○ Review the aftereffects of the course of action to determine if the outcomes and consequences turned out as expected. ○ Identify any corrections or further steps needed to address problems or unexpected consequences of the decided course of action. Are there any changes that need to be implemented to improve professional
competence, institutional, organizational, or societal procedures or policies to avoid future ethical issues? The FSBPT published an article on ethical decision making based on a case study presented by Annette Iglarsh and Nancy Kirsch at the 2006 FSBPT Annual Meeting (FSBPT, 2017b; Iglarsh & Kitsch, 2006).
CASE STUDY
The FSBPT gives the following example of the application of the RIPS Model as summarized in the following case study (FSBPT, 2017b). A board of education complained that a licensed therapist spoke to a family without the permission of the child study team, breaking a rule that all communication goes through the team. The therapist was the school’s employee at the time this complaint was made. She did sign a contract agreeing to a condition of communication through the team that includes documentation of all communication. There was no documentation of the therapist’s communication with the family related to the incident in the complaint. At an investigative inquiry, the therapist said that she gave notice she was resigning two months before the end of the school year. She had been with the district for nine years and asked the district if she should tell the parents. The school district said no because it did not want to alarm the parents. She saw the parents at the end of the school year at a class party. When the parents said see you in September, she felt it was her ethical obligation to tell them that she would not be back in the fall. Case discussion (FSBPT, 2017B). Is there an ethical issue? The problem is that the school PT was constrained from doing what she thinks is right. She wanted to tell the parents the truth. She had been there for several years and probably knew some of these children since they were in preschool. She felt that if she did not say something to give parents an appropriate amount of time to make a decision or try to find somebody, she was abandoning the children. Why is it a problem? Both parties signed that contract. From a professional perspective, autonomy, it hindered her ability to do what she thought was right. From a personal perspective, it offended her personal ethics because she thought she could not do the right thing. Economically, there was not an issue from the therapist’s perspective, but there might have been one from the school’s perspective. Intellectually and societally, the school community felt that its rights were being negated. What ethical principles are involved? Autonomy and veracity are involved. American Physical Therapy Association. (2010). EJC opinion: Preserving confidences: Physical therapist’s reporting obligation with respect to unethical, incompetent, or illegal acts . Retrieved from http://www.apta.org/ EJCOpinions/2002/4/12/ American Physical Therapy Association. (2013a). APTA guide for professional conduct . Retrieved from http://www.apta.org/uploadedFiles/APTAorg/ Practice_and_Patient_Care/Ethics/GuideforProfessionalConduct.pdf American Physical Therapy Association. (2013b). APTA guide for conduct of the physical therapist assistant. Retrieved from http://www.apta.org/uploadedFiles/APTAorg/Practice_and_Patient_Care/ Ethics/GuideforConductofthePTA.pdf American Physical Therapy Association. (2013c). Code of ethics for the physical therapist. Retrieved from https://www.apta.org/uploadedFiles/APTAorg/ About_Us/Policies/Ethics/CodeofEthics.pdf American Physical Therapy Association. (2013d). Standards of ethical conduct for the physical therapist assistant . Retrieved from https://www.odessa.edu/ programs/_documents/pdfs/StandardsEthicalConductPTA.pdf American Physical Therapy Association. (2014). Guidelines: Physical therapist scope of practice. Retrieved from http://www.apta.org/uploadedFiles/ APTAorg/About_Us/Policies/Practice/ScopePractice.pdf American Physical Therapy Association. (2015a). About the National Physical Therapy Examination. Retrieved from http://www.apta.org/Licensure/NPTE/ American Physical Therapy Association. (2015b). Ethics and professionalism . Retrieved from http://www.apta.org/EthicsProfessionalism/ American Physical Therapy Association. (2015c) The physical therapist scope of practice. Retrieved from http://www.apta.org/ScopeofPractice/ American Physical Therapy Association. (2016). Definition of the term scope of practice and clarification of association role. Retrieved from http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Practice/ DefinitionOfTermScopeOfPractice.pdf References
