of ethics to matters of human life. As scientific knowledge expands and healthcare providers have greater control over disease, pain, life, and death, it is necessary to address issues of right and wrong behavior. Although some authors use the term morals to refer to human behavior and ethics to refer to formalized codes of conduct, both words mean the same thing. Ethics comes from the Greek word ethos and morals from the Latin word mores. In recent years, some politicians have substituted the word values for morality, however the word values has a much broader meaning.
Values are treasured ideals and attributes, such as creativity, achievement, adventure, power, friendship, and belief systems. Understanding what you value brings purpose and clarity to life. Seeking such clarity was recognized by Socrates, who is credited with saying "An unexamined life is not worth living." To help people examine their lives and clarify their values, Louis Raths (1979) suggested a seven-step process he called "values clarification," as shown below.
THE VALUING PROCESS
Choosing
Prizing
Acting
Source: Modified from Raths, Harmin, and Simon, 1979.
Belief systems are organized patterns of thought regarding the origin, purpose, and place of humans in the universe. These systems seek to explain the mysteries of life and death, good and evil, health and illness. Typically, belief systems include an ethical code of conduct about how people should relate to the world and its inhabitants.
Religions are schemes of thought and action that usually include belief systems, faith in a mystical power, devotional rituals, and organizational structures. Though some religions are centuries old, with myriad adherents, others are relatively new, with only a few followers. In the United States, when believers band together to perform charitable work they are given special protections and benefits.
Ethical principles are fundamental concepts by which people judge behavior. These principles help individuals make decisions and serve as criteria against which people gauge the rightness or wrongness of behavior. Laws are rules made by an authority with the power to enforce them. Although laws flow from ethical principles, they are limited to specific situations and codified by detailed language. Ethical principles are guiding ideals of conduct that speak to the spirit of a law rather than its letter.
Throughout recorded history, leaders of world religions have taught an overarching ethical principle commonly known as the Golden Rule. It may be expressed in positive terms, "Do unto others as you would they do unto you," or in negative terms, "Do not do unto others as you would not have them do unto you." Some philosophers emphasize certain principles over others. For example, Kant held that duty was the central issue; Mills, the interest of all; Fletcher, love; Thiroux, human dignity; Nodding, care; and Gilligan, care and justice. A single, global principle for exemplary behavior is an attractive approach, but when people face real-life situations they seek more precise guidance.
Over the years, five ethical principles have emerged as especially applicable to healthcare providers. They are: respect for human life and dignity, beneficence, autonomy, honesty, and justice. The Code of Ethics of the American Physical Therapy Association, described below, applies all five principles to practice.
Respect for human life and dignity is one of the most basic of ethical principles. It requires that "individuals be treated as unique and equal to every other individual and that special justification is required for interference with an individual's own purposes, privacy, and behavior" (Rawls, 1971). This principle calls for respect for the life, freedom, and privacy of all humans. When applied to practice, respect for human rights and dignity means that physical therapists:
Beneficence means doing good to benefit others. Although some writers separate beneficence (doing good) from nonmaleficence (not doing harm), Frankena (1973) suggested the ethical principle of beneficence is a continuum, from a neutral not harming, to a positive doing good, that is, not inflicting harm…preventing harm…removing harm… promoting and doing good. At a minimum, beneficence means maintaining professional competence. However, it also means acting in ways that demonstrate care and nurturance. When applied to practice, beneficence means that physical therapists:
Autonomy is the right of self-determination, independence, and freedom. It is the personal right of individuals to absorb information, comprehend it, make a choice, and carry out that choice. Physical therapists carry out the principle of autonomy by providing information to clients, assisting them to understand the information, and helping them make decisions based on accurate scientific information. When applied to practice, autonomy means that physical therapists:
Honesty means truthfulness in word and deed. Even when needing to convey unwelcome information to clients about their illness or treatment options, physical therapists do so truthfully, with compassion, only withholding information when the client is a minor child or an adult under legal guardianship. Dishonesty and deceit are especially odious when they involve theft of pain-relieving drugs or devices. Honesty means absolute truthfulness regarding professional credentials and financial matters, never charging for unearned services or accepting commissions, discounts, or gratuities for covert gain. It means obeying both the spirit and the letter of the law. When applied to practice, honesty means that physical therapists:
Justice implies fairness and equality. It requires impartial treatment of clients. Like other ethical principles, justice is based on respect for human life and dignity. The historic image of justice is a blindfolded woman with a scale, weighing an issue on the basis of objective evidence and judicial precepts. Justice means that scarce resources will be distributed equally, using the same criteria for everyone. When applied to practice, justice means that physical therapists:
A dilemma is a perplexing problem that requires a choice between conflicting alternatives. An ethical dilemma is a moral problem that requires a choice between two or more opposite actions, each of which is based on an ethical principle. For example, a physical therapist must decide whether to honor the ethical principle of honesty and disclose the unlikely value of a proposed treatment to relieve pain or to honor the principle of beneficence and withhold information in order to give the client hope.
