Federal and state laws require that a person’s HIV status kept confidential (APTA, 2014). This means that a healthcare provider or social service provider cannot share HIV test results without written permission, except in limited circumstances. Whether this case involves limited circumstances is problematic. All therapists and healthcare personnel are expected to use standard precautions on every client. The physical therapist in this case can educate Jay’s sister on the importance of using standard wound care precautions, which would serve to protect her without revealing his HIV diagnosis. What is apparent in these cases and others like them is that much of ethical decision making is judgmental. The important point is that physical therapy practitioners who make ethical decisions must systematically think through options and choose an option that they can justify based on ethical and legal principles, rules, and policies. Social justice The principle of social justice states that “physical therapists shall promote organizational behaviors and business practices that benefit patients/clients and society” (APTA, 2010b, Principle 7). Social justice implies access to services. Access should not be interpreted to mean that equal amounts of resources such as money, time, or equipment must be made available to each potential recipient of services. Rather the emphasis should be on fairness, equality, and appropriateness as stated in the Code. Social justice, also called distributive justice, refers to the fair, equitable, and appropriate distribution of resources. The principle of social justice refers broadly to the distribution of all rights and responsibilities in society (Beauchamp & Childress, 2013). In general, the principle of social justice supports the concept of achieving justice in every aspect of society rather than merely the administration of law. The general idea is that individuals and groups should receive fair treatment and an impartial share of the benefits of society. Physical therapy practitioners have a vested interest in addressing unjust inequities that limit opportunities for participation in society (Braveman & Bass-Haugen, 2009). Although opinions differ regarding the most ethical approach to addressing distribution of healthcare resources and reduction of health disparities, the issue of social justice continues to focus on limiting the impact of social inequality on health outcomes. Principle 8 in the APTA Code of Ethics for the Physical Therapist (2010b) focuses on the core value of social responsibility that physical therapists have to their clients and communities. It states, “physical therapist shall participate in efforts to meet the health needs of people locally, nationally or globally” (p. 1). This principle specifically indicates that: ● Physical therapists shall provide pro bono physical therapy services that meet the health needs of people who are economically disadvantaged (APTA, 2010b, Principle 8A). ● Physical therapists shall advocate for reduced health disparities and healthcare inequities (APTA, 2010b, Principle 8B). ● Physical therapists shall be responsible stewards of healthcare resources (APTA, 2010b, Principle 8C). Procedural justice Procedural justice entails knowing and following the rules (laws, policies, regulations, procedures, and guidelines). Ignorance of the rule is no excuse. The principle of procedural justice states that “physical therapists shall fulfill their legal and professional obligations” (APTA, 2010b, Principle 5). Specifically, Principle 5A indicates that “physical therapists shall comply with applicable local, state, and federal laws and regulations.” Procedural justice is concerned with making and implementing decisions according to fair processes that ensure “fair treatment” (Maiese, 2004). Rules must be impartially followed and consistently applied to generate an unbiased decision. The principle of procedural justice is based on the concept
that procedures and processes are organized in a fair manner and that policies, regulations, and laws are followed. Although law and ethics are not synonymous terms, physical therapy practitioners have an ethical responsibility to uphold current reimbursement regulations and applicable local, state, and federal laws governing the profession. In addition, physical therapy practitioners are ethically bound to be aware of organizational policies and practice guidelines set forth by regulatory agencies established to protect recipients of service, research participants, and the public. Principle 7 of the APTA Code of Ethics for the Physical Therapist (2010b) relates to ethical organizational behaviors and business practices that guide physical therapy practice. These behaviors include reasonable remuneration for client care, including: ● Prohibition about accepting gifts that influence or give the appearance of influencing personal judgment (APTA, 2010b, Principle 7B). ● Proper disclosure of financial interest in products or services that may result in conflict of interest (APTA, 2010b, Principle 7C). ● Proper documentation and coding for physical therapy services (APTA, 2010b, Principle 7D). ● Refraining from improper employment relationships that prevent physical therapists from fulfilling their professional obligations (APTA, 2010b, Principle 7E). Veracity Veracity is based on the virtues of truthfulness, candor, and honesty. The principle of veracity in health care refers to comprehensive, accurate, and objective transmission of information and includes fostering the client’s understanding of such information (Beauchamp & Childress, 2013). Veracity is based on respect owed to others. In communicating with others, physical therapy practitioners implicitly promise to speak truthfully and not deceive the listener. By entering into a relationship in client care or research, the recipient of service or research participant enters into a contract that includes a right to truthful information (Beauchamp & Childress, 2013). In addition, transmission of information is incomplete without also ensuring that the recipient or participant understands the information provided. Concepts of veracity must be carefully balanced with other potentially competing ethical principles, cultural beliefs, and organizational policies. Veracity ultimately is valued as a means to establish trust and strengthen professional relationships. Therefore, adherence to the principle also requires thoughtful analysis of how full disclosure of information may impact outcomes. Principle 4A in the APTA Code of Ethics for the Physical Therapist (2010b) relates to the principle of veracity. It states: “Physical therapists shall provide truthful, accurate, and relevant information and shall not make misleading representations.” This principle indicates that physical therapy personnel shall: ● Accurately represent credentials, qualifications, education, experience, training, roles, duties, competence, views, contributions, and findings to their patient/client and public. ● Ensure accurate coding and documentation related to physical therapy charges and patient care. ● Fully disclose financial interest in products and services to patients/clients and the public records. (APTA, 2010b, Principle 4A). Fidelity The principle of fidelity comes from the Latin root fides, which means faithfulness. Fidelity therefore is being faithful to one’s commitments. Physical therapy practitioners have obligations of fidelity to their fiduciary responsibility to work for the best interests of their patients/clients (Doherty & Purtilo 2016). That is to say, they must place the interests of their clients above their own self-interests when possible. The basis of being faithful to the client entails meeting reasonable client expectations. Certainly, clients come to physical therapy with many expectations, some of which are either unreasonable or beyond
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Book Code: PTNJ0824
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