What course of action did the therapist take? The course of action she chose to take was to speak to the parents. The parents approached her. She was not going to lie to them, so she just said she was leaving. That was not what the school had asked her to do. The parents felt that they had not been told the truth, and it caused a lot of angst over the summer. Could she have approached this in another way? She could have been proactive and made the moral judgment early on. Even if they did not say see you in September, she could have said, “According to my code of ethics and professional responsibility, I feel I have an obligation to tell you the truth.” Outcome of the complaint: If the therapist did nothing at all, the school board may have had an even worse situation. The harm appeared to be toward the employer. The family did not really seem to have been harmed. The complaint was found to be without merit. In conclusion, the FSBPT added the following statement: As members of the licensing board, we are responsible for protecting the public. It does not matter what phase of licensure is being discussed, as a student, during the licensure process or after being licensed. We are responsible to protect the public by dealing with illegal and unethical behavior. Since we are now autonomous practitioners in almost all states, we have become the portal of entry into the medical system. Part of our autonomous practice is a trust that we develop and cherish in our patients. An unethical behavior can violate that trust. We can no longer say the doctor told me to do that. Now we are truly responsible for our actions. We need to know or we need to identify that protecting the public is truly our obligation when we take our oath of office. It is very clear (FSBPT, 2017b). This statement by the FSBPT underscores the importance of therapists and assistants to have a working knowledge of the APTA Code of Ethics, the FSBPT Model Act, and state statutes to improve practice for the enhanced welfare of patients to promote the profession and strengthen trust among the public at large. It is the responsibility of all therapists and assistants to apply ethical principles to every action in daily practice and continue to improve their knowledge and skills through continued professional development. American Physical Therapy Association Ethics and Judicial Committee Opinion (EJC). (2001). Sexual relationships with patients/former patients . Retrieved from http://www.apta.org/EJCOpinions/2001/8/3/ American Psychological Association. (2017). Multiple relationships and APA’s new ethics code: Values and applications: Ethics rounds. Retrieved from http://www.apa.org/monitor/jan04/ethics.aspx Federation of State Boards of Physical Therapy. (2016) The model practice act for physical therapy: A tool for public protection and legislative change (6th ed., revised 2016). Retrieved from https://www.fsbpt.org/Portals/0/ documents/free-resources/MPA_6thEdition2016.pdf Federation of State Boards of Physical Therapy. (2017a). Mission and vision. Retrieved from https://www.fsbpt.org/AboutUs/MissionVision.aspx Federation of State Boards of Physical Therapy . (2017b). Ethical decision making to avoid disciplinary action . Retrieved from https://www.fsbpt.org/ Licensees/EthicalConduct/EthicalDecisionMaking.aspx Health and Human Services. (2016). Informed consent tips . Retrieved from https://www.hhs.gov/ohrp/regulations-and-policy/guidance/informed-consent- tips/index.html Iglarsh, A., & Kirsch, N. (2006). Ethical decision making to avoid disciplinary action. Retrieved from https://www.fsbpt.org/Licensees/EthicalConduct/ EthicalDecisionMaking.aspx Kidder, R. M. (1995). Kidder’s checkpoints for ethical decision making . Retrieved from http://www.agsm.edu.au/bobm/teaching/BE/lect03-3.pdf LaSalle University. (2005). Ethics terms and terminology . Retrieved from http:// www1.lasalle.edu/~price/Hon 365 ethics terms.htm Legal Information Institute (LII). (2017a). Bright-line rule. Retrieved from https:// www.law.cornell.edu/wex/bright-line_rule Legal Information Institute (LII). (2017b). Ethics: An overview. Retrieved from https://www.law.cornell.edu/wex/ethics Legal Information Institute (LII). (2017c) Fiduciary duty. Retrieved from https:// www.law.cornell.edu/wex/fiduciary_duty Merriam-Webster .(2017). Definition of autonomy. Retrieved from https://www. merriam-webster.com/dictionary/autonomy
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