Resolution of ethical dilemmas requires careful evaluation of all the facts of the case, including applicable laws, consultation with all concerned parties, and appraisal of the decision makers' ethical stance (whether it is teleological, by which we consider end results, or deontological, by which we obey fixed laws).
Nowadays, ethical dilemmas in healthcare facilities arise more frequently because modern medicine can keep hearts and lungs functioning when brains have lost the ability to think. To help resolve these perplexing issues, many institutions appoint ethics committees made up of healthcare professionals, ethicists, lawyers, and clergy. The task of ethics committees is to help decision makers resolve ethical dilemmas. Often these committees use an ethical decision making process such as the following:
To reduce the number and complexity of ethical dilemmas, and in support of the ethical principle of autonomy, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recommends that all adults discuss their wishes regarding extraordinary treatment measures with their families and sign a legal document, called an advance healthcare directive, appointing someone to make healthcare decisions in their stead if they should become incapacitated (JCAHO, 2003).
Codes of ethics are formal statements that set standards of ethical behavior for a group of people. In fact, one of the hallmarks of a profession is that its members subscribe to a code of ethics.
The Code of Ethics of the American Physical Therapy Association (APTA) makes explicit the values and standards of the profession, providing guidance to carry out the professional responsibilities of physical therapists.
CODE OF ETHICS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION
The Code of Ethics of the American Physical Therapy Association sets forth principles of ethical practice of physical therapy. All physical therapists are responsible for maintaining and promoting ethical practice. To this end, the physical therapist shall act in the best interest of the patient/client. This Code of Ethics shall be binding on all physical therapists.
Principle 1. A physical therapist shall respect the rights and dignity of all individuals and shall promote compassionate care.
Principle 2. A physical therapist shall act in a trustworthy manner toward patients/clients, and in all aspect of physical therapy practice.
Principle 3. A physical therapist shall comply with laws and regulations governing physical therapy and shall strive to effect changes that benefit patients/clients.
Principle 4. A physical therapist shall exercise sound professional judgment.
Principle 5. A physical therapist shall achieve and maintain professional competence.
Principle 6. A physical therapist shall maintain and promote high standards for physical therapy in education and research.
Principle 7. A physical therapist shall seek only such remuneration as is desired and reasonable for physical therapy services.
Principle 8. A physical therapist shall provide and make available accurate and relevant information for patients/clients about their care and to the public about physical therapy services.
Principle 9. A physical therapist shall protect the public and the profession from unethical, incompetent, and illegal acts.
Principle 10. A physical therapist shall endeavor to address the health needs of society.
Principle 11. A physical therapist shall respect the rights, knowledge, and skills of colleagues and other healthcare professionals.
Source: APTA, 2001. Reproduced with permission.
Although physical therapists (PT) and physical therapist assistants (PTA) gain professional certification from their national organization, they must be licensed to practice under state laws. For that reason, both PTs and PTAs need to understand the relationship of ethics to law, the basis of United States law, sources and types of laws, some salient legal concepts, standards and guides for professional conduct, and application of ethics and law to the practice of physical therapy.
Laws flow from ethical principles, but are limited to specific situations and codified by detailed language. They are rules of behavior made by an authority with power to enforce them. As such, they change with time. In the United States, law is based on the old English system where the monarch held supreme power over the land and its people, acting according to "divine right." Decisions of the monarch became the law of the land and were known as common or case law. These case-by-case decisions set precedent and shaped future laws.
