Depending on those facts, it might be appropriate to communicate 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 understanding 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, supervisees, or students are prohibited. This component of Standard 4 is consistent with Standard 4B. Next, consider this excerpt from the EJC Opinion titled “Topic: Sexual Relationships with Patients/Former Patients” (modified for physical therapist assistants): A physical therapist [assistant] stands in a relationship of trust to each patient and has an ethical obligation to act in the patient’s best interest and to avoid any exploitation or abuse of the patient. Thus if a physical therapist [assistant] has natural feelings of attraction toward a patient, he or she must sublimate those feelings in order to avoid sexual exploitation of the patient (APTA EJC, 2001). One’s ethical decision-making process should focus on whether the patient/client, supervisee, or student is being exploited. In this context, questions have been asked about whether one can have a sexual relationship once the patient/ client relationship ends. To this question, the EJC has opined as follows: ○ The Committee does not believe it feasible to establish any bright-line rule for when, if ever, initiation of a romantic/sexual relationship with a former patient would be ethically permissible. ○ The Committee imagines that in some cases a romantic/ sexual relationship would not offend if initiated with a former patient soon after the termination of treatment. In others, such a relationship might never be appropriate. Standard #5: Physical therapist assistants shall fulfill their legal and ethical obligations. 5A. Physical therapist assistants shall comply with applicable local, state, and federal laws and regulations. 5B. Physical therapist assistants shall support the supervisory role of the physical therapist to ensure quality care and promote patient/client safety. 5C. Physical therapist assistants involved in research shall abide by accepted standards governing protection of research participants. 5D. Physical therapist assistants shall encourage colleagues with physical, psychological, or substance-related impairments that may adversely impact their professional responsibilities to seek assistance or counsel. 5E. Physical therapist assistants who have knowledge that a colleague is unable to perform their professional responsibilities with reasonable skill and safety shall report this information to the appropriate authority. Interpretation: Colleague impairment (APTA, 2013b). The central tenet of Standards 5D and 5E is that inaction is not an option for a physical therapist assistant when faced with the circumstances described. Standard 5D states that a physical therapist assistant shall encourage colleagues to seek assistance or counsel. Standard 5E addresses reporting information to the appropriate authority. 5D and 5E both require a factual determination on the physical therapist assistant’s part. This may be challenging in the sense that the therapist might not know or it might be difficult to determine whether someone, in fact, has a physical, psychological, or substance-related impairment. In addition, it might be difficult to determine whether such
impairment may be adversely affecting someone’s work responsibilities. Once a determination is made, the obligation under 5D centers not on reporting, but on encouraging the colleague to seek assistance. However, the obligation under 5E does focus on reporting. But note that 5E discusses reporting when a colleague is unable to perform, whereas 5D discusses encouraging colleagues to seek assistance when the impairment may adversely affect his or her professional responsibilities. Standard 5D discusses something that may be affecting performance, whereas 5E addresses a situation in which someone is clearly unable to perform. The two situations are distinct. It is important to note that 5E does not mandate to whom the assistant should report; it gives discretion to determine the appropriate authority. Standard #6: Physical therapist assistants shall enhance their competence through the lifelong acquisition and refinement of knowledge, skills, and abilities. 6A. Physical therapist assistants shall achieve and maintain clinical competence. 6B. Physical therapist assistants shall engage in lifelong learning consistent with changes in their roles and responsibilities and advances in the practice of physical therapy. 6C. Physical therapist assistants shall support practice environments that support career development and lifelong learning. Interpretation: Clinical competence (APTA, 2013b). Standard 6A should cause physical therapist assistants to reflect on their current level of clinical competence, to identify and address gaps in clinical competence, and to commit to the maintenance of clinical competence throughout their career. The supervising physical therapist can be a valuable partner in identifying areas of knowledge and skill that the physical therapist assistant needs for clinical competence and to meet the needs of the individual physical therapist, which may vary according to areas of interest and expertise. Further, the physical therapist assistant may request that the physical therapist serve as a mentor to assist him or her in acquiring the needed knowledge and skills. Interpretation: Lifelong learning (APTA, 2013b). Standard 6C points out the physical therapist assistant’s obligation to support an environment conducive to career development and learning. The essential idea here is that the physical therapist assistant encourage and contribute to the career development and lifelong learning of himself or herself and others, whether or not the employer provides support. Standard #7: Physical therapist assistants shall support organizational behaviors and business practices that benefit patients/clients and society. 7A. Physical therapist assistants shall promote work environments that support ethical and accountable decision making. 7B. Physical therapist assistants shall not accept gifts or other considerations that influence or give an appearance of influencing their decisions. 7C. Physical therapist assistants shall fully disclose any financial interest they have in products or services that they recommend to patients/clients. 7D. Physical therapist assistants shall ensure that documentation for their interventions accurately reflects the nature and extent of the services provided. 7E. Physical therapist assistants shall refrain from employment arrangements, or other arrangements, that prevent physical therapist assistants from fulfilling ethical obligations to patients/clients.
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