type of caregiver who provides a caring response to clients. The question for ethicists is whether individuals are naturally born with these traits or whether they can be learned and cultivated. Aristotle (trans. 1953) argued that virtues are behaviors or habits that are learned through experience. Many contemporary healthcare ethicists agree that virtues can be taught to clinicians Ethical principles The need to clarify the duties and rights of the physical therapist in relation to his or her clients, their families, and the larger society led to the development of methods that emphasize ethical principles and therefore are termed a principle-based approach (Beauchamp & Childress, 2013). Principles provide a way of seeing duties and rights concretely. In physical therapy, as in many other health professions, the primary principles that guide practice include beneficence, nonmaleficence, autonomy, justice (social and procedural), veracity, and fidelity (Purtilo & Doherty, 2011). These principles are integrated into the APTA Code of Ethics for the Physical Therapist (2010b) and are discussed here in greater detail. The following section highlights the main ethical principles in the APTA Code of Ethics for the Physical Therapist (2010b) . Examples from the Code are used to highlight specific standards of behavior and performance that form the basis of professional accountability to the public welfare. Similar principles are also integrated into the Standards of Ethical Conduct for the Physical Therapist Assistant (APTA, 2010d). Beneficence Beneficence requires that physical therapy practitioners adhere to the core values of the profession and shall act with the best interests of clients over the interests of the physical therapist (APTA, 2010b, Principle 2A). Beneficence includes all forms of action intended to benefit other persons. The term beneficence connotes acts of mercy, kindness, and charity (Beauchamp & Childress, 2013). Forms of beneficence typically include altruism, love, compassion, and humanity. Beneficence requires taking action by helping others, promoting good, preventing harm, and removing harm. Examples of beneficence include protecting and defending the rights of others, preventing harm from occurring to others, removing conditions that will cause harm to others, helping persons with disabilities, and rescuing persons in danger (Beauchamp & Childress, 2013). Beneficence mandates that physical therapy practitioners always demonstrate independent and objective professional judgments (APTA, 2010b, Principle 3A) and always make judgments within their scope of practice and level of expertise (APTA, 2010b, Principle 3D). To the extent possible, beneficence includes ensuring that the evaluation, intervention techniques, and therapeutic equipment are evidence based and within the recognized scope of physical therapy practice (APTA, 2010b, Principle, 6C). Finally, beneficence requires that physical therapists provide notice and information about alternatives for obtaining care in the event that the physical therapist terminates treatment while the client continues to need physical therapy services (APTA, 2010b, Principle 5E). Physical therapy services must be terminated in collaboration with the recipient of service or the responsible party when the needs and goals have been met or when services no longer produce a measurable change or outcome. Services should not be continued just because the maximum allowable billing units have not been reached. In addition, physical therapy practitioners are expected to refer to other healthcare specialists solely on the basis of the needs of the client and not because such referral would enrich the practitioner through a payment or other financial reward. In other words, physical therapy personnel are not allowed to receive “kickback” payments for referring a client to another healthcare professional or from a vendor who sells equipment or supplies
through role-modeling and guided experience to develop moral character and dispositions to guide ethical behavior and action (Purtilo & Doherty, 2011). It is particularly important that a clinical setting or practice develops a culture that promotes ethical behaviors among its personnel.
such as wheelchairs. Referral must be based on client need (APTA, 2010b, Principle 7). Nonmaleficence The second client care ethical principle is nonmaleficence. Nonmaleficence imparts an obligation to refrain from harming others (Beauchamp & Childress, 2013). The principle of nonmaleficence is grounded in the practitioner’s responsibility to refrain from causing harm, inflicting injury, or wronging others. John has to consider his obligations to avoid causing harm to June by not confronting Bill. Although beneficence requires action to incur benefit, nonmaleficence requires nonaction to avoid harm (Beauchamp & Childress, 2013). Nonmaleficence also includes an obligation not to impose risks of harm even if the potential risk is without malicious or harmful intent. This principle is often examined under the context of due care (e.g., avoid causing harm; Beauchamp & Childress, 2013). If the standard of due care outweighs the benefit of treatment, then refraining from treatment provision would be ethically indicated. The Code of Ethics for the Physical Therapist contains principles that can be interpreted as relating to nonmaleficence in physical therapy practice. These principles are those derived from the concepts of harm, due care, negligence, and vulnerability. Harm can be defined as thwarting, defeating, or setting back some party’s interests (Beauchamp & Childress, 2013). Interests may include reputation, property, privacy, and liberty. Harmful actions are usually, but not always, wrong. Some harmful actions involve justifiable setbacks to another’s interests to achieve a more desirable goal such as demoting an employee for poor performance or removing a license to practice because incompetent care was provided. We have already seen how some harmful results may be justified in some cases on the basis of the rule of double effect. Harm may also include causing discomfort, humiliation, offense, and annoyance in some situations. The duty to avoid harm includes both not inflicting harm and also the obligation not to impose risks of harm intentionally or unintentionally (Beauchamp & Childress, 2013). Due care is defined as taking sufficient and appropriate care to avoid causing harm, as the circumstances demand of a reasonable and prudent person (Beauchamp & Childress, 2013). Due care is usually based on a written standard or on a consensus. The APTA Standards of Practice for Physical Therapy (2013) provides the profession’s statement of conditions and performances that are essential for provisions of high-quality professional care. Negligence is the absence of due care. In most healthcare professions, negligence involves a departure from the professional standards that determine due care in given circumstances (Beauchamp & Childress, 2013). Negligence may be intentional when a person knowingly fails to use due care to protect a client from harm, or it may be unintentional when a person carelessly, unknowingly, or inadvertently imposes harm. Physical therapy practitioners should be particularly vigilant about the potential to cause harm to individuals from vulnerable populations. These are at-risk groups that are disadvantaged and often stigmatized by society. Examples include elderly individuals, people with disabilities, people with low socioeconomic status, and groups of people in racial and ethnic minorities (Purtilo & Doherty, 2011). Physical therapy practitioners working with individuals from these groups should be careful about making assumptions based on stereotypes, be sensitive to an individual’s capacity to understand, and be careful about the potential of coercion.
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Book Code: PTNJ0824
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