In the United States, the Constitution is the supreme law of the land, filling the role once held by the monarch. The first ten amendments to the Constitution, the so-called Bill of Rights, place restrictions on the power of government and establish specific individual freedoms, such as the right to free speech and assembly. When people believe they have been denied any of these rights, they can seek redress in the courts.
The U.S. Constitution established three separate branches of government within the federal system: executive, legislative, and judicial. The Constitution grants specific powers to the federal government, called express powers. Under the Tenth Amendment, all other powers are retained by the states, including licensure of healthcare professionals such as physical therapists.
In the states, the division of power mirrors that of the federal government. The judicial branch interprets the law and adjudicates disputes, fulfilling its purpose by administering justice without partiality. The legislative branch make laws on behalf of the people. The executive branch administers and enforces the laws, using the police power of the state. Table 1 summarizes the sources of law in the United States, and Table 2 summarizes the types of law.
| Source: Adapted from Hamilton, 1996. | |
| CONSTITUTIONAL LAW | |
|---|---|
| Source | U.S. Constitution, the supreme law of the nation |
| Functions | Establishes executive, legislative, judicial branches of government |
| Examples |
|
| STATUTORY LAW | |
| Source | Laws passed by legislative bodies of federal, state, and local governments |
| Functions | Protects and provides for the general welfare of society |
| Examples | Control Substance Act of 1971 created a schedule of controlled substances, ranking them according to their potential for abuse from high (I) to low (V). |
| ADMINISTRATIVE LAW | |
| Source | Executive power of federal, state, and local government, delegated by the legislative branch |
| Functions | Carries out special duties of various agencies |
| Examples |
|
| COMMON (CASE) LAW | |
| Source | Precedent, custom, tradition, court-made |
| Functions | Avoids duplication and unnecessary expense of litigating issues many times |
| Examples | Amendment 14 grants "equal protection of the law," but because of the Plessy v. Fergson, an 1896 decision of the Supreme Court, several states continued to segregate children by race in public schools. In 1954, Brown v. Board of Education decision said, "separation of children in public schools solely on the basis of race deprives children of a minority group equal educational opportunities, even though physical facilities and other tangible factors may be equal". |
| Source: Adapted from Hamilton, 1996. | |
| CIVIL LAW | |
|---|---|
| Function | To redress wrongs and injuries suffered by individuals |
| Categories |
|
| Proof | By a preponderance of the evidence; adjudicated by a judge or jury; jury decision need not be unanimous |
| CRIMINAL LAW | |
| Function | To protect society from actions that directly threaten its orderly existence. Criminal acts, while aimed at individuals, are offenses against the state; perpetrators are punished (fined, imprisoned, perform hours of work); victims usually are not compensated but may initiate civil action against perpetrators to make up for injury or loss |
| Categories |
|
| Proof | Beyond a reasonable doubt; unanimous jury decision may be required |
Historically, healthcare regulation has been the province of the states. However, in recent years, the federal government has become increasingly involved. Three pieces of legislation are of particular concern to physical therapy, namely, the Social Security Amendments of 1965, establishing Medicare and Medicaid, the Americans with Disabilities Act of 1995, and the Health Insurance Portability and Accountability Act of 1996.
Medicaid and Medicare provide healthcare for the indigent, the disabled, and people over 65 years of age. Medicaid is a healthcare plan that pays for intermediate and skilled care for indigent people. Medicare is a insurance program that pays for skilled care only (eg, nursing, physical therapy, occupational therapy). Medicare has two parts: hospital insurance and medical insurance. Part A, the hospital insurance, helps pay for inpatient hospital care and some follow-up care such as home health services and hospice care. Part B, the medical insurance, helps pay for such services as physician, nurse practitioner, and physical therapy services, laboratory tests, diagnostic x-ray and therapy, preventive screening tests, surgical supplies, casts, splints, kidney dialysis, diabetic supplies, and more. The "original" or basic plan covers only a small portion of the cost, thus individuals must buy additional insurance sometimes known as "Medigap" insurance (USDHHS, 2005).
