Interpretation: Support: Health Needs (APTA, 2013b). Standard 8A addresses the issue of support for those least likely to be able to afford physical therapy services. The Standard does not specify the type of support required. Physical therapist assistants may express support through volunteerism, financial contributions, advocacy, education, or simply promoting their work in conver- sations with colleagues. When providing such services, including pro bono services, physical therapist assistants must comply with applicable laws and, as such, work under the direction and super- vision of a physical therapist.
8B. Physical therapist assistants shall advocate for people with im - pairments, activity limitations, participation restrictions, and disabilities in order to promote their participation in com- munity and society. 8C. Physical therapist assistants shall be responsible stewards of health care resources by collaborating with physical thera- pists in order to avoid overutilization or underutilization of physical therapy services. 8D. Physical therapist assistants shall educate members of the public about the benefits of physical therapy.
MULTIPLE AND DUAL RELATIONSHIPS CONSIDERATION
public at large. If the public knew of the relationship, would it be viewed in a positive way? (APTA, 2017) The decisions about relationships can be informed directly by the APTA core values: ● Accountability : active acceptance of the responsibility for the diverse roles, obligations, and actions of the physical ther- apist, including self-regulation and other behaviors that posi- tively influence patient/client outcomes, the profession, and the health needs of society. ● Altruism : Is the primary regard for or devotion to the interest of patients/clients, thus assuming the fiduciary responsibility of placing the needs of the patient/client ahead of the physi- cal therapist’s self-interest. ● Compassion : Is the desire to identify with or sense something of another’s experience—a precursor of caring. Caring is the concern, empathy, and consideration for the needs and values of others. ● Excellence : Includes understanding personal limits, integrat- ing judgment and the patient/client perspective, embracing advancement, challenging mediocrity, and working toward development of new knowledge. ● Integrity : Is steadfast adherence to high ethical principles or professional standards: truthfulness, fairness, doing what you say you will do, and speaking forth about why you do what you do. ● Professional duty : Is the commitment to meeting one’s ob- ligations to provide effective physical therapy services to pa- tients/clients, to serve the profession, and to positively influ- ence the health of society. ● Social responsibility : Is the promotion of a mutual trust be- tween the profession and the larger public that necessitates responding to societal needs for health and wellness. (APTA, 2015b) 2. Organizational or institutional : The good of the organiza- tion and focuses on structures and systems that will facilitate organizational or institutional goals. 3. Societal : The common good and is the most complex realm. (Swisher, Arslanian, & Davis, 2004) The RIPS Model includes strategies to identify the ethical dilem- ma and the personal factors that influence the therapist’s decision, ● The realm : Individual, organizational/institutional, societal. ● Individual process : Moral sensitivity, moral judgment, moral motivation, moral courage. ● Situation : Issue or problem, dilemma, distress, temptation, silence. including moral issues. Components of RIPS :
Though the standards and principles clearly state that sexual rela- tionships between therapist and client are prohibited, not all mul- tiple and dual relationships are unethical. Relationships can occur outside of the therapeutic setting in the general community, work settings, church, school, social functions, children’s activities, or recreational settings, for example. There is no definitive bright-line definition to guide participation in dual and multiple relationships, so therapists must rely on the decision making, judgment, knowledge, and experience based on the core values of the ethics code (APTA, 2017). Decision-mak- ing strategies will be discussed in the next section, but there are a few considerations when identifying dual and multiple relation- ships and potential harm to patients. According to the APTA, the therapist must consider the following: ● The therapist must decide if the relationship could impair judgment, objectivity, or effectiveness in treatment or attain- ing the patient’s health goals. This includes the ability of the patient to follow the treatment plan and retain autonomy. ● Could the therapist lose his or her objectivity, which would interfere with his or her ability to perform duties as a therapist? ● The therapist must decide if the relationship would be exploi- tive or harmful to the patient. ● When thinking about the potential for harm or exploitation, the therapist might consider whether any reasonable profes- sional therapist would enter into the relationship in question. If there is any doubt, the relationship should be avoided. ● The therapist should consider whether the relationship pro - motes the health and welfare of the client and improves the collaborative, active participation in the patient’s care plan. If there is any doubt that the relationship will promote the pa- tient’s health and welfare, including emotional health, the re- lationship should not continue. ● A final consideration is whether the outcome of the relation- ship would promote trust between the profession and the
ETHICAL DECISION MAKING
There are many models of decision making. One was designed by licensed members of the APTA for physical therapy (Swisher, Arslanian, & Davis, 2004). They developed The Realm-Individual Process-Situation (RIPS) Model of Ethical Decision Making, which includes elements of Rushworth Kidder’s work on ethical decision making (Kidder, 1995). (The basic components of RIPS will be cov- ered and additional information and examples can be viewed on the APTA website listed on the reference page.) Because of the complex nature of this model, additional study and practice on case study scenarios is required before imple- menting the model in practice. The RIPS Model is based on three areas of ethics involved in man- aged care: 1. Individual : The good of the patient and the rights, duties, re- lationships, and behaviors between individuals, including the therapist, client, and others.
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