Interpretation: Professional judgment (APTA, 2013a). Principles 3, 3A, and 3B state that it is the physical therapist’s obligation to exercise sound professional judgment based on his or her knowledge, skill, training, and experience. Principle 3B describes the physical therapist’s judgment informed by three elements of evidence-based practice. In the patient/client management role, once a physical therapist accepts an individual for services, he or she shall be responsible for the examination, evaluation, and diagnosis of that individual; the prognosis and intervention; reexamination and modification of the plan of care; and the maintenance of adequate records, including progress reports. A physical therapist shall establish the plan of care and shall provide and/or supervise and direct the appropriate interventions. A physical therapist has primary responsibility for the physical therapy care of a patient and shall make independent judgments regarding care consistent with accepted professional standards. If the diagnostic process reveals findings outside the scope of the physical therapist’s knowledge, experience, or expertise, or that indicate the need for care outside the scope of physical therapy, the physical therapist shall inform the patient/client and shall refer the patient/client to an appropriate practitioner. A physical therapist shall determine when a patient/client will no longer benefit from physical therapy services. When a physical therapist’s judgment is that a patient will receive negligible benefit from physical therapy services, the physical therapist shall not provide or continue to provide services if the primary reason for doing so is the financial self-interest of the physical therapist or his or her employer. A physical therapist shall avoid overutilization of physical therapy services. See Principle 8C. Interpretation: Supervision (APTA, 2013a). Principle 3E describes circumstances where sound professional judgment is required through the appropriate direction of and communication with physical therapist assistants and support personnel. Further information on supervision via applicable local, state, and federal laws and regulations (including state practice acts and administrative codes) is available. See Principles 5A and 5B. Principle #4: Physical therapists shall demonstrate integrity in their relationships with patients/clients, families, colleagues, students, research participants, other health care providers, employers, payers, and the public. ( Core value: Integrity. ) 4A. Physical therapists shall provide truthful, accurate, and relevant information and shall not make misleading representations. 4B. Physical therapists shall not exploit persons with whom they have supervisory, evaluative, or other authority (e.g., patients/clients, students, supervisees, research participants, or employees). 4C. Physical therapists shall discourage misconduct by healthcare professionals and report illegal or unethical acts to the relevant authority, when appropriate. 4D. Physical therapists shall report suspected cases of abuse involving children or vulnerable adults to the appropriate authority, subject to law. 4E. Physical therapists shall not engage in any sexual relationship with any of their patient/clients, supervisees, or students. 4F. Physical therapists shall not harass anyone verbally, physically, emotionally, or sexually. Interpretation: Integrity in relationships (APTA, 2013a). Principle 4 addresses the need for integrity in relationships and is not limited to relationships with patients/clients, but everyone physical therapists come into contact with
professionally. Demonstrating 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, 2013a). When considering the application of when appropriate under Principle 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 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 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 may still be subject to interpretation. The EJC Opinion titled “Topic: Preserving Confidences: Physical Therapist’s Reporting Obligation with Respect to Unethical, Incompetent, or Illegal Acts” provides further information on the complexities of reporting (APTA, 2010). Interpretation: Exploitation (APTA, 2013a). The statement is fairly clear: sexual relationships with their patients/clients, supervisees, or students are prohibited. This component of Principle 4 is consistent with Principle 4B. Next, consider this excerpt from the EJC Opinion titled “Topic: Sexual Relationships with Patients/Former Patients”: A physical therapist 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 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, 2013a). 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, while in others such a relationship might never be appropriate (APTA, 2013a). Principle #5: Physical therapists shall fulfill their legal and professional obligations. ( Core values : Professional duty, accountability. ) 5A. Physical therapists shall comply with applicable local, state, and federal laws and regulations. 5B. Physical therapists shall have primary responsibility for supervision of physical therapist assistants and support personnel. 5C. Physical therapists involved in research shall abide by accepted standards governing protection of research participants. 5D. Physical therapists shall encourage colleagues with physical, psychological, or substance-related impairments that may adversely impact their professional responsibilities to seek assistance or counsel. 5E. Physical therapists who have knowledge that a colleague is unable to perform their professional responsibilities
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