The Americans with Disabilities Act (ADA) is a broad-reaching civil rights statute. It protects the rights of people with a variety of ailments, including persons infected with human immunodeficiency virus (HIV) and those with respiratory and musculoskeletal disorders. Its provisions include many issues of special concern to physical therapists, such as access to public buildings, equal protection of disabled persons, and nondiscrimination in employment.
The Health Insurance Portability and Accountability Act (HIPAA) limits the extent to which health insurance plans may exclude care for preexisting conditions. Another important section sets standards regarding the electronic exchange of private and sensitive health information. Known as Privacy Standards, these rules (1) require the consent of clients to use and disclose protected health information, (2) grant clients the right to inspect and copy their medical record, and (3) give clients the right to amend or correct errors. Privacy Standards require all hospitals and healthcare agencies to have specific policies and procedures in place to ensure compliance with the rules.
All fifty states and jurisdictions of the United States have physical therapy practice acts. Typically, these acts describe the administration of the regulatory body within the state, the scope of practice, educational institutions, business corporations, penal provisions, revenue, and categories of practice, including physical therapists, physical therapy assistants, and aides. The administrative body, usually called a board, writes rules and regulations that give detailed instructions to practitioners and educational institutions with the goal of protecting the public and providing high-level physical therapy care. It is the responsibility of physical therapy practitioners to know and abide by their state's practice act and the rules and regulations. This information is available day or night on the Internet.
The American Physical Therapy Association (http://www.apta.org) has published the following professional conduct guides for physical therapists and physical therapy assistants. These documents are revised and updated periodically by APTA—they are provided here for the convenience of practitioners.
APTA GUIDE FOR PROFESSIONAL CONDUCT OF PTs
This Guide for Professional Conduct (Guide) is intended to serve physical therapists in interpreting the Code of Ethics (Code) of the American Physical Therapy Association (Association), in matters of professional conduct. The Guide provides guidelines by which physical therapists may determine the propriety of their conduct. It is also intended to guide the professional development of physical therapist students.
The Code and the Guide apply to all physical therapists. These guidelines are subject to change as the dynamics of the profession change and as new patterns of health care delivery are developed and accepted by the professional community and the public. This Guide is subject to monitoring and timely revision by the Ethics and Judicial Committee of the Association.
Interpreting Ethical Principles
The interpretations expressed in this Guide reflect the opinions, decisions, and advice of the Ethics and Judicial Committee. These interpretations are intended to assist a physical therapist in applying general ethical principles to specific situations. They should not be considered inclusive of all situations that could evolve.
Principle 1. A physical therapist shall respect the rights and dignity of all individuals and shall provide compassionate care.
1.1 Attitudes of a Physical Therapist
Principle 2. A physical therapist shall act in a trustworthy manner towards patients/clients, and in all other aspects of physical therapy practice.
2.1 Patient/Physical Therapist Relationship
2.2 Truthfulness
2.3 Confidential Information
2.4 Patient Autonomy and Consent
Principle 3. A physical therapist shall comply with laws and regulations governing physical therapy and shall strive to effect changes that benefit patients/clients.
3.1 Professional Practice
3.2 Just Laws and Regulations
3.3 Unjust Laws and Regulations
Principle 4. A physical therapist shall exercise sound professional judgment.
4.1 Professional Responsibility
4.2 Direction and Supervision
4.3 Practice Arrangements
4.4 Gifts and Other Consideration(s)
Principle 5. A physical therapist shall achieve and maintain professional competence.
5.1 Scope of Competence
5.2 Self-Assessment
5.3 Professional Development
Principle 6. A physical therapist shall maintain and promote high standards for physical therapy practice, education and research.
6.1 Professional Standards
6.2 Practice
6.3 Professional Education
6.4 Continuing Education
6.5 Research
Principle 7. A physical therapist shall seek only such remuneration as is deserved and reasonable for physical therapy services.
7.1 Business and Employment Practices
7.2 Endorsement of Products or Services
7.3 Disclosure
Principle 8. A physical therapist shall provide and make available accurate and relevant information to patients/clients about their care and to the public about physical therapy services.
8.1 Accurate and Relevant Information to the Patient
8.2 Accurate and Relevant Information to the Public
Principle 9. A physical therapist shall protect the public and the profession from unethical, incompetent, and illegal acts.
