site. Inherent in a physical therapist assistant’s ethical decision- making process is the examination of his or her unique set of facts relative to the Standards (APTA, 2013d). Standards and interpretations Standards #1: Physical therapist assistants shall respect the inherent dignity, and rights, of all individuals (APTA, 2013d). 1A. Physical therapist assistants shall act in a respectful manner toward each person regardless of age, gender, race, nation- ality, religion, ethnicity, social or economic status, sexual ori- entation, health condition, or disability. 1B. Physical therapist assistants shall recognize their personal bi- ases and shall not discriminate against others in the provision of physical therapy services. Interpretation: Respect (APTA, 2013b). Standard 1A addresses the display of respect toward others. Unfortunately, there is no universal consensus about what respect looks like in every situa- tion. For example, direct eye contact is viewed as respectful and courteous in some cultures and inappropriate in others. It is up to the individual to assess the appropriateness of behavior in various situations. Standard #2: Physical therapist assistants shall be trustworthy and compassionate in addressing the rights and needs of patients/clients. 2A. Physical therapist assistants shall act in the best interests of patients/clients over the interests of the physical therapist assistant. 2B. Physical therapist assistants shall provide physical therapy in - terventions with compassionate and caring behaviors that in- corporate the individual and cultural differences of patients/ clients. 2C. Physical therapist assistants shall provide patients/clients with information regarding the interventions they provide. 2D. Physical therapist assistants shall protect confidential patient/ client information and, in collaboration with the physical therapist, may disclose confidential information to appropri- ate authorities only when allowed or as required by law. Interpretation: Altruism (APTA, 2013b). Standard 2A addresses acting in the best interest of patients/clients over the interests of the physical therapist assistant. Often this is done without thought, but sometimes, especially at the end of the day when the clinician is fatigued and ready to go home, it is a conscious decision. Standard #3: Physical therapist assistants shall make sound decisions in collaboration with the physical therapist and within the boundaries established by laws and regulations. 3A. Physical therapist assistants shall make objective decisions in the patient’s/client’s best interest in all practice settings. 3B. Physical therapist assistants shall be guided by information about best practice regarding physical therapy interventions. 3C. Physical therapist assistants shall make decisions based upon their level of competence and consistent with patient/client values. 3D. Physical therapist assistants shall not engage in conflicts of interest that interfere with making sound decisions. 3E. Physical therapist assistants shall provide physical therapy ser - vices under the direction and supervision of a physical thera - pist and shall communicate with the physical therapist when patient/client status requires modifications to the established plan of care. Interpretation: Sound Decisions (APTA, 2013b). Standard 3C, the physical therapist assistant must be knowledgeable about his or her legal scope of work as well as level of competence. As a physical therapist assistant gains experience and additional knowledge, there may be areas of physical therapy interventions in which he or she displays advanced skills. At the same time, other previously gained knowledge and skill may be lost because
The APTA standards for physical therapy assistants (APTA, 2013d) and interpretations from the guide (APTA, 2013b) are as follows.
of lack of use. To make sound decisions, the physical therapist assistant must be able to self-reflect on his or her current level of competence. Interpretation: Supervision (APTA, 2013b). Standard 3E goes beyond simply stating that the physical therapist assistant op- erates under the supervision of the physical therapist. Although a physical therapist retains responsibility for the patient/client throughout the episode of care, this standard requires the physi- cal therapist assistant to communicate with the supervising physi- cal therapist when changes in the patient/client status indicate that modifications to the plan of care may be needed. Further in- formation on supervision via APTA policies and resources is avail - able on the APTA website (APTA, 2013d). Standard #4: Integrity of relationships. Physical therapist assistants shall demonstrate integrity in their relationships with patients/ clients, families, colleagues, students, other health care providers, employers, payers, and the public. 4A. Physical therapist assistants shall provide truthful, accurate, and relevant information and shall not make misleading rep- resentations. 4B. Physical therapist assistants shall not exploit persons over whom they have supervisory, evaluative, or other authority (e.g., patients/clients, students, supervisees, research partici- pants, or employees). 4C. Physical therapist assistants shall discourage misconduct by health care professionals and report illegal or unethical acts to the relevant authority, when appropriate. 4D. Physical therapist assistants shall report suspected cases of abuse involving children or vulnerable adults to the supervis- ing physical therapist and the appropriate authority, subject to law. 4E. Physical therapist assistants shall not engage in any sexual relationship with any of their patients/clients, supervisees, or students. 4F. Physical therapist assistants shall not harass anyone verbally, physically, emotionally, or sexually. Interpretation: Integrity in Relationships (APTA, 2013b). Stan- dard 4 addresses the need for integrity in relationships. This is not limited to relationships with patients/clients. It includes everyone physical therapist assistants come into contact with in the nor - mal provision of physical therapy services. For example, demon- strating integrity could encompass working collaboratively with the health care team and taking responsibility for one’s role as a member of that team. Interpretation: Reporting (APTA, 2013b). When considering the application of when appropriate under Standard 4C, keep in mind that not all allegedly illegal or unethical acts should be reported immediately to an agency/authority. The determination of when to do so depends upon each situation’s unique set of facts and applicable laws, regulations, and policies. Depending on those facts, it might be appropriate to communi- cate with the individuals involved. Consider whether the action has been corrected, and, in that case, not reporting may be the most appropriate action. Note, however, that when an agency/ authority does examine a potential ethical issue, fact finding will be its first step. The determination of ethicality requires an under- standing of all of the relevant facts, but it may still be subject to interpretation. Interpretation: Exploitation (APTA, 2013b). The statement is fairly clear: sexual relationships with their patients/clients, super- visees, or students are prohibited. This component of Standard 4 is consistent with Standard 4B.
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