● Physical therapy practitioners will demonstrate professional behavior and will adhere to their professional and legal obligations, particularly those in their Code of Ethics for the Physical Therapist (APTA, 2010b, Principle 5). ● Physical therapy practitioners will abide by their organizational policies, including appropriate business practices that benefit them or society as a whole (APTA, 2010b, Principle 7). ● Physical therapy practitioners will honor agreements and promises, including informed consent and verbal agreements (APTA, 2010b, Principle 2).
the scope of physical therapy practice. Physical therapists should be aware of what is considered a reasonable or unreasonable expectation. Doherty and Purtilo (2016) describe what a client can reasonably expect from physical therapy. Clients and families can reasonably expect that: ● Basic respect will be shown to them (APTA, 2010b, Principle 1). ● They will receive competent care (APTA, 2010b, Principle 3).
THE ETHICAL DECISION-MAKING PROCESS
Jim Donovan, age 67, had a stroke 3 weeks ago. Mr. Donovan has heard about constraint-induced movement therapy (CIMT) and is eager to try this approach so he can get movement back in his right hand. Currently, he exhibits no active movement in his right hand and wrist. Mr. Donovan speaks with his doctor, Dr. Androlou, about receiving CIMT. Dr. Androlou thinks the approach is another “quack” therapy designed to separate clients from their money but agrees to write a referral for a 2-week trial. Mr. Donovan’s wife is concerned about having to drive Jim to and from the therapy center every day for 2 weeks. She works full-time and will have to use vacation hours to drive him. Their two grown children live out of state, so they cannot help. Understanding the six-step process Making decisions about ethical problems, such as those in the case study about Mr. Donovan, can be challenging. A guide that provides a series of steps to follow may be helpful. Doherty and Purtilo (2016) suggest a six-step process for making an ethical decision: 1. Get the story straight – gather relevant information. 2. Identify the type of ethical problem. 3. Use ethics theories or approaches to analyze the problem(s). 4. Explore the practical alternatives. 5. Complete the action. 6. Evaluate the process and outcome. Get the story straight There is often “noise,” or distracting elements, in a case presentation. That is, there are elements in a case that are not directly relevant to the ethical issues involved. Also, many times a case presents the viewpoint of only one or two of the primary stakeholders. A stakeholder is a “person or group that has a deep and compelling interest in a situation that it wants to protect” (Doherty & Purtilo, 2016, p. 187). Many ethical cases involve multiple stakeholders, one reason why ethical cases are often challenging to solve. As a result, those who are trying to navigate through the case to a solution may not have a full and accurate account of what occurred based on the perspectives of all major stakeholders. In the case presented here, Dr. Androlou’s opinion of CIMT is of interest but is not central to the complaint issued by Mr. Donovan. Mrs. Donovan’s concerns about driving Mr. Donovan are relevant only if Mr. Donovan missed several treatment sessions because she could not drive him. It appears that the real issue may be the professional competence of the therapist, Scott, but additional relevant facts are needed to continue on to the next step in the decision-making process. For example, it is still unclear why Mr. Donovan reported Scott to the state board. Was he unhappy about the outcome? Did Scott follow established protocol? What is the customary outcome of CIMT on hand function after 3 weeks? Did Mr. Donovan comply with treatment? Did Scott discuss his lack of experience with Mr. Donovan before treatment and obtain his consent to proceed? As mentioned, the narrative approach helps decision makers fill in “gaps” in a story to make a more informed and fair decision.
Scott Raymond is Mr. Donovan’s physical therapist in an outpatient rehabilitation clinic. Scott has a current state license. He is familiar with CIMT because he listened to a lecture in school but did not practice the technique during his PT clinical affiliations in school, nor has he attended a continuing education course on CIMT. Nevertheless, he feels he can read enough to use the technique with Mr. Donovan. Three weeks after starting CIMT, Mr. Donovan reports Scott to the state licensure board and to the president of the physical therapy state chapter for failure to provide effective treatment because he has made no progress. Identify the type of ethical problem As described previously, an important step in ethical decision making is to identify the type of ethical problem – that is, determining whether the issue in this case is a legal issue, an ethical issue, an issue of communication, or a combination of the three. The APTA Code of Ethics for the Physical Therapist (2010b) stipulates that physical therapists shall make judgments within their scope of practice and level of expertise (APTA, 2010b, Principle 3C). Because Scott had no previous training or experience in implanting a CIMT, it is reasonable for the state board to question his level of competence. The responsibility for physical therapists to provide services within their scope of practice and expertise is both an ethical and legal obligation (via state practice acts). In addition, Principle 2C (“physical therapist shall provide the information necessary to allow patients and their surrogates to make informed decision”) and Principle 6 (“physical therapist shall enhance their expertise through the lifelong acquisition and refinement of knowledge, skills, abilities, and professional behaviors”) apply in this case. Use ethics theories or approaches to analyze the problem One ethics theory that applies to this case is deontology. Scott has a duty to provide effective and safe physical therapy services. Principle 3B states that “physical therapists shall demonstrate professional judgment informed by professional standards, evidence, practitioner experience, and patient/ client values” (APTA, 2010b). There are numerous research studies on the use of CIMT. For Scott, the duty involves applying the information in a skillful manner based on the available knowledge. Scott did receive initial knowledge about CIMT but does not have experience in applying the skills needed to administer the technique. The issue is how Scott assessed Mr. Donovan and how he implemented the intervention. According to Phipps and Roberts (2013), Overall, there is conflicting evidence of the benefit of CIMT over traditional therapies in the acute state of stroke; however, there is strong evidence of the benefit of CIMT and modified CIMT over traditional therapies in the chronic stage of stroke. The benefits appear to be confined to stroke patients with some active wrist and hand movement (p. 825).
EliteLearning.com/Physical-Therapy
Book Code: PTNJ0824
Page 10
Powered by FlippingBook