9.1 Consumer Protection
Principle 10. A physical therapist shall endeavor to address the health needs of society.
10.1 Pro Bono Service
10.2 Individual and Community Health
Principle 11. A physical therapist shall respect the rights, knowledge, and skills of colleagues and other healthcare professionals.
11.1 Consultation
11.2 Patient/Provider Relationships
11.3 Disparagement
Source: Guide for Professional Conduct, 1981, 2004. Reproduced with permission.
APTA GUIDE FOR CONDUCT OF THE PTA
This Guide for Conduct of the Physical Therapist Assistant (Guide) is intended to serve physical therapist assistants in interpreting the Standards of Ethical Conduct for the Physical Therapist Assistant (Standards) of the American Physical Therapy Association (APTA). The Guide provides guidelines by which physical therapist assistants may determine the propriety of their conduct. It is also intended to guide the development of physical therapist assistant students.
The Standards and Guide apply to all physical therapist assistants. These guidelines are subject to change as the dynamics of the profession change and as new patterns of health care delivery are developed and accepted by the professional community and the public. This Guide is subject to monitoring and timely revision by the Ethics and Judicial Committee of the Association.
Interpreting Standards
The interpretations expressed in this Guide reflect the opinions, decisions, and advice of the Ethics and Judicial Committee. These interpretations are intended to guide a physical therapist assistant in applying general ethical principles to specific situations. They should not be considered inclusive of all situations that a physical therapist assistant may encounter.
Standard 1. A physical therapist assistant shall respect the rights and dignity of all individuals and shall provide compassionate care.
1.1 Attitude of a Physical Therapist Assistant
Standard 2. A physical therapist assistant shall act in a trustworthy manner towards patients/clients.
2.1 Trustworthiness
2.2 Exploitation of Patients
2.3 Truthfulness
2.4 Confidential Information
Standard 3. A physical therapist assistant shall provide selected physical therapy interventions only under the supervision and direction of a physical therapist.
3.1 Supervisory Relationship
Standard 4. A physical therapist assistant shall comply with laws and regulations governing physical therapy.
4.1 Supervision
4.2 Representation
Standard 5. A physical therapist assistant shall achieve and maintain competence in the provision of selected physical therapy interventions.
5.1 Competence
5.2 Self-assessment
5.3 Development
Standard 6. A physical therapist assistant shall make judgments that are commensurate with his/her educational and legal qualifications as a physical therapist assistant.
6.1 Patient Safety
6.2 Judgments About Patient Status
6.3 Gifts and Other Considerations
Standard 7. A physical therapist assistant shall protect the public and the profession from unethical, incompetent, and illegal acts.
7.1 Consumer Protection
Source: Guide for Conduct of the Physical Therapist Assistant, 1981, 2004. Reproduced with permission.
APTA STANDARDS OF ETHICAL CONDUCT FOR PTAs
This document of the American Physical Therapy Association sets forth standards for the ethical conduct of the physical therapist assistant (PTA). All physical therapist assistants are responsible for maintaining high standards of conduct while assisting physical therapists. The physical therapist assistant shall act in the best interest of the patient/client. These standards of conduct shall be binding on all physical therapist assistants.
Standard 1. A physical therapist assistant shall respect the rights and dignity of all individuals and shall provide compassionate care.
Standard 2. A physical therapist assistant shall act in a trustworthy manner towards patients/clients.
Standard 3. A physical therapist assistant shall provide selected physical therapy interventions only under the supervision and direction of a physical therapist.
Standard 4. A physical therapist assistant shall comply with laws and regulations governing physical therapy.
Standard 5. A physical therapist assistant shall achieve and maintain competence in the provision of selected physical therapy interventions.
Standard 6. A physical therapist assistant shall make judgments that are commensurate with their educational and legal qualifications as a physical therapist assistant.
Standard 7. A physical therapist assistant shall protect the public and the profession from unethical, incompetent, and illegal acts.
Source: APTA, 2001. Reproduced with permission.
CASE 1
Tom Bruno, PT, the owner of City Physical Therapy Center, placed an advertisement in the local newspaper claiming to treat people without the need for "time-consuming, individualized examinations."
In this scenario, Tom is violating a specific principle of professional conduct, the one that requires public emphasis upon individualized examination (8.2., Guide for Professional Conduct).
Discussion question: What action should you take as a professional colleague, if any?
Suggested answer: As a colleague, you should ask Tom to address his unethical behavior. If he does not change his ad, then discuss the issue with the local APTA chapter.
CASE 2
The neighbor of Molly Soft, PTA, repeatedly complains about her painful neck and asks Molly to treat her. At first Molly refuses, but eventually she gives in and performs four manual therapy treatments on the neighbor's cervical spine. At first the treatments help, but after the fourth one the neighbor complains of increased neck pain.
Molly has violated a specific standard of professional conduct, the one that requires a PTA to work under the direct supervision of a PT (3.1., Guide for Conduct).
Discussion question: What action should Molly take?
Suggested answer: Molly should refer her neighbor to a physician for examination and treatment. She needs to tell the neighbor that Molly, as PTA, should not be treating her without supervision. Molly has put both her neighbor and herself in jeopardy.
CASE 3
Joe Peal, PT, an employee of the local home health agency, feels a strong sexual attraction for the daughter of one of his clients. He is considering asking her for a date and shares his thoughts and feelings with a colleague.
In this situation, there is a specific principle of professional conduct that prohibits a PT from exploiting any aspect of a client relationship (2.1., Guide for Professional Conduct).
Discussion question: If you were Joe's colleague, what would you advise him to do?
Suggested answer: Joe should ask his supervisor to assign another PT to the client and to terminate his PT/client relationship before pursuing an association with the daughter.
CASE 4
A PT just started her own business and is heavily in debt. She does not have a full caseload, but says she does not want to "start a precedent" by providing pro bono services to clients.
A specific principle speaks to this issue (10.1, Guide for Professional Conduct), recommending PTs provide reduced- or no-fee services when possible.
Discussion question: What ethical principle could you use to appeal to your colleague?
Suggested answer: The ethical principle of beneficence, which means taking action to benefit others.
CASE 5
Pam Newsom, a new PT graduate, is placed in a wound-care rotation in a nursing home, alternating with a group of experienced PTs. A 33-year-old client is admitted who has severe systemic cellulitis with weeping sores covering her legs and lower torso. Pam has never done wound care and does not feel she has the experience or competence to treat this client.
Pam knows the specific principle that authorizes only the care defined by the state practices act and within the scope of practice of a PT (9.1., Guide for Professional Conduct).
Discussion question: What should Pam do?
Suggested answer: Pam should not perform procedures that are outside the scope of practice of a PT, nor should she perform procedures she does not know how to do. She should communicate immediately with her supervisor.
American Physical Therapy Association (APTA). (2004). Code of Ethics. Retrieved June 06, 2005 from http://www.apta.org.
American Physical Therapy Association (APTA). (2001). Guide for Conduct of the Physical Therapist Assistant. Retrieved June 06, 2005 from http://www.apta.org.
American Physical Therapy Association (APTA). (2001). Guide for Professional Conduct. Retrieved June 06, 2005 from http://www.apta.org.
American Physical Therapy Association (APTA). (2001). Standards of Ethical Conduct for the Physical Therapist Assistant. Retrieved June 06, 2005 from http://www.apta.org.
Franken WK. (1973). Ethics. Paramus, NJ: Prentice-Hall.
Hamilton PM. (1996). Realities of Contemporary Nursing, 2nd ed. Menlo Park, CA: Addison-Wesley Nursing.
Joint Commission on Accreditation of Healthcare Organizations (JACHO). (2003). Hospital Accreditation Standards. Oakbrook Terrace, IL: author.
Raths LE, Harmin M, Simons SB. (1979). Values and Teaching, 2nd ed. Columbus: Merrill.
Rawls JA. (1971). A Theory of Justice. Cambridge, MA: Harvard University Press.
Thiroux JP. (2003). Ethics, Theory and Practice, 8th ed. New York: Macmillan.
U.S. Department of Health and Human Services ,Centers for Medicare & Medicaid Services. (2005). Medicare & You. Publication No. CMS-10050. Baltimore, MD: author.
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